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Old 04-07-2012, 10:17 AM   #61
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I'd be curios as to your vision of "basic level of care" is and I'm not being snarky, just cannot imagine a healthcare structure that could provide universal cradle to grave healthcare for 300,000,000 Americans.
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Old 04-07-2012, 10:26 AM   #62
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I'd be curios as to your vision of "basic level of care" is and I'm not being snarky, just cannot imagine a healthcare structure that could provide universal cradle to grave healthcare for 300,000,000 Americans.
Instead of trying to define basic level of care, I'd start with what the 30+ developed countries with universal care provide. If they can provide more access and (more) effective basic care (including catastrophic) than the US at on average half what we spend per capita, it would seem we could learn a lot. I don't think anyone seriously considering universal health care in the US expects everyone should have Cadillac health care, I certainly don't. Again, those who can afford more or better care than the universal standard, are entitled to whatever care they choose...
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Old 04-07-2012, 10:28 AM   #63
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I've said this many times here, and I'll say it again, a single payer system does not have to exclude private insurance, through employement or otherwise.

... snip...

I don't think a single payer system will be accepted in the USA because of the great distrust Americans have of their government. (Note that in the UK the recent documentary on CNN stated that overhead costs of the NHS Trusts running the healthcare is 5%). However, the argument that single payer excludes private insurers is a scare tactic that works very well to ensure it won't happen. (except when you get to Medicare age).
Oh, I only said I want to keep mine as is, I didn't say the government was trying to take it away. My point was having exactly the option you mentioned in your surgery, i.e., avoiding waiting lists. And I'm very skeptical that I would be able to find surgery as quickly if/when a single payer system comes into existence.

For instance, your example of foot surgery. Currently let's say foot surgeons in the US do 20 per month and on 01 May 2012 the single payer system is implemented. I cannot imagine that would not impact my waiting time.
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Old 04-07-2012, 10:40 AM   #64
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Instead of trying to define basic level of care, I'd start with what the 30+ developed countries with universal care provide. If they can provide (more) effective basic care (including catastrophic) than the US at on average half what we spend per capita, it would seem we could learn a lot. I don't think anyone seriously considering universal health care in the US expects everyone should have Cadillac health care, I certainly don't. Again, those who can afford more or better care than the universal standard, are entitled to whatever care they choose...
The concept is fine, the details of implementing it are many and I don't see anyone with a plan. Just lots of folks jostling to keep their piece of the pie.
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Old 04-07-2012, 10:40 AM   #65
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Oh, I only said I want to keep mine as is, I didn't say the government was trying to take it away. My point was having exactly the option you mentioned in your surgery, i.e., avoiding waiting lists. And I'm very skeptical that I would be able to find surgery as quickly if/when a single payer system comes into existence.

For instance, your example of foot surgery. Currently let's say foot surgeons in the US do 20 per month and on 01 May 2012 the single payer system is implemented. I cannot imagine that would not impact my waiting time.
I think you make my point quite nicely. Americans don't trust their government to do big programs like this well. (I'm not saying that you are wrong or right in this belief).
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Old 04-07-2012, 11:01 AM   #66
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I think you make my point quite nicely. Americans don't trust their government to do big programs like this well. (I'm not saying that you are wrong or right in this belief).
Oh gosh yeah, you are absolutely correct, it's not a "belief", it's a "knowledge". We know for a fact they could not do it. Every congress person would want some benefit for his state.

In a perfect world, they should negotiate with someone in the private sector, give them the Medicare funds and say, "here, run it as a service to the government". Then tax current workers, retirees, and corporations to pay for the service. Make Medicare totally funded by taxes and no cost to users.
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Old 04-07-2012, 11:31 AM   #67
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The concept is fine, the details of implementing it are many and I don't see anyone with a plan. Just lots of folks jostling to keep their piece of the pie.
You may see this as heavy handed (or out of date), but there was a time when 'folks jostled to keep their piece of the pie' regarding slavery, women's rights, etc. Hope springs eternal.

Again, I am convinced until there's a mainstream demand for better access to affordable, quality health care - special interests are very well equippped to maintain the status quo. Politicians can't fight special interests (and can't really be blamed) without a serious groundswell behind them.
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Old 04-07-2012, 11:32 AM   #68
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Make Medicare totally funded by taxes and no cost to users.
I'm assuming Medicare is similar to regular HI in that every visit is followed by multiple, confusing, EOB's and bills. Like you I think that for older folks, free at point of service would be a great blessing.

First week in March DW and I had a physical (hers included mammogram, pap smear and bone density scan). We are leaving on a 3 month vacation in 2 weeks and still haven't had the billing for all the procedures arrive in the mail. Fortunately we'll have our son checking on our mail to alert us to these paper invoices that will still be coming through.
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Old 04-07-2012, 11:41 AM   #69
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In a perfect world, they should negotiate with someone in the private sector, give them the Medicare funds and say, "here, run it as a service to the government". Then tax current workers, retirees, and corporations to pay for the service. Make Medicare totally funded by taxes and no cost to users.
The private sector without real competition has brought us the very high health care prices we have now. While free markets work well for most goods & services that face competition and elastic demand, they haven't worked for health care with controlled competition (or worse) and patients who have little to no (short term) control over demand. But there are countries that have managed to provide cost effective universal care with government intervention (Switzerland comes to mind first), and many have combinations of public and private.
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Old 04-07-2012, 12:14 PM   #70
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The unfettered private sector has brought us the very high prices we have now. ...
While we agree there are problems, and changes are needed, I hardly think we can call our present system 'unfettered'. Govt has done things like meddled with the pricing of insurance (by giving it tax breaks for employers), which has also led to the crazy tie of employment to HI, and not allowed comp across state lines, etc. That has had a lot to do with the high prices we have now.


OT: just had to laugh that hardly anyone uses the term 'fettered'. "Unfettered' seems much more common. Odd.

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Old 04-07-2012, 01:04 PM   #71
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Healthcare in the US is all over the board and IMHO will not change until a significant portion of the employer sponsored health insurance group has no coverage.

When I worked, my employer sponsored insurance was generous and I could pick my doctor. After ER, I lived in Thailand for niine years and I could choose my doctor there as well- as long as I paid cash

Since September 2011 I've been back in the US and now I'm using the VA, $15 co-pays for the GP and $50 for a specialist. But choice is pretty much eliminated and they see you when they see you. Over all I'd rate the VA (Veterans Administration) as "Satisfactory" and I'm just happy to have access to medical services. But its no where near the level of service that comes with generous employer sponsored health care benefits.

I just don't see a comprehensive single payer plan evolving as long as a significant number of employers subsidize health care...
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Old 04-07-2012, 01:06 PM   #72
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While we agree there are problems, and changes are needed, I hardly think we can call our present system 'unfettered'. Govt has done things like meddled with the pricing of insurance (by giving it tax breaks for employers), which has also led to the crazy tie of employment to HI, and not allowed comp across state lines, etc. That has had a lot to do with the high prices we have now.

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... plus the exemption HI companies enjoy from the Anti-Trust regulations which fetter the rest of the business world.
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Old 04-07-2012, 01:13 PM   #73
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While we agree there are problems, and changes are needed, I hardly think we can call our present system 'unfettered'. Govt has done things like meddled with the pricing of insurance (by giving it tax breaks for employers), which has also led to the crazy tie of employment to HI, and not allowed comp across state lines, etc. That has had a lot to do with the high prices we have now.
Agreed. An "unfettered" private health care market would have some pretty predictable problems. High prices wouldn't generally be one of them . . . although it would be interesting to see what a heart transplant would go for on the open market (edit to add: I'm not trying to assign that free-market position to you or anyone else, just making an observation).
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Old 04-07-2012, 01:29 PM   #74
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Alan, I posed a solution using private, in-place, healthcare to run any single payer system and in part because you doubted that Americans would trust the government. Then Midpack comes back saying it's the private sector that are the crooks.

So question is: Do you think the US could operate an NHS type organization at 5%?
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Old 04-07-2012, 01:58 PM   #75
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You may see this as heavy handed (or out of date), but there was a time when 'folks jostled to keep their piece of the pie' regarding slavery, women's rights, etc. Hope springs eternal.
...
I think the difference is that so many in the general public are isolated from the problem. Either their private employer 'pays for it', or their govt employer 'pays for it', or the Govt 'pays for it'. Many people just don't see the real cost.
Some real transparency would get a lot more people a lot more excited I think.


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... plus the exemption HI companies enjoy from the Anti-Trust regulations which fetter the rest of the business world.
That's the other issue I was thinking of, plus extra points for using 'fetter' in a sentence

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Old 04-07-2012, 02:12 PM   #76
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You may see this as heavy handed (or out of date), but there was a time when 'folks jostled to keep their piece of the pie' regarding slavery, women's rights, etc. Hope springs eternal.

Again, I am convinced until there's a mainstream demand for better access to affordable, quality health care - special interests are very well equippped to maintain the status quo. Politicians can't fight special interests (and can't really be blamed) without a serious groundswell behind them.
I did not make clear but I when I was talking about "jostling for their piece of the pie", I meant HI, pharma, etc.

I agree, no groundswell is imminent. I support much of the content of the current healthcare bill but it is still total fail, went for a homer and ended up a bunt rolling slowly along first base line. May go foul.
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Old 04-07-2012, 02:14 PM   #77
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Alan, I posed a solution using private, in-place, healthcare to run any single payer system and in part because you doubted that Americans would trust the government. Then Midpack comes back saying it's the private sector that are the crooks.

So question is: Do you think the US could operate an NHS type organization at 5%?
In countries that have universal health care based entirely on privately held companies then the HI companies are not allowed to be non-profit so they compete for business on quality of service. The more efficient they are, the better placed they are to offer better service and attract more customers.

In the UK the NHS has been around for over 60 years so has had plenty of opportunity to improve efficiency, with many governments, present and past, pledged to lower costs and improve service. It has a national database so that you can go and see any doctor anywhere in the country and they will bring up your complete medical history on their desktop PC. (I don't know if all PCP's have PC's on their desks, but it was certainly the case in 2010 at FIL's Doctors' offices).

The average admin costs for countries with single payer systems was 12% IIRC from that CNN documentary, and that compares with over 20% admin costs for US private HI companies. Could the US government beat the performance of US private companies is a more relevant question, I think.
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Old 04-07-2012, 02:22 PM   #78
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That's the other issue I was thinking of, plus extra points for using 'fetter' in a sentence

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Old 04-07-2012, 02:43 PM   #79
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...

In the UK the NHS has been around for over 60 years so has had plenty of opportunity to improve efficiency, ......

The average admin costs for countries with single payer systems was 12% IIRC from that CNN documentary, and that compares with over 20% admin costs for US private HI companies. Could the US government beat the performance of US private companies is a more relevant question, I think.
Bet most US'ers would answer, "No".
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Old 04-07-2012, 02:53 PM   #80
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In countries that have universal health care based entirely on privately held companies then the HI companies are not allowed to be non-profit so they compete for business on quality of service. The more efficient they are, the better placed they are to offer better service and attract more customers.

In the UK the NHS has been around for over 60 years so has had plenty of opportunity to improve efficiency, with many governments, present and past, pledged to lower costs and improve service. It has a national database so that you can go and see any doctor anywhere in the country and they will bring up your complete medical history on their desktop PC. (I don't know if all PCP's have PC's on their desks, but it was certainly the case in 2010 at FIL's Doctors' offices).

The average admin costs for countries with single payer systems was 12% IIRC from that CNN documentary, and that compares with over 20% admin costs for US private HI companies. Could the US government beat the performance of US private companies is a more relevant question, I think.
Does the 12% represent only the cost of admin for Single Payer system or are the private insurers numbers included also in those also? Just making sure it's apples to apples.
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