To the non-Americans:

1. If your country operates with a Universal health care system, are there any ways you think it should be made to operate better or is it fine just the way it is?

2. Are cuts to programs being made elsewhere to fund the system...or not?

3. is everyone pleased?

To the Americans:

1. if you are in favor of Universal Health Care for this country, how do you see it working?

1. There are ways that health-care in Canada can be improved. In fact, the Canadian government launched a sweeping inquiry into the subject and a lot of details came out. A decentralization of implimentation protocols combined with a centralization of regulations and funding devices ensures equity and efficiency in delivering services. Of course, funding needs to be expanded as the population ages and that is always a vital consideration.

2. I'm not sure how exactly to answer this question. Priorities are something that every government has, and these priorities are applied to all government spending decisions. Things are not cut in one area specifically for another. Funding in a program is cut because the funds are not available.

3. This is a silly question and you know it. When is everyone completely happy with anything (whether it be a government program or something else entirely.)

I think that the idea of universal health care is misunderstood, largely because people often think that it would require a much larger burden to be placed on the tax-payers, and that the quality of care would be "dumbed down" so everyone would be getting less. I don't believe this is true.

I work in an EMS crew. Our tax dollars pay for it. We do not ask people to pay before we help them. In public hospitals, people are not turned away from EDs for not being able to pay. We (tax payers) are already paying for this. It is my contention that if we were providing a basic level of preventive health care for everyone, the cost of treating preventable diseases would go down. It costs less to treat hypertension in its early phases than it does to treat the complications later on.

In our country, more money will always get you something better. If everyone had the right to a TV, for example, would that mean that everyone had the right to a widescreen plasma HD TV? Somehow I doubt it. I don't see healthcare as any different. There will always be people who choose, because they have the means, to visit a doctor with high-tech laser tools, or whatever. Just because we have public education doesn't mean those with money can not choose to have their children educated privately.

I see what we have now as a pretty bad in-between. On the one hand, our medical community and the wider society have decided that it is immoral to deny emergent care to those who require it. On the other hand, we could be cutting a percentage of that emergent care by providing (cheaper) preventive care.

Of course the other alternative is to leave people to die if they cannot pay. I don't think anyone thinks this is really a good idea.

I live on an Indian reservation which is an hour from the nearest hospital, two hours from the nearest trauma center, and four hours from the nearest serious trauma center. Health care here is provided by the US government, via the Indian Health Service. The people here are, compared with most communities, fairly poor. A private clinic would have little "market incentive" to operate here. How would they make a profit? Many people in this community get their money from fishing. They can't afford health insurance.

It is cheaper to treat these people with preventive health care than it is to wait for emergencies and have to helicopter them to Seattle for a heart attack. Without an EMS system, and without the local clinic, unable to afford insurance, would many of these people drive an hour or two for regular health care? Doubtful. If someone had a heart attack, they would die in their house.

Right now we spend loads of tax money treating outcomes. It would be better (and in my view cheaper) to spend tax money treating causes. Though I'd love to hear someone's rational argument for having no public money funding any health care anywhere. Disband the CDC, the NIH, the IHS, public hospitals. Go for it.

UJ -
does this thread bug you? I hope not. try answering questions without your usual condescending tone.

no questions are silly. either answer them...or not. Isn't pleasing EVERYONE something that should be strived for? if not, then why bother since you'll be replacing one person's pleasure with another persons pain.
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As far as I can see, Total Universal health care in America will be beset with major problems. finding realistic solutions to these FIRST should be more important than the promises of free health care itself.

let me start by saying that I DO wish for no one in this country to be without.

Universal HC: first, the money to fund free health care for america's 280+ million people would have to be taken from someplace. In one unnamed country, the military budget is almost non-existent in order to pay for the ever rising free health care. Is this something America can stand to do? Realistically and regardless of politics would America be fine with a military that might be cut in half? I'm not totally convinced of this yet.

secondly and perhaps this is to our favor. America has always enjoyed an influx of immigration. mostly from south and central america and asia, as this grows, more "young" immigrants would be available to "pay for" any unbalance in the aging of existing americans. However, if immigration should slow as well as birthrates in this country slow, the problem of funding then starts to manifest as is happening right now in sweden. Aging population, lack of young immigrant workers, decimated military...where would the funds come from? just questions I have from reading issues faced by other countries.

Innovation. america has certain advantages in the development of drugs some over countries. privitization. our pharmacutical companies develop more of the cutting-edge treatments that other depend on due to an overabundant availability of private funds. We can do this because of incentive. profit incentive. statistically a new medicine coming to market will cost into the millions in research and development. every other year it seems a new disease comes onto the scene. NEW vaccines and medicines and treatments are needed to treat them. Many other countries DEPEND on our being able to do this. Not having the exact info I wonder how much of the worlds medicines were funded through govt grants vs private? would innovation or incentive slow? I'm not sure.

these are but just a few areas for deeper consideration. there are probably more and they should all be adressed realistically rather than emotionally as it will effect all of us, including our neighbors.

You raise a very interesting point here. The need for medical care simply does not match up neatly with the ability to pay for it. In your case I'll bet the need for certain kinds of care is significantly higher than average but, as you point out, there's just no money in it to attract profit-driven providers. There seem to be several common responses:

• Too bad. If you can't pay for something - anything - you shouldn't have it, cost or benefit to society notwithstanding.
• Everyone should have access to minimal healthcare, because it's even more costly to society to deny it.
• Healthcare is too important to be subject to market/profit considerations at all.

I'm pretty much in the middle myself, tending perhaps more toward the third response than the first. Some people seem to have their feet planted firmly in the first camp. As I see it, those people are cutting off their own nose to spite their face. They're degrading their own life experience, acting against their own self interest, knowingly entering a lose/lose scenario out of attachment to their reverse idealism. They're stuck on the idea that in some imagined world it's generally better to keep government weak and paralyzed, and stick to that approach even though in this case, in this world, the tradeoff clearly goes another way. I don't understand how people can be so committed to acting against their own self-interest, and would be interested in hearing an explanation instead of (what I expect) the usual parade of "total universal healthcare without limits" strawmen and "heartless bureaucrats making my medical decisions" scaremongering as though exactly that didn't happen today under the so-called free market.

True to an extent, but if we wait until all of the problems are eliminated, in everything we do, we will never get anything done. If we have most of the major problems solved, we can always tweak as we go along.



Government funds about half of the research on new drugs through direct grants, university research, tax breaks and private charities, such as MDA, the American Lung Association, etc.

The biggest problem is that after giving to the charity of your choice, or through your tax dollars, you have to pay again through pharmaceutical monopolies. Why? Because for some reason, we give these companies the patent rights to medicines we have paid most of the research for.

So American consumers are doubly privileged: first we get to subsidize, with our tax dollars, the research that creates the drugs. Then we get to pay the highest prices in the world - in some cases more than twice as much as Canadians or Europeans pay for them. Yet, thanks to Pharmaceutical company lobbying, we are, by and large, not allowed to import these drugs from countries where they are sold much cheaper. (It seems that the principle of free trade is not universal after all.) Link to the numbers can be found here, and here.


Note that these drugs still cost about $9,000 dollars a year here, of course, because the law, lobbied for by the pharmaceutical companies, prevents us from importing these generics, until after the patent has expired.



Let's look at the copycat drugs they are talking about, using a "for instance" I am more than familiar with. You've seen commercials on TV for Lipitor and Zocor, I'm sure. One company made their's first (I'm not sure which, for certain). The second, made their's to compete with the other, without using the exact same formula. Both received government research grants and such, and both charge outrageously for their product (Along the lines of $80 for a 30 day supply). But the second company probably made their medication, already knowing a great deal about what was in the first one, so their "research" costs were much less. Yet they still get the benefit of a patent, and get to charge whatever they want for it. And the second company gets to say "hey, we have that too".

Now, there are generic versions of both on the worldwide market, but we cannot benefit from them here because of the importation laws that they lobbied so strongly for. What's the difference in cost between the originals and the generics? The same $80 for a month's supply of the original, would get me about 2 1/2 months of the generic, if I could get it.

Ending the patents on drugs we already pay for to research, would definately lower drug costs by a significant amount.

With all due respect, this kind of philosophy does not sit well with me. Why shouldn't eliminating all problems be part of changing a policy as ENORMOUS as this would be? There's a plan, these are the pros - these are the cons, what protocols can be instituted to try to eliminate or lessen to an appropriate extent...the cons. I don't want Universal health care to go the way of Sweden or Canada or any of the nations having funding issues. If we are to go the free health care I would rather not sacrifice quality over quantity.

Studies don't lie.
Once an illness becomes worse than strep throat (for instance) the wait for "specialized" treatment can be a wait anywhere up to 90 days. for the wealthy or poor alike. THIS is when timely treatment is MOST important not less important.

This is not to say that UHC or some combination of cannot work IF situations like these are worked out.

Please understand, I did not say we needed to ignore the potential problems, or not try to solve them.

What I meant was, even if you reduce or eliminate all of the supposedly known problems, once you impliment the program there will always, always be something that crops up, that was unforseen and unintended. These smaller problems can be worked out as we go along.

If you stop implimenting programs because you're afraid you haven't accounted for absolutely everything that can go wrong, you will never get anything done. If you have covered all the major problems, however, you can fix the smaller stuff during the process itself.

I don't suppose you've actually looked at any of the links I've provided; which detail the enormous popularity and relative sucess of Universal Health Care in Canada.

actually I was familiar with the Romanow report of almost a year ago before your posting.

Almost a year later are cancer patients waiting on shorter lists for treatment? no.
Sure, Canada's HC is still remaining popular yet how many, who can afford to, come to the states for treatment rather than wait on long lists?

Canada faces problems that have not yet, since the Romanow report been addressed. Funding being one of them. the BC fires, Sars, the beef debacle, these issues come square with funding HC. It's a concern.


Am I misunderstanding the broad issue here?



Rationing of services has come to the forefront in UHC.
Canada has only 15 pediatric heart specialists. even within the provinces specialists leave looking for better opportunities, pay, and work conditions. some move to the states. not uncommon, but when there is only 1 such specialist for one province based on the resources and revenue of that province who suffers? yes, Romanow is trying to inject change. that's a good thing. i'd like to see that.

Lets take a look at how "rationing" is seen in the US. many people have HMO's. Health insurance paid for by employers. there are no waiting lists here in the states. HMO's provide numerous Dr's who participate with particular HMO insurance. All are different. All fine drs. these Dr's for the most part can dictate whether you need an MRI or biopsy, sonogram or any "expensive" procedure. 99% act on the side of the patient. The 1% that may not have been the causes of lawsuits galore. Americans demand services they need and 9 times out of 10 they get it. there is never a waiting list. can you imagine telling Americans to wait for their health care services?

While in theory Americans may like the idea of free medical, once reality were to ever set in they'd be the first to scream bloody murder.

I could be wrong too.

You COULD be wrong... This is true. But your understanding of my health-care system seems shallow at best. No slight intended mind you. I do however find it odd that you knew the results of the Romanow report yet you have not to this point identified any of it's contents despite my repeated references to it.



I don't know. Care to provide statistics indicating that it is a large number?



Sure it's a concern. When is a government program ever completely satisfactory. But you overstate the level of unrest. SARS funding has not had a dramatic effect on health-care budgets because health-care is funded federally, and the SARS relief was handled provincially. Likewise, the Mad Cow scare has cost the Canadian economy money, but it has not directly impacted government because it was an isolated incident that didn't require that much money to address.



Nobody has disputed that some rationing takes place. We however feel that it is better for EVERYONE to have access and to sacrifice a bit of expedience in the process.



That's very nice. By Specialist do you mean a Pediatric Heart Surgeon or someone who has some sort of official title or certification? How many are in the United States? Without this context that number is fairly useless don't you think?



I'm not sure what you're trying to say here. Canada is comprised of provinces. Where else could they go? More specifically, how is this different than private-health care setup? Are you suggesting that doctors in the U.S. don't make similar moves?



Again this statement is kind of muddled... But you don't really seem to understand how health-care works here. Revenues for health-care are provided by the Federal Government in the form of transfer payments. Provincial finances play a role, but they are not the sole determinant. I'm not sure what you mean by "1 such specialist" either. Is there a scenario where healthcare is unavailable in one province and not another? That is not something that I've seen in the critical literature. In case you weren't aware the Canada Health Act specifies mobility, a person's health care is universal in the country. If someone has a problem and one province is unable to address it (rare) then that person can travel to another province.



That's quite the 'pie in the sky' scenario. My question is, what are you basing that on? If you want to say that American health-care works then you are entitled to do so, but you can't simply make up numbers. I'm curious though, do you actually believe that doctors act in the best interest of the patient in the U.S. more than Canada? If you do you are again demonstrating a poor understanding of our Universal Health Care. While we're on the subject of phantom numbers however, what happened to 43 million? They don't have waiting lists or incompetent doctors either... because they can't afford health insurance at all. And in case you're wondering I didn't pull that number out of thin air... here's one handy mention of it:

Uninsured Americans

Edited: Whoopsie... don't know what happened there. Someone delete the second post?

Ooh, hundreds! The major difference between the US and UK health systems at the point of delivery is that, because resources are limited, you have to wait in line. You can't just see your family doctor (we call them GPs, short for General Practitioner), be referred to see a specialist that day and be under the knife before breakfast, the way you can when you are paying a premium for first class service.

Most Americans DO pay a premium for first class service - your healthcare system, in terms of number and quality of clinical outcomes for the money spent on it, is one of the most expensive in the world, where the NHS is one of the cheapest.

There are waiting lists in the National Health Service for all routine operations, because there are only so many surgeons. Some people do die while waiting for a particular operation. Most of the political effort in the last 20 years has been geared to cutting waiting times, with varying degrees of success.

While there are thousands of horror stories of poor standards and medical incompetance, few of them are exlusive to nationalised healthcare, and the vast majority of people's experience of the NHS is of enormously caring and dedicated staff.

The problem is less with the medical staff, although there are concerns here with the self-regulation of doctors and surgeons, and more with the administration, all the way up to political interference in management and funding levels.

Under the Tories, it is now widely acknowledged that the NHS was underfunded, especially in terms of capital spend on equipment and buildings, and on hygiene services in the marketing sense - all of the things, like cleaning, repairs, catering, support services, that you don't really notice unless they are not up to scratch.

The Blair government have dramatically increased funding to the NHS, but have at the same time introduced layers of bureaucracy that must have absorbed much of that spend on non-clinical services. Their empahsis on wiating lists has skewed priorities in some cases away from clinical need, towards non-urgent cases that can help meet the churn targets.

Even now, there are unfashionable areas - mental health care, in particular, has always been something of a "Cinderella service", but I think that is as much to do with wider society's ambivalence towards mental illness as any structural flaw in the NHS.

All the while, it is perfectly posible to use private medicine, although that too has it' disadvantages (no visible regulation or performance standards, few or no acute services - if something goes wrong on the operating table, patients sometimes have to be transferred to the NHS for treatment - etc). Historically, most people with private healthcare had it funded by their employers, but with the rise of "consumer medicine" like cosmetic surgery, and with a more consumer-led attitude in the public, more people are prepared to pay these days, possible as an unintended consequence of the public sector empahsis on waiting times.


This has never really gone on to my knowledge. However, the reverse did - during the years that the NHS was "underfunded", the Tories cut taxes. As a core of the Thatcherite ideology, this wasn't specific to health, and anyway most of the tax cuts were funded by the revenues from North Sea Oil (the wisdom or otherwise of which is a different thread), so we could still afford to have an NHS and such a low-tax regime during the frequent economic recessions of the 1980s and 90s.


No. They say, you can't fool all the people all the time, and that seems to apply to pleasing them, too. But, broadly, I think that the underlying principle of the NHS is practically bullet-proof, and has been taken to heart by the vast majority of the British people. No serious political discourse since its foundation has suggested its abolition - the arguments are about the areas it should concentrate on and how it should be orgnaised, not whether it should exist at all.

I'm not sure that it could have been created at any other time than the immediate post-WW2 years, though. The national mood was open to the creation of a comprehensive healthcare service funded form taxation, where if it had never happened, the most we could expect would be the kind of basic provision being considerd by liberals in the USA.

That would still be better than nothing, though, I think.

great post Julian from the UK perspective. thanks much for being informative rather than taking it personally.

clearly both the American HC system and the NHC system have their pros and cons. In a recent poll here in American on 10/13/03. where insured, americans are satisfied, yet would see a NHC system that provided basics for everyone as favorable. the majority of the questions asked were asked during the Clinton administration and as of last month. A Universal Prescription drug plan is favored by the vast majority and is seen as of major importance. http://www.washingtonpost.com/wp-srv/polit...data102003.html

health care provided by the US govt:

medicare = government health insurance program for people 65 and over.
medicaid = A federal and state health insurance program designed to provide access to health services for persons below a certain income level. provides health care to women and children who qualify for Aid to Families with Dependent Children (AFDC) and the impoverished elderly who are poor.

yes there are people who are not "insured" either privately or through an employer yet either through state funds or federal, these working and non-working citizens do have access to care. It isn't perfect. There are problems for which proposals for reform are under way. http://www.heritage.org/research/features/agenda_health.cfm

We do, actually, have an American model for national health insurance. The Veteran's Administration has handled the health needs of millions of discharged servicepeople for over 50 years. How has that one worked out?

Edited to add: For anyone who doesn't know the answer, I recommend a trip to your nearest VA hospital.

Ahh, but the biggest problem remains completely unsolved. How to fund it, and to do so in such a way that those currently paying insurance don't end up paying more, and for less service. Health care costs are already a burden for many--having them pay even more so that others get coverage is a problem that needs to be addressed. However, I will say that there is the potential that similar levels of service can be provided without passing along any costs. Currently, those that don't have insurance are forced to use the emergency rooms to get medical care. This is a very inefficient use of these resources, and the costs incurred are certainly passed on to those in the hospitals that do have insurance. A system that reallocated these funds might lead to the ability to provide coverage to the uninsured without raising the overall cost of the system. This, of course, would require that the hospitals lower their costs as the need to compensate for the uninsured went away. Anyone taking any bets on that happening?

There is, actually, one outstanding example of a universal health care system that I know of. I didn't think of it until I took the kids to the park today and met another mother from Israel. I've known many Israelis here and overseas who believed their healthcare to be the best in the world. That might be a good place to look to find solutions to our healthcare problems....I've personally never been to Israel, experienced their healthcare, or know much about it other than everyone I've spoken with was quite satisfied. Here's a link

Hobbes brings up the exact point that I would have...

How do we insure that the 200+ million people who currently DO have medical insurance do not end up paying more for an inferior product?

Examples abound where US service is better than Canadian service. I am sure that examples abound of people who would otherwise have no insurance have greatly benefitted from Canadian services.

There are misconceptions on both sides. One, for example, is that those without health insurance have no access to medical attention. Patently untrue. There are free clinics in all urban areas (my family used to go to one, although infrequently). Is this policy "inefficient": absolutely. It is wrong: that is debateable.

Mrs. P's example of the VA is a very good one. The VA has a reputation for the worst care anywhere. I remember jokes about how they treated broken bones with saws... You can also look to Medicare as another example. I know a few people who work in nursing homes and other medical service providers and they all say that dealing with the red tape of Medicare is burdensome and drives up the cost of services, while Medicare gives them only a fixed amount for a given service.

My real concern with a National Health Care system would be accountability. Americans have a real problem with the "me, me, me" attitude. If they feel they are short-changed, they sue. In the case of government health care, I can see it already: If a government doctor misdiagnoses you, who pays? Me. If you feel you need a certain treatment and don't get it, who pays? Me.

I predict that the government would be more prone to performing unnecessary procedures than would be done under private insurance. Then there is the "discrimination" angle where every hospital would be required to be of equal quality. This either leads to unnecessary costs (redundancy) or a lowering to the lowest common denominator (i.e. all hospitals are equally mediocre).

National health care has lead to a shortage of doctors in both Canada and the UK.
Canada lagging in doctors per capita: report
Working conditions for Canada's doctors is also reportedly bad, I suppose because of overwork:

as of today the population of the US is 292,525,496 based on projection. http://www.census.gov/population/www/intclok2.html

according to est., 42,000,000 americans are uninsured yet NOT without some form of health care. Being uninsured does not necessarily mean "no medical service" at all.

if the US census projection is close to being correct that would leave 250,525,496 americans who ARE insured.

I have to wonder the same as Amlord...what of those who are insured? would their services lessen as is being seen in areas where UHC is the norm?

No, but it does usually mean substandard care at a higher price than those who have insurance. From a report by Consumers Union:




And this, from the American Medical Assn.


So, yes, they can get service, usually at the Emergency Room, at costs over and above insured patients, but with much less follow up, and almost no preventative care, that can make the difference in quality care.