Well, there have been sideways pokes at the issue in various threads around the board and that's usually a sign of a good debate in the making...

I could waste a lot of time with an introduction about how the US is the only "rich" country in the world without universal healthcare and how even Brazil, Argentine, and Chile have their own plans.

About how South Africa and Mexico are working on implementing it etc...

but why bother?

In the long-run, say twenty years from now, what healthcare system would you like to see in the United States:

Universal government coverage? What kind?

Universal private coverage? What kind?

Non-universal coverage? What kind?

Note these question assume that any hurdles needed to implement such a system, such as constitutional changes and the like, are accomplished.

Looking for a debate on outcome, not procedure.

I voted yes, and my vote is split between Universal government coverage and Universal private coverage. It is absolutely essential that whatever model is chosen, the funds/organizations are run as non-profit. The model for me is Germany, and if anybody need a brief introduction into their healthcare system, they can look here. Yeah it's a blog, but general facts seem to be pretty accurate. (Spare me the tales of "months-long waiting lists" in European hospitals for procedures - members of my extended family in Germany just went through surgeries and the wait was measured in days... 9 days I believe. This is for a non-life threatening surgery. No wait at all for a cancer treatment.)

I believe that our healthcare system is NOT run on the same capitalist principles that dictate the success or failure of basically any other business in the nation.

We need to figure out how to cut out insurance companies and force pricing and efficiency to be the markers of success for healthcare providers. Right now, there is no expectation that Doctors get the job done right the first time or at a reasonable rate.

Let's use a few quick questions to illustrate what I mean:
1. When you go to a restaurant or plan a nice night out, do you look at the pricing on the menu?
2. How many hospitals ever let you know what things cost in advance (ie a list in the doctor's office)?
3. How many people don't care because the insurance company will pay it and the co-pay is your only concern?

True choice doesn't really exist in the same form as say, gasoline or a hamburger. Most people in the US choose based upon availability in terms of geography and who is on their approved providers list.

Furthermore, insurance companies force a dependant nature on our people, and encourage hypochondriacs. I have a sniffle? I go to the doctor. Fall in the yard? Go to the Dr. It only costs a $10 co pay, but the insurance companies pay hundreds. What if I knew that it would cost me $50? Would I go, or just go buy Benadryl at Walmart or put ice on the bruise?

Alternative medicine? Never. Many insurance companies don't even approve chiropractors that might cost <$100 visit, but WILL approve a back operation, prescription drugs, etc.

Our medical system in the US is drug dependant and insurance company needy. Why can a Nurse with a 2-year degree (I know what y'all are thinking... yes my wife is a Nurse, but she's has a B.S.!) make $75-80K (dep on shift and expertise) in Dallas to chart progress and change dressings? There are highschool graduates at Children's that are tech's making $16-17/hr with as little as 6 mos experience. It's absurd.

Hospitals don't work like other businesses. The whole system is corrupted with the lack of true competition and profitability calculations. They WILL make money without some mis-mangement screw ups. Good Lord. Ever known someone that works in those 24hr "doc in a box" places? Nurse Practitioners in Texas can make $100-120K in those places if they'll work nights or weekends, literally with basically a master's degree... and honestly I know a lady who does it and makes that much money working about 35hrs/week.

Ok... my SUGGESTIONS:

1. Allow for alternative medicine. Right now- people that aren't pill pushers (outside of massage places or Chiropractors) cannot open their doors. Why not? It works for other countries. If it doesn't, in the US people won't go and they'll fail. If it DOES work, people go back and they make money.
2. Attempt to eliminate American dependance on insurance companies by giving tax breaks to employers who increase salaries when insurance is not selected and who save for medical bills pre-tax in "commissary" type programs. Let customers go direct, choose their providers, and decide whether going to the doctor is really important.
3. Give tax breaks to hospitals that have pricing programs that are aggressive and cater to "cash paying" customers.
4. Allow for pharmaceutical companies to get tax breaks for selling generics at cut rates.

Think of the Health Insurance issue right now. Let's use round numbers. If the average couple pays $4000/yr for insurance and the company pays another $5200, you're looking at $9200 annually in medical insurance premiums. How often do people go to the Dr.? Maybe there could be hospital savings plans that bear interest, etc.

There definitely could ways to break free from the chains of Blue Cross/Blue Sh and Aetna, coupled with the shackles of medical care that isn't price sensitive. Right now, Doctors and Hospitals charge with wanton abandonment.

20 years out is ridiculous. By the end of Hilary Clinton's second term (what a joke it was when she said that) is ridiculous. The nation had needed this for some time; we need it now.

The most sensible course would be the single payer model, which is employed in almost all Western nations.

This is in concept a very simple debate, but you need some ground rules:

1) There will never be enough health care resources for everyone in the US (or for that matter, any major nation--just ask Canada and all their citizens who come here for health care and to avoid huge lead times) to get the health care to which, at least in today's mindset, they think they are entitled;

2) No nation could afford to offer the kind of health care to which people in the US today think they are entitled (and if we think taxes are high now, just you wait....);

2) Because of 1) and 2), some kind of rationing of available health care will be necessary (and always has been necessary), even if we undermine the doctors by permitting RNs, nurse practitioners, and other kinds of para-doctors to serve in roles the medical profession has traditionally reserved to doctors.

With those truisms in place, we then must determine if we want to ration (AA) by ability to pay, (BB) by need (or perceived need), or (CC) by giving everyone access all the time, in which case care is rationed by diminishing care to a de minimis level of quantity for each citizen (and with it, an inevitablly significant drop off in quality).

In a nation with a free economy, (AA) seems the most fair, as anyone determined enough can make enough money to buy health insurance and get care. It may require not having a good car, renting instead of buying, etc., i.e. making sacrifices, but one can be assured if you work hard and smart, you should be able to get health care. This was certainly true 30 years ago.

We have messed up this system with Fed govt poor and elder care, Medicare and Medicaid, which are already in place and pay well below market rates for care (and which doctors are requried by law to accept). This has stretched the limits of available resources by giving more people access, and no one is really happy today with long waits, with overworked doctors and staff who are inattentive, and with increased costs to those not on Medicare and Medicaid (and their insur cos.) as the med profession tries to maintain its net revenue on the backs of those who can pay market rates. PPOs and HMOs were the result of this process. Add to this that anyone indigent in the US must by law be treated in an emergency room, and in reality anyone in the US now can get some access to health care, and this has really stressed our available resources and is a portent of things to come with a more "formal" universal program.

Option (BB) is tricky, as some Big Brother must decide who has the greatest need. I am not a communist, so I simply will not go there. Of course, our organ donor program does work like this, as do many European systems.

Option (CC) will be the culmination of where we are headed already with option (AA), as we have modifed it, as described above. Everyone will have access at below market, fixed govt rates, and we'll have huge shortages of personnel and equipment with attendant long wait times (like 6 month waits for MRIs in Canada now). Service may or may not be any good, depending on how much we try to shorten the waits (haste makes waste). If we try to reduce personnel shortages with foreign doctors, letting non-doctors do doctoring, etc., the best and the brightest, who used to go to medical school, will become investment bankers, etc., and make much more money and quit messing around with the decaying medical profession. Many of my doctor friends, seeing where we are headed, have advised their kids not to go to medical school (or become dentists, where HMOs and PPOs have not killed their revenues) for this very reason. We will have a large shortage in primary care doctors (GPs and internists, who make the lower dollars) in 10 or 20 years, no question.

That is all there is to it.

Now, it is possible that through the use of central databases, non-doctors could perhaps treat lots of routine matters on every streetcorner, so to speak, by prescribing drugs and doing some other mundane tasts. We'd have to radically change licensing and malpractice rules. However, you cannot amelioriate the coming shortage of good surgeons and specialists, as there is no way some dude off the street can look at a chart and remove your diseased prostate. Of course, maybe robotic surgeons can help a little as we go forward, albeit at very high initial costs for such machines.

There you go--take you choice.

Agreed. You hit some good points, but consider that most Doctors that you see are not surgeons. I believe that if we utilized Nurse Practitioners and PA's the way the military does (who is not restricted to state requirements so long as they practice on post/base) that healthcare costs would go down and efficiency would go up.

If Aetna has to pay a Phd to diagnose _____ and write a script for said _____ at a rate of $225 hr, but the PA costs $125/hr - it's obvious where the savings will come into play.

PA's and NP's in some states do much of this, but in others they don't. RN's aren't allowed to do much, when often times they're the ones with the practical experience.

Maybe that's the beginning of the answer to single payer systems where WE are the payer.

Something most people who aren't involved in healthcare don't understand is that a large part of the "grunt" work that is billed out at hundreds of dollars per hour or thousands/day is done by LPN's and Techs. Want dressings cleaned? LPN. Want vitals tracked, bed pans changed, etc? Techs.
RN's ironically often times simply supervise all of this, as maybe a Lt or Senior NCO might in the military. They track progress, give drugs when needed, etc. The only case where I believe Nurses are utilized to their potential is with CRNA's (nurse anesthetists).

Great idea quick.... that gets me to thinking...

This is coming from a guy who visits hospitals for three reasons (so far, all the bones and limbs have held up fine )
1.) Contagious Disease (and then only if I can't quarantine myself)
2.) Life-threatening Emergency
3.) Government/School Requirement

Expectations?

Not the problem.

Frankly it would be a lot more sensible if everyone could get regular check-ups and preventative advice. We'd save money and lives.

...and I don't see Canadians complaining too much about their wait times compared to ours.

Link
We wait a lot longer if we can't afford it... like.... forever.

Health care quality is just fine in Canada, the UK, France. Hardly perfect but it compares favorably to our more "market driven" system.

I suspect that's because the wants of insurance companies and patients are forever at odds.

The insurance company wants to extract the maximum premiums from you while paying the minimum in services without the providing employer finally throwing their hands up and finding someone else.

I've watched it work and it isn't pretty.


That, for instance, is the wait for non-urgent MRI's. England has much lower wait times, they just buy more scanners. Not brain surgery.

It's keeping pace with sky-rocketing demand that is at stake, the West is growing older quickly, but that's a planning problem not a structural one.

I'm still researching, but I lean towards a single-payer system like Canada's Medicare.

Random myth number 1. Actually, what little 'cross-border' shopping there is is for elective surguries, not medically necessary ones. Furthermore, per capita there is FAR more cross-border shopping of Americans coming to Canada, and not just for drugs, but for quality health care. One of those things the right wing neglects to mention.
http://www.scenesofvermont.com/border-medical/index.html

Somebody finally did a study on how many Canadians go to the US for medical services, rather than relying on right-wing assertions, and discovered:

Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.

http://content.healthaffairs.org/cgi/conte...amp;ck=nck&



Really? Golly, I'll tell my father that! Two weeks ago he was told he needed an MRI at a doctor's appointment, The wait time between the decision and the actual MRI? 18 hours.. Longest wait I have ever HEARD OF for a medically necessary MRI? 11 days. Again with the absolute fiction dressed up as arguments: wait times exist for ELECTIVE proceedures, not for medically necessary ones, and guess what? Wait times exist for elective proceedures in the US too! Oh, except in Canada we dont have to pay for them...

Huge wait times and mass medical travel to the US are boogeyman that simply do not exist in reality, for anything but elective surgury, and lest anyone forget, wait times exist for elective surgury in the US as well (though on average, less...)

If you are going to debate the issue, debate on facts, not fiction.



Hmmm? The US is the only first world nation on the planet without universal health coverage, and yet they spend more on health per capita than any other first world country on earth. The inescapable conclusion is that universal health care is UNIVERSALLY cheaper than the current US model, and overall produces better results.




None of those 'truisms' are in any way true, and all are in fact axiomatically disproven just by loking at the rest of the first world. Solid, tangible proof that they are not true exists in the form of Canada, France, Scandinavia, Germany, Japan, and so on...





It might be easier if people based their choice on, you know... reality.

In the long-run, say twenty years from now, what healthcare system would you like to see in the United States:

I would like to see a different kind of universal healthcare than we already have. Now those who can pay do so and those who don't put off healthcare and prevention as long as possible and then show up in the emergency rooms where they are treated. Our least covered people receive the most expensive care and that care clogs up our emergency services.

If the freer market stops obstructing and begins to be part of the solution for our failing healthcare system with exorbatant costs without the results.
Healthcare, especially as practiced today (described quite well in one of Aevans posts in this thread) I would prefer a well-managed system that has the government or non-profit government contracters create an infrastructure for needed services that leaves our country better able to handle emergencies. (I.e. a plan that has the facilities in place to meet bed and emergency room needs of catastrophic conditions)


Universal government coverage? What kind?

Yes. I would prefer a private/public mix. The government contracts with resources and personnel on a contract basis and offers a baseline level of service that meets minimum needs. Americans can pay for higher level of services from the government. The private sector can offer additional supplemental or completely separate services. When all costs are accounted for instead of being defrayed into our private costs today we will be better off. I also think the exisitence of for-profit hospitals is a very dangerous trend. Hospitals need to provide many services that do not match up well with the profit motive. i. e. cutting out lower producing services.

Universal private coverage? What kind?

see above

Non-universal coverage? What kind?

No

Anyway those are my two pennies

For my Contemporary Political Thought class last semester, I wrote a paper which pit philosophers against eachother on the issue of universal healthcare. On the one side I had John Dewey, Hannah Arendt, and John Rawls and on the other I had Nietzsche, Hayek, and Foucoult. Learning about the various perspectives on health and and well-being, as well as the role of the state in providing that, really opened by eyes to different justifications to 'the right to health." Its the first time I read Rawls, and while I a do not agree with some of his points, I can see why he is so highly-regarded. However, the one philosophical point that I could not get out of my head had to do with this "right to healthcare" or the idea that everyone should be treated to their own satisfaction. The philosophical problem with this is that if you have a right to health, then that means that a doctor would be required to provide you with that care. The problem is that healthcare is not an infinite resource. There have to be doctors that are trained to provide that care as well as all the supplies and equipment necessary. If there are not enough doctors that are able to perform a procedure, then is there a violation of rights if healthcare is not provided?

On the practical side, I think that the current debate over universal coeverage always revolves around the pro-socialized medicine crowd decrying the current system for its "profit motive". Advocates believe that the government needs to step in and "even out" the injustice that occurs in who has access to healthcare. The problem is that those who advocate "free-market" solutons, such as i, are not defenders of the current system. I see the way that healthcare is run as an overregulated mess that is controled through a corporatist framework (just ask CruisingRam about that). Basically, people are criticizing a system in which there is no market and much of the drugs and procedures are controlled are atleast influenced by government activity. Things like Medicare and Medicaid, two programs that will eventually bankrupt us, have further affected the market in a negative way. Healthcare is a huge lobby in Congress and they are able to monopolize the industry and vanquish competition through legislation. Socializing medicine would make prices go through the roof because nobody is accountable. Who cares how much a given procedure is, the government is footing the bill. If the government is paying for everything then there is no reason to keep prices down.

This leads me to the main point which is that universal coverage does NOTHING to decrease the costs. By all probabilities, the costs will go up at a much greater rate. This means that instead of high premiums, we will get high taxes and an entitlement program that will eventually become to large to manage. Advocates of universal healthcare want everyone to be covered, and thats all well and good. But free-market advocates are looking for solutions that actually lower prices so that more people can afford it without government help. One thing that can be done is CUT TAXES. Cut the taxes of the consumers so that they have more money to spend on healthcare and cut corporate taxes so that they can pass on those benefits to the consumer. Furthermore, we have to stop servicing elderly patients with expensive procedures. it may sound cruel, but procedures that cost hundreds of thousands of dollars that would prolong a life maybe a year or two might have to be reconsidered. So much money is spent on elderly care and senior citizens are living longer because of it. Their extended lives hurts the overall resources of our healthcare. Finally, we have to stop subsidizing bad choices. If you smoke, do drugs, are obese, or do other harmful things to yourself, we as society should not have to fund your bad choices. Individuals should be responsible for their own actions and be made aware that if they choose to become obese, that society will not be the ones who pay for their procedures. If people were eating right, and exercising on their own, many health problems + costs would go away. The first step towards universal healthcare should have nothing to do with government or pharmaceutical companies or hospitals...it should be the responsibility of every individual to take care of themselves and their family.

It's an academic question to ask on so very practical a subject. If there are not enough doctors, right or no right...

...we need more doctors.


Then how to explain how other countries spend less on health care (both absolutely and proportionally) than we do despite universal coverage or even government ownership of hospitals like in Britain?


See... this is why people wonder about the "market solution"

turnea, it appears that it is becoming a habit of yours to pop into a thread, nitpick a few sentences out of context, and respond only to those lines. I have to say that it is an annoying new debate technique that you have acquired.



What was I thinking? We could just go down to the Doctor Store to pick them up.



Firstly, the populations of all those other countries are a lot smaller than that of the US. None of them are dealing with 300 million potential patients. Secondly, prescription drugs R&D is done a great deal in the US. Once the patent is up on those drugs, they can be sold for generis prices abroad. They can afford to provide low prices because they are only paying for production and not research. Furthermore, it is possible that other countries are not as prone to go to hospitals for non-emergency visits as we are in the US. There are a lot of factors that cannot be quantified. To be honest, I would need more research in this area, but it in no way changes my position.

Although it's true I don't waste space quoting an entire post, only those points I take issue with, I'm pretty careful about context.

Nevertheless if anything I quote is misleading in anyway, feel free to voice that objection.


Ah, but the point was that this is a practical dilemma regardless on one's position on the "right to healthcare."

It's not a theoretical problem, it's universal.


It's not just on an absolute scale, but as a percentage of GDP and per capita.

As I recently was reminded in the education thread, the concept of "economies of scale" would suggest we should actually spend less per person for having a higher population.


...but not at home?


Could you back that with evidence that it's the cause of the discrepancy?


Link

If we have limited resources for doctors then maybe we could loosen the entry controls for the doctors guild we call the AMA. Also the use of contracts could provide doctor's training in return for an obligation of service a la the US military academies or Northern Exposure. The Doctor store is there and it just takes a little while for an order to be filled. The thread's first question gives us 20 years. Quite doable imo.


And if I could just chime in about weeding out the inefficiencies via reducing the amount of care for the elderly, I simply second Turnea's highlight of the quote and response, whether that is nitpicking or not.

Words coming of the mouth of an obviously healthy, obviously young guy .
Why stop there? Social Security is about to go bankrupt, and you know why? Because all these aging baby-boomers are about to become elderly and drain the overall resources. Cut off SS to them, what's their worth to society anyway at this point?

I don't remember who said it, but the gist was that the measuring stick of how civilized the society is would be how the society treats its elderly and infirm.




The population of Germany is 82.5 million. The population of UK and France is 60 million each. Not exactly small countries in terms of population.

I just wanted to mention that the US is not the leader in R&D in pharmaceuticals. It's a nice myth that people like to repeat over and over, as a way to justify our high prices, and to demonize universal healthcare (those socialist countries are stealing our ideas!). Donald Light and Joel Lexchin wrote an article in 2004 about this subject:



Etc. Worth reading.

My libertarian tendencies lead me to distrust a completely state-run system. But then, I don't really understand the nuts and bolts of how the "state-run" systems work in places with universal health care. I suspect it varies.

Single payer sometimes gets conflated with single employer, but I know there are private practices in countries with universal healthcare, and that doctors don't all get government paychecks. I'd be interested to hear if anyone here has experience on the healthcare provider side of things, in countries with universal government coverage. And while I'm fishing for anecdotes, does anyone here have any experience with the Dutch model? I've read, vaguely, that it includes private insurance in the mix, yet they're still able to keep costs down well below what we pay in the US. And they're taller than us, too, so they must be doing something right.

I know the current system in the US is extremely wasteful (30% paperwork overhead) and can be maddeningly difficult to navigate for the people who need care. If we can't figure out a way to structure the market so that we get a return on healthcare spending that's comparable with the dreaded "socialized medicine", then I'd say socialized medicine is a bad idea whose time has come.

Twenty years is too much time, so I voted no.

Actually, I don't think the American public can think well enough to do universal health care. It's not even being penny wise and billion dollar foolish.

I don't think the American public thinks at all.

But then I'm not in a very good mood. Tourists have invaded my little mountain town. My opinion on humanity has taken a huge dive.

And we've had a recent death in the family. The behavior of some survivors sicken me. I'm not going to the funeral, bunch of egomaniacs, liars, manipulators . . . and I knew the guy just in passing. He left his daughters with the funeral costs . . . bahstad. The infighting was over the stupid Harley, but he had a loan out on it -- moot point.

Yeah, went out on a Harley with no helmet, no life insurance, stupid trailer bashed his skull, never made it to ER. Don't like Harleys (the loud ones) and absolutely hate trailers. Get a freaking car. I haven't been out once this season on the KLR650 because even a broken bone costs too much, and I have no insurance.

Errgghhh. At least he died quickly without running up HUGE medical bills to really SCREW his daughters. Maybe it was good not wearing a helmet. Errgghhh.

There's a really good reason for universal health care -- ignorant irresponsible fathers once again destroying lives, or trying to. He's not my blood. He's not Lydia's blood. Screw it. I don't need the aggravation.

But the US needs universal health care, and soon. Twenty years is ridiculous, so I suppose that's what people will want. Maybe fifty years. A hundred. Maybe never.

But hey, carry $10,000 in life insurance, will yah? Your sorry butt has to be dealt with, and it ain't free. Me, I got a $25,000 policy so's people can have a party. It's about $30 a month. Don't stiff your family as a stiff.

I don't think that these suggestions are bad, aevans, but such a system would require quite a bit of newly-created bureaocratic overview. It would take thousands of jobs to effectively oversee the above. These types of 'cost cutting plans' usually remind me of a letter my husband received from the wing commander not long ago that went something like this:



Just from personal observation, back when the military used champus a soldier or his/her dependents needed an ID card and could obtain healthcare easily (sometimes a small copayment was necessary). Nice. Now, every time we move I need to change primary care providers, view a list of places that are willing to take Tricare, select from 20 different types of coverage options, co-pays, deductibles, and weed through various acronyms. This for government funded healthcare. Just a guess, but I doubt this has streamlined anything from the taxpayer end, and I know for a fact it has created work on the user end.

When my relatives in Italy have health problems, they go to the local hospital and are treated. I can't say they've never encountered any problems, but no more so than they would in the US system that costs 10+ times more. Several of my relatives who live in Tamai have had cancer, one had cancer in his brain about 20 years ago, and not one of them has died or been disabled from the cancer. All have been in remission for over 7 years (effectively cured). Nearby is one of the best cancer hospitals in the world.

I'm for single payer, universal healthcare, with the option to go to private clinics and pay out-of pocket (or with supplemental insurance) if one wishes.

Edited to add: Sorry about the recent death in the family, AM.


Edited (again) to add: For those who answered 'no' becuase they think twenty years is too long, the question does not indicate that twenty full years must go by before such a system is in place, it just asks what should be happening twenty years from now. Could start tomorrow as far as the question is concerned.

There are three arenas that we could revolutionize the health care sector in our country, and improve health care for all, and possibly even make it more "free market" driven:

1) End frivolous patent extensions for drugs, and stop allowing patents on drugs that are not fundamentally different in nature. Real problem in the US, but seemingly, no where else! Should be some kind of indicator there. Also- recognize that america is in no way, shape or form even competitive in new drugs coming to the science of health care- it is foriegn companies PATENTING thier drugs in the US- Pfizer, Bayer etc are all foreign companies BTW

2) Dismantle the AMA, and stop allowing ANY entity from artificially limiting thier numbers to drive up costs. I believe the death penalty is appropriate for those Drs/laywers/lobbyists that have perpetuated this system.

3) Go to a single payer insurance system, a hybirdization of everything that works from every western nation in the world. the insurance industry is 180* out in philisophy for health care, as noted above by some posters, and it needs to be abolished.

Start there, and in a year or 5, we would not have a health care crisis, and our actual economy would improve, and business would stop having to be competitive in wages AND health benefits to be competitive globally- something other western nations have already recognized.

It occurs to me that this issue is so fundamental, I suspect it could even make significant cuts across party boundaries.

In my cynical moments I often suspect that Galbraith was right as usual...


Health care is simply so expensive that it flexes the boundaries of the age old, unacknowledged, classism that dogs our country's every move, probably time to start that topic too

In any case I think the more time goes by the clearer it gets that the primary arguments against socialized medicine tend to be based on the fact that the public has never been asked to decide upon it squarely. I mean I can't even find a poll that asks people what they think.

Which is yet another reason for the adoption of universal health care. I suspect it will strike a blow for reason in our political discourse as well.

Random myth number 1. Actually, what little 'cross-border' shopping there is is for elective surguries, not medically necessary ones.

Exactly how do you determine what is medically necessary? What a load of crap that is. If my knee is bothering me and I can't play tennis, it is medically necessary to me to get an MRI soon. In Canada, that would be a 6 month wait. Get it?



Wait times exist for elective proceedures in the US too! Oh, except in Canada we dont have to pay for them...

What a crock. Of course you have to pay for them, through a much higher tax structure than we have here in the US.



Huge wait times and mass medical travel to the US are boogeyman that simply do not exist in reality, for anything but elective surgury, and lest anyone forget, wait times exist for elective surgury in the US as well (though on average, less...)

The US system today is, as I said above, a hybrid. It is a private system on to which was grafted the socialized systems of medicare/medicaid/and emergency room care. The system is a mess, but it started when we allowed people to use govt below market payments to distort the system. Providers then began to overcharge those who could pay, which lead to HMO/PPO cost control measures, etc.

Our system is a mess, but all systems--including Canada's--are a mess when you distort the market.

QUOTE

2) No nation could afford to offer the kind of health care to which people in the US today think they are entitled (and if we think taxes are high now, just you wait....);

Americans expect care for everything, all the time. No one can afford this. Every socialized system rations based upon wait times and availability. They have to. What your comments prove is someone else decides what is medically necessary, other than the patient and his doctor, and it is the govt. In the US today, it also is the govt and HMO/PPOs who decide what you need, although if you want to pay for extra care, you can certainly do so, which is often not true in socialized care nations--you must wait in line no matter how much money you have. In the not-to-distant past in the US, it was just the patient and the doctor, as it should be.


Hmmm? The US is the only first world nation on the planet without universal health coverage, and yet they spend more on health per capita than any other first world country on earth. The inescapable conclusion is that universal health care is UNIVERSALLY cheaper than the current US model, and overall produces better results.

As I said, in our march toward my option (CC) in my prior post, we have an expensive, mangled hyrbrid system in the US. Just 35 years ago, I had a bad car wreck, was hosptitalized, and never saw a bill. My employer-provided insurance took care of everything. Unlike you, I actually was around when our health care system was an absolute marvel, but only for those who could pay for it, admittedly.


None of those 'truisms' are in any way true, and all are in fact axiomatically disproven just by loking at the rest of the first world. Solid, tangible proof that they are not true exists in the form of Canada, France, Scandinavia, Germany, Japan, and so on...

Every nation you name has much, much higher tax rates than we do to pay for the health care system. At least here you have a choice, even if we do spend a higher percentage of our GDP on health care than many other nations. Of course, this GDP argument is a red-herring in that most of that cost differential is in drug development, which our higher drug prices subsidize for the entire world. If we didn't do that, drug cos would have to share the billions in development costs more evenly, and Ger, Japan, etc., would have to pay more for the drugs or simply steal them until the drug cos go out of business.

There is no free lunch.

In the current system, I think we have two options for determining what is medically necessary. 1. Doctors - with the patient's input. 2. "Managed care" people in some insurance office.

As a practical matter, I would prefer that my doctor make those decisions without diagnostic assistance from the insurance folks.

See, there's another easily disproved falsehood. Private hospitals exist in Canada and in most other nations with universal care.

People with enough money can always get what they want. Canada's system works better for the majority, why not try it?

Already disproven in this thread, twice.

Quick- everything you have posted has been disproved- as Turnea said- twice.

The single most socialist/truly communist institution on the planet is the AMA. It is, by definition "the means of production is controled/owned by the workers"- the AMA gets to set WHO and HOW MANY Drs enter the market- instead of allowing the market to determine the supply/demand. If Drs pay get's to low according to whatever AMA trustees decide- then they simply force the university to allow less "slots" for medical school.

The single most important step is to make this illegal. Allow the market to determine how many Drs are available- NOT the Drs themselves.

What? Who said that Canada's system works better for the majority? You might've said that...
But these people didn't:
http://www.liberty-page.com/issues/healthc...zed.html#canada
http://www.cbsnews.com/stories/2005/03/20/...html?cmp=EM8705
http://www.cbc.ca/healthcare/

GREAT QUOTE from last link:





AMEN BROTHER!!!!!!!!!!!!!

Seriously. How can the market ever change if there are artificial limitations put on it? It's a monopoly in the truest form with the AMA dictating excess and shortage.



I don't know about that. Consider that if the drugs aren't different or better, Doctors will most often prescribe the cheaper drug (i.e generics, etc.). However, often new drugs come out that ARE better and include patents. I think this is necessary to spawn innovation. Why do the VAST MAJORITY of new drugs come from the US? Hmmm....




I think the problem with people making the decision on something like this is that frankly most people don't understand the economic ramifications of what you're asking for, even some people on this board. However, I'm sure people will come out in droves to vote on both sides of the topic with relative ignorance.

Isn't this what happens in Presidential elections??? .... hmmm....

I hate to be a stick in the mud, but I've asked this of several posters on AD numerous times, and I've yet to receive a response:

You argue that unregulated, private operations are always more efficient and effective. Prove it. Simple request. If your theory is true and absolute, then surely there must be hundreds (if not thousands) of articulate, well thought out and irreversible truths. Go ahead, find one study... I will personally ship to you a picture of myself in the most degrading pose that you can imagine if you actually go and bring proof to this thread that the free market is ALWAYS more efficient.

The reason I ask this is because your position (as well as Lederuvdapac but he actually seems to read and learn things) basically boils down to random personal anecdotes, isolated statistics which have no value in a larger context, and the unshaking belief that the problem is the fact that the government is involved. Does the government create complications? Certainly, but just once, I beg you, evince some intellectual honesty and back up your assertions that inefficiency is the sole domain of the public sector.

Come on... do it...

It is at this point I want to highlight the definition of "majority".

I don't think I follow.

The inability of the "anti" side to mount a logical defense is due to ignorance on the "pro" side?

Thanks for that link, kimpossible. FWIW, the European pharmaceutical companies don't seem to agree that Europe is beating the US in drug development:



That's from the Pharmaceutical Forum, an industry-led group that would like to charge higher prices for drugs sold in Europe. So take it with a grain of salt, but also note that the figures they report are more recent than the ones in the Bioethics paper.

I'm also not sure that the authors of the Bioethics paper are taking into account the enormous failure rate of new drug candidates, when they're calculating how much it costs to bring a new drug to market.


Actually, Pfizer is a US company that was founded in Brooklyn, New York, in 1849. Bayer is a German company, and a big one, but only the 13th biggest pharma company. Of the top ten, five are American, two are Swiss, one is French, one British, and one British-Swedish. The foreign companies do quite a bit of research in the US.

I don't think patent extensions are that big of an issue. It's basically impossible to extend a patent beyond 20 years from its date of issue. (The usual term is 20 years from date of filing.) When people talk about drug patent "extensions," they're usually talking about new variants on a drug that have been granted a new patent. Common examples are time-release formulations, single-pill combinations of two or more drugs, or single enantiomer purifications of a chiral drug molecule.

In all of those cases, the original drug is off-patent, in the public domain, and able to be manufactured by generic drug companies. Insurance companies (including government-run insurance) will only cover the new variant if it's significantly better. (A single time-release capsule may have better patient compliance than a regimen of six pills per day, for example.) If it's really significantly better, why shouldn't the company get the benefit of a patent on the improvement?

Firstly, depending on where you are, it is about a 3 week to 3 month wait right now. A bit higher in the North, for obvious reasons, thats nor elective proceedures. Non elective, the waiting list is measured in HOURS.

Secondly, let us be VERY clear about what you are suggesting. You make it sound like for elective proceedures, you with wait a bit in canada, or get it sooner in the US. That is an absolutely false scenario that leaves out one of the most important realities.

The REAL situation is, you wait a bit in Canada, or you get it sooner in the US... If you can afford the 800$ for a single MRI scan. How MUCH do you want to play tennis? Enough to pay for the scan, then the surgury to repair it? I suppose thats better than waiting IF you have that kind of disposable income lying around (as many insurance plans won't cover elective proceedures). Many do not.

So don't pretend otherwise. Yes, I and all Canadians will admit, if you happen to be a millionaire and need elective surgury, it is better to be in the US. sadly, thats a pretty small sample group.




No sir, your response is a 'crock', pretending that a couple percentage points higher tax rate if you are rich (did you know the tax burden for the lower income brackets is almost the same in canada and the US? So much for your point) is the same as being compelled to pay out of pocket extremelyt large sums of money for proceedures.

Oh and as an aside, I'm sick of people asserting that Canada has a vastly higher tax rate as if that were gospel. Here is the tax structure of the USA:

· 10%: from $0 to $7,550
· 15%: from $7,551 to $30,650
· 25%: from $30,651 to $74,200
· 28%: from $74,201 to $154,800
· 33%: from $154,801 to $336,550
· 35%: $336,551 and above

And here it is for Canada

0% on the first $8,800 of income, plus
· 15.5% on the first $37,178 of taxable income, plus
· 22% on the next $37,179 of taxable income (on the portion of taxable income between $37,178 and $74,357), plus
· 26% on the next $46,530 of taxable income (on the portion of taxable income between $74,357 and $120,887), plus
· 29% of taxable income over $120,887

Now to be fair, add a couple percentage points to canada because of the addition of provincial taxes. Even with that addition, please tell me where you would rathyer live if you were rich: Note also the graduated system for Canada, so even the rich pay LESS tax on the first 120,000$ of their income. In terms of income tax, Canada is significantly better.

So where does this idea of higher taxes in Canada come from? Well, some provinces have higher priovincial taxes than others (such a Quebec) and there is also higher sales tax on things like gasoline and a few others, as well as a Canada-wide 6% sales tax (the GST). But reality check, NONE of this makes up the fantastic tax burden the far right in the US has taken to assuming without bothering to check.


Then we have the fact that even IF tax rates were so much higher as you pretend, the US STILL spends more per capita on medical care than Canada does.

Oh but wait, you made some assertions to address that point as well!



Firstly, that has been dealt with already by those who have pointed out that the US does not seem to have a lock on Pharmeceutical R&D that you pretend it does.

But ignoring that point for a second, Lets actually take a look at your assertion, shall we?

The US spends 16% of its GDP on health care costs, while Canada spends 9.8%. Thus, if its all about Drug R&D as you pretend, one would assume that the US spends about 40% of all its health care spending on Drug R&D, as thats the percentage higher than canada.

Ooops, turns out, the US spends less than 10% of all health care spending on Drug R&D, meaning if the US spent ZERO money on drug research, absolutely NOTHING, it would STILL be paying FAR more in percentage of GDP than... well, every other first world nation on the planet, ALL of whom have socialised medicine in one form or another.



Please stop repeating this utter falsehood. SOME of the nations which have socialised medicine have somewhat higher tax rates, and NONE of them use that tax rate to pay for socialised medicine, thats right, none of them, as they all pay significantly less per GDP than the US does.

What always, in my view, trips up universal healthcare v. private healthcare debates is one key definition. How do we define an "effective" healthcare system. What is "good" as it relates to judging a healthcare system. Some argue that a healthcare system that is 'effective' or 'good' is one in which if you are sick, you will get treatment, period. What makes me appear to be a heartless jerk and what differentiates my argument from my opponents is that I do not subscribe to that particular definition of an 'effective' or 'good' healthcare system. I believe that a 'good' healthcare system is, strangely enough, one that does not subscribe to the theory that healthcare is a 'right'. In my view, a good healthcare system is one that involves no government coercion or force [much like many other things that I consider to be 'good']. As a result, I do not support a government/taxpayer funded healthcare system because it involves the initiation of government force on several fronts. First, citizens are forced to pay taxes that fund the healthcare of another person and then they are forced into accepting a mulitiude of government regulations that would not be in place in a privately run system.

A privately run, deregulated system in which government coercion is minimized. One that, admittedly would not ensure [by law] that all who need medical care receive it. But again, that is consistant with my view that medical care is not a 'right'. Those without the funds to receive care coudl be partially subsidized by charity and other non-profit acts by private individuals and/or hospitals. Again, this would not guarentee universal coverage, and I fully admit and understand that.

No, unlike universal healthcare, non-universal, private coverage would not violate any part of the Constitution; a very convenient side-effect.

CP

Understandable.

The opposing view, as usual, simply points to the trade off.

Con: Taxes
Pro: Lives

It's not heartlessness that vexes, it's confusion over priorities.

Oversimplication leads to such a conclusion.

Who's responsibility is it to save those lives, Turnea? America as a whole, or the individuals' whose lives we are speaking of?

I believe it is the responsibility of the individidual to preserve their own lives. That is to say, we shouldn't be FORCED to contribute to the preservation of those lives...We should however [as I do] volunteer to do so.

Color me heartless

CP

I think that holds the key to the entire discussion.

Clearly the practical downsides of universal health care are... overstated.

It is only the theoretical that can hope to hold.

The fact is the vast majority of society has already decided the lives of other Americans are our responsibility.

The standing armed forces for instance (not present in early America) or mandatory emergency care, Medicare etc.

Of course, one can disagree, but it's a judgment call.

A totally hypocritcal argument, CP. Well, unless you are also arguing that things like police and fire protection, and even defense are things in which the government uses the "force" of taxes and regulation to accomplish. As Turnea noted, this country has already decided that the lives and well being of other Americans are the responsibiltity of us all. Now the question is only to what degree.


Gee, sounds just like what we have now, and which a vast majority of Americans has decided isn't working.

The problem is CP, and the main problem with libertarian arguments- is theory vs reality. I woud love it if goverment would get out of healthcare, and try a, perhaps, third option- because the two options see to be, idealogicaly- to defend the curent, crappy goverment run system, that is disguised by corporate America as something resembling "free market"- which it is clearly NOT, or, the universal/single payer insurace/socialized medicine- which, well, corporate america has won the propaganda war of disinformation- Aevens can't even seem to understand majority - In 2001, 21.7% of those waiting for non-emergency surgery and 26.7% of those waiting for specialist services said the waiting times were not acceptable.- that would mean around 78%,you know, the majority, said the waiting periods are acceptable

Jobius- thanks for correctling my very old information- Iwas a pharmacy tech about a gazzilion years ago- but I read your post very carefully- and noticed something very odd- it is NOT more EFFECTIVE drugs that are importan for PUBLIC HEALTH we are talking about= but rather "the best sellng drugs" as quoted "In the past, Europe was leading in developing the most successful breakthrough pharmaceuticals. This trend has reversed. In 2004, two thirds of the 30 top selling medicines in the world were developed in the USA[2].

Lipitor, and other anti-cholestorol drugs, but nothing really ground shaking- in fact, if anything, drug companies are suffering an "innovation drought"- and it is my belief that it is because marketing is SOOO much more important than innovation in the US drug market- which, of course, is the lion's share of all the drugs sold in the world-

http://www.wired.com/science/discoveries/news/2006/03/70508

Let's not rewrite history in terms of where the innovations of 10 years ago came from," Aitken says. Many of them, he notes, came from Japanese companies, like cholesterol pill Pravachol, or academia, like the cancer drug Taxol. Both of those became huge sellers for Bristol-Myers Squibb

One thing that's visibly lacking from the list of international bestsellers is a biotech drug. In the United States, three anemia treatments, two from Amgen and one from Johnson & Johnson, have cracked the top 10. But the biotech revolution brought by drugs made of protein that must be injected hasn't had quite the same impact worldwide, although the category still grew 17 percent to $53 billion. Most of the drugs on the list are small molecules, the same kind of chemicals, resembling German dyes, that kick-started the drug business into existence at the turn of the last century


Bottom line is- America isnt really putting out any kind of "innovative" new drugs- they are simply re-designing the old stuff and for really not very important breakthrough. Look at, oh, Viagra. Man, great seller- but, over all, is it as important as , oh ,birth control - I only see one drug coming down the pike that is anything more than a "vanity drug" designed to overcome bad health choices- like smoking or eating too much or, help young me "perform" over and over at the next sex party- is possibly a biotech anti-cancer drug- which is good news- but get's pretty lost in the advertisements for Nexium and Lipitor and Calais-

I am all for more free market on drug production- but I think a single payer insurance would make that happen better, and a better version of the FDA, with some reform in that direction, look where liability laws in other countries are fair, punish bad behaviors, while allowing testing trials to follow through with new innovations.

Also- once again, we get into the hand and glove conflict of interest/incestuousrelationships between drug companies and Dr prescribing for extra dough.

There is more- but that is all I have for now

You should know my ideology better than that, Nite Guy. Healthcare is not a collective good, police protection is. That is the difference.
."Noted" implies that it is a fact, not an opinion. It's an opinion, one that I don't agree with. So the question, in my view, is not "to what degree". The government has no business forcing me to pay for another's healthcare. Unlike policing, if someone is unhealthy, I do not become less healthy whereas in the case of police protection, if my neighbor is not safe, I too become less safe. That's the difference between a collective good and healthcare.

Right...We spend more taxdollars on healthcare than any country on God's Earth...That sounds just like a private system . As Leder said, private healthcare supporters do not proport to defend our current system. We need not do so because our current system is not completely privatized. Government regulation and general activity are both rampant in our system.


CR, you tailed off...I mean to say that you never completed your thought. You said you would love to get gov't out of healthcare but never explained why you don't support privatization. Why don't you?

CP

I haven't come across a listing of drugs sold, ranked by their importance to public health. I'd like to see one, and I suspect that most of them would be off-patent, generic drugs. Birth control pills, for example, have been around for over 40 years, so almost all of the market is probably generics.

But that doesn't mean there isn't important work being done in new drug development, or that most of that development isn't happening in the US. Drug companies get a bad rap for chasing "me too" drugs (like the anti-cholesterol statin drugs), but they're actually doing a lot of innovation. The trouble is, most of the innovative work doesn't pay off. Huge investments have been made in genomics and computational chemistry, without a lot to show for it. It may be that the low-hanging fruit has all been plucked by now, and that useful new drugs are going to be harder and harder to find.

And frankly, the "me too" drugs have their place. Isn't it better for competition when there's more than one manufacturer of cholesterol inhibitors? Consider Pfizer's latest disaster, torcetrapib. Sure, it's intended to treat the same problem as other statins (like the now off-patent Zocor). But there were reasons to expect it to be much more effective. It doesn't just lower LDL cholesterol, it increases HDL cholesterol (the "good" cholesterol). People with high HDL and low LDL tend to live longer and have lower rates of heart disease. So a drug that encouraged a higher HDL/LDL ratio should be great, right? Well, no, it turns out it's much worse than the current statins, and even worse than placebo. That's an important and surprising scientific result that cost Pfizer hundreds of millions of dollars to find out, money they're never going to get back.


Yes, protein-based biotech drugs are difficult to market, because they have to be injected. You can't dose them in a pill, because the gut is so efficient at breaking down proteins. So maybe American firms were foolish to invest so much in biotech (because of this injection barrier), but you can't blame them for lack of innovation. America leads in biotech, and other risky drug development. The problem isn't failure to swing for the fences, it's that too often they strike out.

CR, you tailed off...I mean to say that you never completed your thought. You said you would love to get gov't out of healthcare but never explained why you don't support privatization. Why don't you?

CP



Your right- got distracted by my babies I am afraid - that is why I had to "cut and run" -

Anyway- I would love for a TRUE free market- one where the company is held liable only for NOT disclosing side effects and contraindications or the like, where pharmacueticals and "recrational street drugs" where allowed side by side on a shelf, with purity and quality control the only goverment interference, where anyone can open a drug store and compete with other drug stores equally- maybe they have pharmacist, maybe they don't. That was another debat as well- pharmacists are yet another "protected" class of the health care field- where, because the goverment restricts entry- it also restricts competition- that is why the abortion pill debate is an issue. And on and on- the problem is- the american public just don't like freedom all that much- so the reality is- we only have two choices- keep doing things the crappy way we are doing, and keep telling ourselves, that, despite all evidence, a large part of our population keeps believing our system is somehow better than any other developing nation

or, we adopt some sort of single payer hybird.

There are some good arguments to the single payer system, not really any logical argument to keep the system we got, and no way the american public will buy into the libertarian ideal.

So what else is there CP?

Um, CP, yes you do become less healthy if your neighbor is unhealthy. That's basic pathology. Think bubonic plague. In fact, your overall health is at least, if not more directly attributable to your "neighbor's" than security issues. You can always buy a gun, but not as easily combat a penicillin resistant strain of bacteria caught from touching a shopping cart (from an untreated person's hand sore) and then rubbing your eye, or pneumonia from someone's sneeze on a bus.

And I can't imagine a system as unregulated as you seem to indicate would be desirable. I think I've seen that type of system on the shows 'Deadwood' and 'Rome' but never the first world. Hello nosocomial infections.

Contaminated, used needles are cheaper than new ones. Who will know the difference? It'll be a hard case for your surviving relatives to prove in court....Your wife has just given birth and is led to a bloody shower. Not cleaning it is easier than cleaning it, and is she really going to run across the street and use another hospital? How is someone in bed with a catheter going to exercise his "free market privilege" to go elsewhere?

No, Mrs. P, I am not inherently less healthy if my neighbor is sick. If my neighbor gets the flu, I do no come down with it automatically. Sure, I could get it if I try hard enough, but it is far from automatic. If my neighbor allows his/her house or property to be surrounded by the wrong crowd, however, my property's safety is inherently threatened as a result.

Mrs. P, why would a hopsital who requires the money of its customer's to function, allow it's conditions to become as dangerous and disgusting as those that you just described? What incentive would there be to use used needles knowing that if someone gets sick, not only will you be sued, your reputation will plummet as a result. It simply does not make sense, fro