something worth discussing

[tasty sweeps]

this mostly concerns american citizens, but anyone is free to comment on this as input from users of more advanced and logical systems could hopefully shed some much needed light on the subject:

HEALTH CARE. the US has an absolutely back asswards system of privatized health care. costs are through the roof, output is very poor. these are things that effect many of us in our day-to-day lives and almost everyone is in favor of a nationalized system [australia has a pretty great system, but canada's is the one americans tend to look at because it's so close that it's hard to obscure it from our view, although in many cases it is obscured from our view].

my goal in starting this is to bring people around to the idea. we in the US are so far behind any comparable society in terms of health care. and as much as people genuinely care about it, they're easily distracted with things like swine flu [but really that's an issue of agra business subsidies and destruction of family farms south of the border, as we were warned about over 7 years ago. overcrowd the pigs, feed them antibiotics in their slop just to keep them alive in the horrible conditions they're subjected to, viruses mutate, problems arise, but that's beside the point].

discussion is one thing, and like i said, the goal here is simply to make people aware if they weren't, and to bring it to the front of your brains.

how to bring the system about is fairly straight forward. it starts with organizing. look at nationalized health care systems already in place, there are great ones that serve as outstanding models, and push for the ideas to be implemented.

it's about time we nationalized something other than private corporate debt and risks.

[tplyons]

Wrong-- about nationalizing health care anyway. I spent a large portion of time studying and writing on the topic. Nationalized health care leads to over consumption, very much as in the case of the Czech Republic and Canada. Yes, national health care is "free" but it's often inferior to what is available through a free market.

I'm going to dig through my files and see if I can find the two papers I wrote on the topic.

[tplyons]

Papers found, if you would like to read them.

Both were written for a course I had called the Economics of Health and Healthcare.

[xgator4u]

How about the Brits as well. I dunno maybe it's just me but IMO the countries that do have National health care are NOT the people that exude health. Not to mention Nationalized dentistry.

[two fingers]

I couldn't dissagree more. I think that netionalized health care would ruin the best health care in the world, ours in the U.S. There are people from all over the world who come here (and go to India as well) because their nationalized health care systems have left them with no other options. If we had nationalized haelth care, some "suit" who knows nothing about medicine will make the decision of whether or not you get the health care you want. The salaries of health care providers would plumit, thusly who in their right mind would want to go to school for 25 years to make the same amount of money that your average government employee makes. I certainly don't want the same jackasses in Washington we have there now making ANY decisions for me, much less any HEALTH CARE decisions. Sorry buddy. You're drinking the Kool Aid and don't even know it. No offense to any other nation, but there are more chances to make a living here than anywhere else. ANYONE who TRIES hard enough can find work. You may have to move, but it can be done. I think as a nation of individuals we have become weak. We give up too easily. It's not the job of government to TAKE CARE of ANYBODY! In fact, I would like it if we went back to the way things used to be. The FEDERAL government was never meant to have even 1% of the power it has today. Yes, we have made stupid mistakes (slavery comes to mind first), but this is a great country. And every step we take towards the nanny state makes us not so great. Give me Liberty every time. Read the Constitution when you get a chance.

[two fingers]

Originally Posted by tplyons

Papers found, if you would like to read them.

Both were written for a course I had called the Economics of Health and Healthcare.

I hope you don't mind. I saved these to share with my wife. Nice work.

[tplyons]

Originally Posted by two fingers

I hope you don't mind. I saved these to share with my wife. Nice work.

Go ahead, I'd like these to get more use than getting me an A in the class. If I can spread some good information, I'd be more than happy to share.

[UnsungZeros]

Originally Posted by tplyons

Wrong-- about nationalizing health care anyway.

I'm perplexed. The thesis of your paper seems to support nationalization. I understand that every system has its flaws, I'm just interested in knowing where you stand.

Anyway, since research has been posted, I'm going to go ahead and post mine...

http://bit.ly/M8vD6

This may actually end up being one of the most informed threads on Talkbass ever!

[SundanceChile]

An argument I had with a self-proclaimed libertarian(I doubt she had any idea what a libertarian even is)...

I lived in France for a year. I saw what higher taxes and universal health care does for a nation. It destroys it. France is headed down the **** hole.
-Hey. Hey Jessy. You know there's this other country that has even HIGHER taxes and still manages universal health care. They seem to pretty well off. Decent economy, people are happy over there. Man, what was it's name again?...oh yeah, Germany. Ever hear of it?

I'll eat some more taxes if it means some DECENT health care for myself.

[tplyons]

Originally Posted by UnsungZeros

I'm perplexed. The thesis of your paper seems to support nationalization. I understand that every system has its flaws, I'm just interested in knowing where you stand.

Anyway, since research has been posted, I'm going to go ahead and post mine...

http://bit.ly/M8vD6

This may actually end up being one of the most informed threads on Talkbass ever!

Yes, I've done some more research since this paper was written. My feelings are still mixed.

I could support nationalized health care if it were done properly. But, these days, I wouldn't count on it.

However, we would lose the caliber of professionals we have through this. Basically, I believe Medicare needs to be expanded. Health Care as we know it is expensive, and unfortunately often ties us to our jobs, however, expensive health care and capitalism allows us to have the best health care available... to those who can afford it.

I've got very mixed feelings on the topic. Simply centralizing the health care system would do more harm than good, however, several significant steps need to be taken.

[Happynoj]

OK, to start with - why the hell does America think that Britain has bad dental care? Whenever the health system is brought up, Americans wade in and talk about how bad British teeth are. My teeth are perfectly healthy, and always have been, the same as 99% of everyone else I know.



On the subject of healthcare - I am in favour of a nationalised system, because it means that everyone can receive treatment no matter how well off they are, and you don't have to try and scrape together the cash to buy medical insurance. However, we also have a private healthcare market over here, for those who think that they are too good for public healthcare. Also, I feel that private healthcare and education help to promote the class system.

[Ericman197]

Quick note: feeding pigs antibiotics has nothing (that I know of) to do with the swine flu. Antibiotics are for bacterial infections, which are very different from viruses (swine flu).

RE: nationalized healthcare:

I think it's a bit of a mistake to make this a polarized issue. It doesn't have to be 'our system' vs. nationalized health care. We can work within our current system to make changes without going to a nationalized system.

For those who are unaware, the system we have now works like this:

Most people get their health insurance from their employer (due to government incentives), or the government (medicare/medicaid). A small percentage are self insured.

As for those (majority) of us insured by employers, it works something like this:

The boss needs to pick a plan(s) that fits the needs of his employees. It is cheaper to offer one, or a few plans from a single provider than to offer each employee every possible option, because this way the boss can buy in bulk. However, this leads to a problem: which plan is right for everyone? And which plan is right for the company? Obviously, the cheapest one. So, capitalists we are, the boss will pick the cheapest plan(s) he can get away with.

But this isn't good enough for everyone. Though it would be a mistake, many people would settle for the cheapest plan possible and would rather make a little extra income. On the other hand, some of us are VERY concerned about our health and would rather buy the best plan we can afford, or a plan that is tailored to our individual needs. I don't believe our current system puts much emphasis on individual choice.

But there is an alternative: a free market system in which we all pick our own plans. Insurance companies would then have to cater to the needs of individuals. We could even use our doctors (or other health care professional) to help us pick a plan based on what our needs are likely to be. For example, someone with a family history of mental illness needs a plan that provides good access to a psychiatrist, psychologist, therapists, and other services if the need arises. Or, conversely, someone who is perfectly happy with NO family history of mental illness could go with a plan that provides only minimal psych coverage, if he'd rather save the money (this may turn out to be a bad idea, but resources are always limited).

To cover a few miscellaneous points:

Nationalized healthcare is not really going to be the savior people make it out to be. There are about a million reasons for the disparity in cost vs. outcomes between the United States and Europe. One of the biggest is defensive medicine. To be brief, America is a very lawsuit happy country. Malpractice suits take up an enormous amount of the health care budget - much more than most people think. Most of it is in 'defensive medicine.'

Basically, doctors are frightened of being sued, and so will often perform tests and scans that don't really need to be done - just to be sure. This has good and bad sides to it. Being thorough is a great thing, and it does save lives - but it costs money. I'm not saying doctors shouldn't order an extra MRI to be on the safe side - but if they're only doing it so as to prevent getting sued, that is a problem.

There are MANY, MANY research papers that have been written on defensive medicine. Here is just a small example:

http://www.medscape.com/viewarticle/508416

Nearly 60% said that they often order more tests than indicated
33% prescribe more medications than indicated
32% suggest invasive procedures to confirm diagnoses
39% avoid caring for high-risk patients

And this is not something that can necessarily be solved by a national health care system. It can be solved by modeling our lawsuit system like those of some other countries, in which if your lawsuit is baseless, you suffer severe penalties (such as paying the other side's legal fees, perhaps facing fines and countersuits as well). In other words, none of this "I think the doctor didn't do a good job so now I'm going to sue." A malpractice suit should only go to court if there is clear evidence that the doctor did something negligent. Every time a malpractice suit gets thrown out of court (and they do all the time), it wastes many, MANY thousands of dollars in the doctors' and lawyers' time, and as we see in the above article, it VERY strongly affects how the doctor practices medicine.


Another important point about how medicine works: The only player that is allowed to practice true capitalism is the insurance company! With the exception of plastic surgery and a few other fields which are largely made up of elective procedures, doctors do not set their own prices. They take what the insurance companies, HMOs, Medicare/aid will give them for a service. This has good and bad points. On the one hand, it's a cost control measure. But whose costs are being controlled - the consumers, or the insurance companies?

Although I am not altogether ready to toss the insurance companies aside for a national system, what we have now is pseudocapitalism - there's a sort of triad between the government, insurance companies, and doctors... but nowhere are the patients involved. Patients take what insurance they can get from their employer, just as doctors take what reimbursement they get from the insurance companies.

I think an individualized insurance scheme would be a great way for patients and doctors to both benefit. For example, it could even be advertised that a given (expensive) plan pays doctors more than another plan. Why would patients prefer this plan? Because it could allow them access to any doctor they want, including some of the best.

What I think would be best is a system that gives incentives for patients to pay more, as well as incentives for doctors to provide better services to patients. That isn't to say that middle class folks will not be able to afford decent doctors - just that their choices will be more limited than someone who springs for 'the gold plan' (which is basically how it is now anyway - if you even have health insurance). But I do believe that with legal reform we can bring down the cost of providing medical care tremendously. And as for the poor, we could perhaps bridge medicaid with private insurance, and offer partially subsidized plans.

[MakiSupaStar]

There are many things wrong with the OP. Not everyone agrees with a nationalized healthcare. Our current health care system however, with the power and influence the insurance companies have on major medical decisions, needs a considerable about of work. I believe the happy medium is a somewhere between a completely private system, and a nationalized, somewhat socialized system. Japan has a great medical system. People pay into it monthly and they can get medical treatment at local clinics and outpatient facilities that then in turn refer to specialists and hospitals. We kind of have a hybrid right now, but too many people fall between the cracks.

I think to start with, we need to overhaul the insurance industry, and firmly determine their boundaries and limits. I don't think a doctor's diagnosis and decision should be scrutinized by an insurance claims adjuster.

You're comments about pigs south of the border, might be true, but the same atrocious conditions for pig farming exist right here in our own country too. The reason those pig farms exist in Mexico is not entirely because of us. They are practically the same here.

Beyond this, we're getting into the pull of insurance lobby groups and politics and I can't foresee this thread staying open.

[GregC]

Originally Posted by two fingers

some "suit" who knows nothing about medicine will make the decision of whether or not you get the health care you want.

The first thing that came to mind when I read this part was "HMO".

[Ericman197]

Originally Posted by Happynoj

OK, to start with - why the hell does America think that Britain has bad dental care? Whenever the health system is brought up, Americans wade in and talk about how bad British teeth are. My teeth are perfectly healthy, and always have been, the same as 99% of everyone else I know.



On the subject of healthcare - I am in favour of a nationalised system, because it means that everyone can receive treatment no matter how well off they are, and you don't have to try and scrape together the cash to buy medical insurance. However, we also have a private healthcare market over here, for those who think that they are too good for public healthcare. Also, I feel that private healthcare and education help to promote the class system.

Well, um... we don't mean to stereotype; most people know that not all British people have crooked teeth. But I think the experience of many Americans has been that if you line up 100 Brits, 100 Germans, 100 Italians, etc. it would be the British with the most crooked teeth - hence the stereotype. True? I don't know.

Also, yes, the private healthcare market is a great solution to the problems of nationalized healthcare. Not all Americans are aware of it, but for a premium, Europeans can receive health care that is just as high quality and immediate as anyone could get in the United States. My father met a number of people involved in such a program at a conference in Davos.

You want a hip replacement? Wait in line for weeks or months, and get your surgery done by a resident-in-training. Or, pay $50,000 and have it done by a top rated surgeon, with the technicians who made the implant on standby, along with a great anesthesiologist, the most comprehensive post operative care and physical rehabilitation, etc.

You may say it's unfair, but I say it's only right. You don't go through years of medical school, residency, and fellowship training to make the same salary as every other doctor in your field, regardless of competency. While I'm aware that the European system has schemes to provide incentives to doctors who are the best in their field, some of them are just silly. Such as providing bonuses to primary care physicians who are rated 'excellent' by their patients (Denmark). That's all good and well, but is a patient survey the best way to judge a doctor's performance? I have known some very incompetent doctors who are LOVED by their patients.

The fact that the rich in Europe are able to get the care they need without using the national system only helps you, because it means fewer people using the system. As for stealing the top 1% of doctors, well, I don't think that drastically impacts the health care you receive - the majority of doctors are quite decent - these rich patients just want the ones who were educated at the Mayo Clinic (or whatever the European equivalent is).

[Unrepresented]

We're going to pay for people to get medical care regardless of whether healthcare is nationalized.

People are sick. They go to the hospital. They run up a bill they won't be able to pay. We're left holding the bag, either directly through higher premiums, or through taxes that repay the hospitals. The only way to prevent this is to deny care to people who can't afford it, which is of course, evil.

So, knowing that we're paying for it eventually anyway, how do you propose we decrease the resources that are wasted in our current system? Nationalization seems like an obvious answer.

[Ericman197]

Originally Posted by Unrepresented

So, knowing that we're paying for it eventually anyway, how do you propose we decrease the resources that are wasted in our current system? Nationalization seems like an obvious answer.

Tort reform and other changes could greatly reduce costs. Nationalization, as I see it, doesn't really provide a mechanism for reducing cost. There are many good (and bad) things about it both from the perspective of the doctor as well as the patient - but I just don't see how a single payer system would reduce costs. Well, other than cutting out the insurance companies (which would be a big savings), but then you're trading one form of inefficiency for another (government).

It would be difficult to do, but IF we could increase the percentage of people who are insured, we would be much better off. Clearly we were doing SOMETHING right back in the day, and something wrong now - as everything we've done to cut costs has backfired horribly.

[ehque]

The way it's done over here, which is rather interesting, i suppose, is kind of a two-track system. There's nationalised healthcare, which is nearly free, and of reasonable standard. I got my ankle reconstruction done under something of the sort, and my surgeon was the professor at the medical school, not some resident in training.

Then there's this sort of sliding scale based on your income. You get less and less government subsides the more you earn, but you get better and better rooms. Of course you can opt up (or down) for rooms of other class, but generally you forfeit your subsidies if you opt down (and pay more if you opt up).

Beyond that there is the private sector, where there are no subsidies and generally much better rooming. The standard of care, on the other hand, appears comparable.

I find our healthcare system rather useful. The masses get their affordable healthcare, but the rich carry their own weight when they get sick.

[M@ddest_H@tter!]

Personally, IMHO the amercian healthcare system is designed to make more money, not focus on the problem at hand. Here's an example: with all the money companies spend on finding better hair care and body care products, they could be researching ways to cure parkinsons or any other disease. Also, you always see new prescriptions for different things, but the side effects are worse than the original problem! I have also noticed that commercials say..."use this with your existing prescription"

Edit: Luckily I am in the military, and do not have to worry about healthcare as it is provided for me. The only thing I have to pay for are my wifes glasses every two years or so.

[Happynoj]

Originally Posted by Ericman197

Well, um... we don't mean to stereotype; most people know that not all British people have crooked teeth. But I think the experience of many Americans has been that if you line up 100 Brits, 100 Germans, 100 Italians, etc. it would be the British with the most crooked teeth - hence the stereotype. True? I don't know.

So is this thing just about crookedness, or actual health? Because if it is just crookedness then I guess that is a perspective thing - I'm guessing that Americans are a lot more concerned about how straight/white their teeth are, and have procedures performed to correct them. Generally, the attitude over here is that if your teeth are healthy it doesn't really matter if they aren't quite perfect white. In fact I'd rather have unperfect teeth - perfect teeth don't look natural.

Originally Posted by Ericman197

Also, yes, the private healthcare market is a great solution to the problems of nationalized healthcare. Not all Americans are aware of it, but for a premium, Europeans can receive health care that is just as high quality and immediate as anyone could get in the United States. My father met a number of people involved in such a program at a conference in Davos.

You want a hip replacement? Wait in line for weeks or months, and get your surgery done by a resident-in-training. Or, pay $50,000 and have it done by a top rated surgeon, with the technicians who made the implant on standby, along with a great anesthesiologist, the most comprehensive post operative care and physical rehabilitation, etc.

You may say it's unfair, but I say it's only right. You don't go through years of medical school, residency, and fellowship training to make the same salary as every other doctor in your field, regardless of competency. While I'm aware that the European system has schemes to provide incentives to doctors who are the best in their field, some of them are just silly. Such as providing bonuses to primary care physicians who are rated 'excellent' by their patients (Denmark). That's all good and well, but is a patient survey the best way to judge a doctor's performance? I have known some very incompetent doctors who are LOVED by their patients.

The fact that the rich in Europe are able to get the care they need without using the national system only helps you, because it means fewer people using the system. As for stealing the top 1% of doctors, well, I don't think that drastically impacts the health care you receive - the majority of doctors are quite decent - these rich patients just want the ones who were educated at the Mayo Clinic (or whatever the European equivalent is).

My objection to the private system isn't so much about funding/quality of doctors etc, it is more of a moral thing.