Poll: Whos is in favor of a single payer Health Care System?

[NW-Bound]

The new laws already open up access to health care, and provide subsidies and all that. Why are people bringing up the old stuff?

The new system will not be truly active until 1/1/2014, so can we just wait to see how it works?

Lol. Ready to ditch Obamacare already?

Perhaps because they see that it still costs them something. As if it were really free in other countries.

PS. Being an American, I still have to admit that with our lifestyle and health habits, if we send our citizens overseas to be treated by other countries, we would bankrupt the system over there in a hurry.

When traveling overseas, I have never had to visit their hospital, nor learned much about their healthcare. However, just from looking at how trim and fit their residents are, I figure that it's got to make a difference in their healthcare cost. The mademoiselles (well, some not so young) do look so shapely, kind of like DW . And their men rarely sport a beer belly, even in Belgium where the beers are so good, and they do drink a lot of it. How do they do it?

OK, OK, I knew a few things that they did differently. But it would be tough for me to follow. My BMI is 25 at the highest, and blood pressure and blood sugar are similarly in the high end of the normal range, but to improve it further requires sacrifices I have not been willing to make.

 

[explanade]

Don't know about the finances of hospitals but their CEOs are well-paid:

Chart: Hospital CEO Pay And Incentives - Kaiser Health News

And here is the CEO pay of the top non-profit hospitals:

CEO Compensation of the 25 Top-Grossing Non-Profit Hospitals

 

[samclem]

I haven't seen anything to suggest that in any of the research reports I have read. Perhaps you have some references to back that up?

"That"?
I assume you don't take exception to my assertion that our cost of care is high. Right?
I assume you agree that Germans would be less healthy if they were as fat and sedentary as Americans. Right?
I assume you agree that a lot of Americans are in poor health because of their lifestyle choices (eating, smoking, lack of exercise) not their medical care, right?
If so, then we are in agreement regarding most of what you excerpted from my post.
Americans (all inclusive) who have been diagnosed with many types cancer, heart disease, diabetes, and many other diseases live longer and have better outcomes than do people with similar diagnoses in many (or all) other industrialized countries. The below quotes are from an article by Dr Scott Atlas.

Cancer:

American cancer patients, both men and women, have superior survival rates for all major cancers. For some specifics, per Verdecchia, the breast cancer mortality rate is 52 percent higher in Germany than in the US, and 88 percent higher in the United Kingdom; prostate cancer mortality rates are strikingly worse in the UK, Norway, and elsewhere than in the US; mortality rate for colorectal cancer among British men and women is about 40 percent higher than in the US. Removing “lead-time bias,” where simply detecting cancer earlier might falsely demonstrate longer survival, death rates from prostate and breast cancer from the early 1980’s to 2005 declined much faster in the US than in the 15 other OECD nations studied (Australia, Austria, Canada, Finland, France, Germany, Greece, Italy, Japan, the Netherlands, Norway, Spain, Sweden, Switzerland, and UK).

Heart disease:

Another comparison study showed that fewer Americans than UK residents die (per capita) from heart attack despite the far higher burden of risk factors in Americans for these fatal events. In fact, the heart disease mortality rate in England was 36 percent higher than that in the US. These superior outcomes from US medical care are particularly impressive, considering that American patients have far more risk factors (diabetes, obesity, chronic kidney disease) that worsen outcomes and death rates after heart attack and after heart surgery.

Diabetes:

A 2007 comparison of Canadians and Americans showed the same -- a higher percentage of American diabetics than Canadian diabetics actually receive treatment. In the same WHO analysis, the US also performed best by several different quality measures, including blood glucose control, as well as effective management for all three key factors in diabetics (blood glucose, blood pressure, and blood cholesterol), approximately twice the success of England and Scotland. Here’s the bottom line: if you had diabetes, you were more likely to receive treatment and be treated successfully for the disease and the important risk factors for its serious sequelae in the US than in any other country studied

Is this a peer-reviewed article? No. Of course, but neither is an article in Time or The Atlantic. But I've read "real" studies that generally tracked the same way: Once you are sick (and including those wth and witout insurance), Americans had better health outcomes than citizens of many other developed countries. It is just not reasonable to disregard lifestyle choices and other important factors and assume that healthcare (or "access" to healthcare in our buzzspeak) is the prime determinant of life expectancy or morbidity.

 

[daylatedollarshort]

Well, if you want to use one article written by one person on a Fox News web site instead reports from WHO, OECD and the Common Wealth Fund -

(U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives - The Commonwealth Fund

and this metrics based chart from Bloomberg.com

http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries

there isn't much else for me to add.

 

[Letj]

None of these other countries has a population even remotely like the US. Look how many excess US deaths are caused by people killing other people. Most of these other countries have much better educated populations, more law abiding, more literate and enumerate. On a population wide basis, Americans are astoundingly stupid, ill educated, violent group. Also, the sheer size of our country means that some things are more likely to be lethal here than in much smaller, more densely populated countries.

Ha

Very true; we not comparing apples to apples.

 

[NW-Bound]

The statistics and reports that samclem and daylatedollarshort cited did not contradict each other.

One said a lot of sick people did better with the US system than they would elsewhere (cost was not considered here).

The other set of reports said the US health care is expensive overall (one has to be under a rock to not know that), and that some people do not get healthcare.

These reports are complementary, and analyze different aspects of the problem.

So, the people who have been doing well under US healthcare must be having good insurance in order to pay for that. In the past 3-4 decades that my megacorp, then myself paid big bucks for healthcare insurance, I really used zilch of healthcare. In those years, my healthcare usage was peanuts compared to my dental cost, and that besides the fact that I still have most of my natural teeth, compared to many other people who spend tens of thousand on their teeth.

And then, just this year, I racked up big healthcare costs to make up for all those years. And I am grateful that the service was so prompt and good. Could the cost be lower? Sure, and that needs to be worked on. It requires drilling down to the specifics, not simply that we spend more, which everybody already knows.

If a population overall is sicker than his neighbors, then that population overall would have to pay more for healthcare, or if it wants expensive treatments that may still be experimental. Can it be any different?

 

[samclem]

Well, if you want to use one article written by one person on a Fox News web site instead reports from WHO, OECD and the Common Wealth Fund -

(U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives - The Commonwealth Fund

and this metrics based chart from Bloomberg.com

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there isn't much else for me to add.

Whatever. You are not processing what I'm writing. These studies are not responsive to the points I raised.

 

[donheff]

I don't find the results of this survey all that surprising. A very large majority here favor some form of universal access to insurance (we had a poll a couple of years ago where 75% felt we should leave the ACA in effect and work to improve it). This poll simply shows that many people here would prefer an even more progressive system. I agree with the posters who said (in effect) "the ACA is law so lets get on with it." If we and our reps would work toward implementing the darn thing we could eventually get on with improving it.

 

[Alan]

I don't find the results of this survey all that surprising. A very large majority here favor some form of universal access to insurance (we had a poll a couple of years ago where 75% felt we should leave the ACA in effect and work to improve it). This poll simply shows that many people here would prefer an even more progressive system. I agree with the posters who said (in effect) "the ACA is law so lets get on with it." If we and our reps would work toward implementing the darn thing we could eventually get on with improving it.

+1

 

[NW-Bound]

This poll simply shows that many people here would prefer an even more progressive system...

I agree with the posters who said (in effect) "the ACA is law so lets get on with it."...

Some people may be disappointed that ACA (Affordable Care Act) still costs them some money, because their definition might be "affordable = free".

Of course we all know that in reality "free = prepaid with taxes", or "free = OPM". And as ERs no longer work, they pay less income tax than workers, so they like what works for them. Progressive is good, if one can take advantage of it.

As an ER myself, I would be able to arrange my finances to have a low income, despite having good assets, which is just above average according to a poll here, but outrageous to the public at large.

I can see the headline now: "Rich early retiree got healthcare subsidy, used it to feed gas-guzzling motorhome". Oh boy! How long do we have until they do asset testing on ACA subsidy?

Remember that the government already has knowledge of, or can demand access to your 401k, bank and brokerage accounts, a rough estimate of your real estate, etc...

Enjoy the subsidy while it lasts, but I'd rather see the true cost of hospitalization gets driven down, such that heavy subsidies are not needed.

 

[meierlde]

On the whole wealth tax issue, to see what forms might look like look at form 706 the estate tax form, and imagine filling that out every year. (it is on the IRS web site). Now I will admit with software it would be easier.

 

[NW-Bound]

On the whole wealth tax issue, to see what forms might look like look at form 706 the estate tax form, and imagine filling that out every year. (it is on the IRS web site). Now I will admit with software it would be easier.

NWB: "Can I not fill out the form, if I am not trying to get any subsidy?"

IRS: "What subsidy? We want to know so that we can levy the new Medicare tax on your assets. Actually, we already know, but want to catch you lying."

A fantasy? I dunno. As I said, I'd rather see the hospitalization cost gets lowered than get excited about "free money".

 

[Fermion]

What if your assets are physical in nature? Do you think there will be a house to house search for hidden stash of gold, silver, artwork, etc.?

Nobody has offered a good explanation of how you do means testing on someone with a paid off $600,000 house and low or no income vs someone with $600,000 invested in stocks who rents.

I predict although there will be small pockets of protest over early retirees who manage their income getting subsidies, the end result will be the subsidies stay income based. Anything else just adds cost and complexity.

 

[modhatter]

There are so many things that can be done, no matter which other country's system we may wind up with.

But the biggest elephant in the room is the Cost of Healthcare. The ACA improves the access to healthcare, and to some small degree may help in the long term to cut some costs, if we are successful in making everyone purchase insurance.

First and paramount in delivering and maintaining quality health care is taking the profit out of health care. When I first envisioned this my immediate reaction was:
"yeh, I can just see closing down all those insurance companies out there"
But then I realized. No that's not the way it's done. Insurance companies don't deliver health care (though they may deny it) They are just the middle man who collects the money, creates a lot of paperwork that's expensive for everyone involved, then lops off about 20% of it to spend on huge salaries, very big advertising budgets, etc., and shareholder profits. I wasn't considering that insurance companies could still operate, only not in the same manner. You just take out the "for profit" part of health care.

For Profit doesn't benefit the consumer at all, as it puts profits and large overhead in between the doctor and the patient. Pitting patients needs against shareholder needs and executive compensations tied to stock share prices, is a losing game for the patient.

This is still not the most cost effective method, but a major improvement over what we have. Medicare is much more cost effective, in that due to large size it has much better cost controls by it's sheer size and number. With cost containment paramount in the imploding US health care market, having one big player doing the bargaining, will by itself reduce costs.

Medicare actually could have much greater cost savings, but Congress has pretty much cut off the legs of every cost savings measure that has been introduced, as they will not risk hurting the money flow from the health care industry, who has continued to lobby very aggressively forever to prevent these cost saving measures. I'll include a link to this below

We have lots of issues to correct as well, as to how to increase the number of physicians in the US. I can see lots of solutions there.

Then when it's all done, we tackle Tort Reform

Video on over inflated health care costs in US

Charlie Rose 1 of 2 w/ Stephen Brill Interview Time Magazine - YouTube

http://youtu.be/fdO8reLFk5A

 

[NW-Bound]

What if your assets are physical in nature? Do you think there will be a house to house search for hidden stash of gold, silver, artwork, etc.?

Wealth tax would be indeed difficult to levy and to enforce except for the top 0.01%. They've got so much money it's difficult for them to hide in their backyard. Heck, Forbes publishes a frequently updated list. I do not want to sock them however.

However, impractical laws have been passed in the past in order to appease the public. And these ER's with fat 401k and Fidelity, Schwab, Scottrade, and Vanguard accounts and I bonds, how are they going to hide?

Perhaps you can hide gold in your backyard, but you would then need to run FIRECalc with 100% gold portfolio. And then when you are selling an ounce here and there to get cash for food, I am going to catch you, dig up your yard and confiscate it all.

Nobody has offered a good explanation of how you do means testing on someone with a paid off $600,000 house and low or no income vs someone with $600,000 invested in stocks who rents.

The local RE taxes levied by the state, county, or city are already value-based. We can just use that valuation. It's not perfect, but if things were perfect, we would not have all kinds of "cliffs" in ACA subsidy calculations.

Yeah, $600K is $600K, whether in your house or at your broker. Tax them just the same.

 

[haha]

I predict although there will be small pockets of protest over early retirees who manage their income getting subsidies, the end result will be the subsidies stay income based. Anything else just adds cost and complexity.

early retirement is a passing fad for other than truly rich people, most of whom would never wish to live as we do here.

There will be a nice crash, that does not respond well to being doused with Bernanke fluid, and early retirement will once again be the exclusive domain of government pensioners, most of whom have income that cannot be disguised well. And don't forget the VAT. Those mobile home owners will pay handsomely to keep these things rolling along.

Ha

 

[modhatter]

No, although I am sure those blogs are there. Or perhaps the poor people may not even have the means or the time to make a blog.

But the above was not the point.

I think a system that allows people to buy additional insurance so that they get a better treatment than a 2-hr wait for blood draw would be good. Some people want to pay more for cars, or houses than their neighbors, even if they have the same income. Some narcissistic people want to pamper themselves with more expensive care than my frugal self would. Why do I deny them their choice? It appears the 4 nations that I listed allow that.

PS. Umm, in case one says that the big-and-fancy car and McMansion lovers are also narcissistic and should be reined in, I will come to their defense (I am not one of them), and say that they may simply have better taste than this cheap guy. They also stimulate the economy like crazy! And I love that it would boost the stock price of my companies. I am not just frugal, but also selfish and want to see my portfolio going up and up.

There are lots of countries that do this. You can buy a supplemental policy that gives you all kinds of perks if you can afford it and chose to have it, while still providing basic necessary care for all. Evan the NHS has private doctors and hospitals that you can go to if you chose not to use the NHS, but I understand that still 95% of the people chose the NHS>

Also, my experience at MD Anderson. I had the fancy menu with the choices of an actual restaurant. In fact I could pick up the phone at any time and call down for a milk shake, a cup or coffee or anything I wanted at any time. But something else that I did notice, especially since they kept me there 30 days and really didn't administer any real treatment except some minimal physical therapy at the gym for a couple of hours over a ten day period, and a shot in my belly twice a day (that I gave myself) But I had LOTS of doctors dropping in my room to say Hi, How are you doing, at a charge of god knows what per doctor, (I must have had at least six drop in a day, and had no clue who they were or what they were there for) and the nurses coming in every couple of hours to try and push pain pills (which I did not want or need) or anything else they could push on me to take (that I did not need) Even so, that 4 week hiatus came to $129,000, and this is not including any cancer treatment or radiation, which I got out patient back home. I am not casting any aspersions on MD Anderson. I think it is a fine hospital. I am just saying, I think that things are pushed in the hospital to rack up the big bills. I did not have to be there for 30 days, I could have easily been out of there in two weeks.

I'm one of the nut jobs who cares about what Medicare is being charged. I can remember going to a Neurologist sometime after my treatment, and him suggesting to me I take an expensive test. When I asked him, what good would taking the test be? Would it improve my condition at all? He answered no, it wouldn't. So I said, then why take the test? His answer to me, and this is 100% true. "What do you care, your not paying the cost, Medicare is." It's stuff like that, that is costing us dearly.

 

[NW-Bound]

Oh Ha, I do not like it when someone talks like the economist Dr. Doom (but I do have a motorhome, which I can camp out in New Mexico with a state camping license for less than $300/year if it comes to that).

I try to restrict my imagination to something less severe, for example the 2 following polls.

I would ask in this forum:

"Do you think healthcare subsidy should be based on income or assets? A - income, B - asset".​

Wait a minute. Why should I bother, if I already know the answer from forum members?

Here's a 2nd poll a news media can ask the public at large:

"Given the recent headline that rich early retirees with $500K in assets, and even in the millions in many cases, are getting ACA subsidy, do you think that these should be disallowed any subsidy and instead should contribute more to the national health care? A - Yes, B - No".​

Knowing that the median networth of persons in the age bracket 55-64 is only $142K, I fear to see the poll result.

 

[ERhoosier]

New Health Rankings: Of 17 Nations, U.S. Is Dead Last - Grace Rubenstein - The Atlantic


This article is focused on public health issues rather than the health insurance system per se. It is no secret that Americans tend to engage in more self-destructive behaviors than most of the developed world (inc non-compliance with recommend medical therapies whether funded or not).
Is a single payer system really going to solve the higher US mortality from traffic accidents, homicide, drug abuse, obesity, etc.? The article provides a big argument that it may not since better access to care (the main touted advantage of single-payer) was NOT related to better health in US:

"The authors took pains to counteract the possible assumption that U.S. numbers must be negatively skewed by poor and underserved populations. In fact, the report cites data suggesting that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere. "

The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.

 

[NW-Bound]

Modhatter, the general hospital with the nice meals (that I did not get to sample due to being kicked out just as my surgeon upgraded me to full normal diet) was not Anderson, but now I know that the fancy meal deal is getting more popular.

My surgeon in fact showed signs that he had some pressures from my insurer about me getting well enough to leave. Just kidding about the steak that I missed. I was in no condition to enjoy a steak, even though I was allowed to have it, and a home meal would be a lot better for me (my wife would bring one in). I was indeed well enough to leave, and I wanted to leave.

About the patients not caring about costs because Medicare pays everything, I have seen that with my elderly relatives. A lot of time, they did not query about the tests, because they thought that if it did not help, it would not hurt (but it could hurt physically even if not financially). But if they had a copay, the patients would pay more attention.

OK, if there's no copay, then someone else will have to oversee the process, not too differently than my insurance company that keeps tabs on things. I should add here that I have not had any tests or procedures denied by my insurance, and I tried to learn about all these tests and surgeries for my own good. Everything was explained to me, and how the test results would affect the treatment, based on what they found. No bogus tests, because they knew that I knew the costs.

In all, I had no complaints, and indeed even feel sorry for my insurer who paid so much for hospital costs. I was very happy with my surgeon, and indeed told everybody that the guy was working so hard for his pay, and knowing only what he made in my treatment, thought that I would not want his job. It's certainly more than what I used to make, a high level few engineers got up to, but I am too lazy for his kind of work (assuming that I had the ability to learn medicine, which I knew I did not even care to), and he spent more time for his training.

Now, back on this hospital charge...


PS. I chose all my doctors and specialists. My choice was based on somewhat flimsy info, but they knew that I was the customer, and I liked to understand what was being done to me. No bogus visits in the hospital from doctors I did not know. The doctors that were assigned by the hospital were anesthesiologists. I did not think of these, and do not know if I could even choose my own (based on what?).

 

[samclem]

The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.

Better funding to buy what? Is there anybody that doesn't know already that smoking is bad, being fat is bad, exercising is good, etc. The ACA already mandates provision of many preventative care services/screenings. I'm not sure more public service announcements will work. And more coercive methods, at the hands of our servants in the US government, probably won't sit well.
And yet . . . publicly-funded insurance (subsidies, Medicare, Medicaid, etc) gives every taxpayer a vested interest in the efficient provision of health care to the public in general. If a person won't exercise, watch what they eat, or take their medications, how much resultant expensive medical treatment is he/she owed by other Americans?

 

[pb4uski]

...The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.

WADR funding is not the problem - we spend more than most nations on health care so the problem is not how much we spend but the efficiency and effectiveness of what we spend.

 

[daylatedollarshort]

New Health Rankings: Of 17 Nations, U.S. Is Dead Last - Grace Rubenstein - The Atlantic


This article is focused on public health issues rather than the health insurance system per se. It is no secret that Americans tend to engage in more self-destructive behaviors than most of the developed world (inc non-compliance with recommend medical therapies whether funded or not).
Is a single payer system really going to solve the higher US mortality from traffic accidents, homicide, drug abuse, obesity, etc.? The article provides a big argument that it may not since better access to care (the main touted advantage of single-payer) was NOT related to better health in US:

"The authors took pains to counteract the possible assumption that U.S. numbers must be negatively skewed by poor and underserved populations. In fact, the report cites data suggesting that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere. "

The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.

I don't disagree with health being above and beyond the medical system, but the first recommendation from the article was affordable health insurance for everyone.

Upfront the authors stated that, "More than other countries, our health care system is fragmented, unaffordable for many people, and short on primary care."

And later on in the article, "Senator Tom Harkin, chairman of the Committee on Health, Education, Labor, and Pensions, said via a spokesperson that the existing Affordable Care Act "addresses many of these primary causes" of our health gap. New support for primary care, free cancer screenings, improved women's care, and other features of the law "will all help address these disadvantages," he said."

 

[F4mandolin]

Ah....the Romney answer...."we have health care for those people.....they can go to the emergency room". Yep....works if you are having a heart attack. What if you just want the skin cancer cut off you body like I did today. The people without health care can't do this......it needs to be deadly before anything would be done. I'm planning on moving back to the UK....and likely dropping my private insurance......the US way needs help. The attitude from some people that the socialist medicine is crap....is only sorta true.

 

[explanade]

I'm not so sure that Americans lead less healthy lifestyles than people in other developed nations.

For one thing, I think Americans smoke a lot less. Not sure about alcohol, one war or another.

Processed foods may be worse though, because the agricultural subsidies encourage unhealthy ingredients like fructose corn syrup and more processed foods, though I think in general, poorer people everywhere are more susceptible to bad diets.