Universal Health Care - what are we waiting for?

[Zero]

From the pie chart it appears more than 60% of "uninsureds" are doing so by choice or are illegally in the country. Am I reading that correctly?

 

[Midpack]

From the pie chart it appears more than 60% of "uninsureds" are doing so by choice or are illegally in the country. Am I reading that correctly?

According to the Senator who provided the info...

 

[MichaelB]

Here is Kaiser Foundation data on the uninsured in the US The Uninsured: A Primer - Kaiser Family Foundation, with lots of data for those interested. While this data has been used extensively, much of it has been interpreted and framed in many different and creative ways.

 

[Gone4Good]

I see your logic. The differences between list and negotiated price are so great I can't imagine getting a better deal with cash. The fact that cash upfront is such a better deal for the provider yet they can't even make that deal just shows how dysfunctional this whole thing is.

True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."

 

[MichaelB]

True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."

If you read Kenneth Arrow's paper (not an easy chore) he points out that price discrimination is a key impediment to free market functionality.

 

[Midpack]

Here is Kaiser Foundation data on the uninsured in the US The Uninsured: A Primer - Kaiser Family Foundation, with lots of data for those interested. While this data has been used extensively, much of it has been interpreted and framed in many different and creative ways.

Good read. It doesn't appear one could compare the Kaiser data to the Senators chart directly, which speaks to your "creative ways" point. Bias is always a challenge...

 

[ERD50]

True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."

Good point, and subtle enough that it is hard to tell how big an effect it has. I could see how it could be a big deal for many.

An interesting side-note to this - I've seen some stories about the kinds of procedures generally not covered by insurance: lasik, cosmetic surgery, etc. In these cases, prices are totally transparent, they can't get business if people don't know what it is going to cost them, and the customers can comparison shop. It's a shame that low deductible insurance most have has warped this whole process.

I think if our system had been centered around high-deductible policies, things would be very different.

-ERD50

 

[Zero]

Our convoluted health care system goes back to the wage and price controls initiated during WWII. The single payer system used by most of Western Europe and Canada goes back to the end of WWII and was made possible to a large extent by the Marshall Plan. Both approaches effectively ration care. The US does it by employment status and income. The single payer systems have prioritization policies. Of course, the rich from these countries have ways around the rationing aspect.

I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.

I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.

 

[Midpack]

I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.

I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.

US health care is already rationed/prioritized. You can't have any and all procedures done, nor can you be charged an unlimited amount for the services provided.

And if wealthy folks can buy better care for themselves, that's as it should be. Wealthy folks in developed countries with universal care already do that, and they're entitled to. Universal care should provide some basic level of care IMO, not the best medicine available. YMMV

Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organizations (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.

Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare and Medicaid programs, arguing that a proper rationing mechanism is more equitable and cost-effective. The Congressional Budget Office (CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.

 

[Alan]

Our convoluted health care system goes back to the wage and price controls initiated during WWII. The single payer system used by most of Western Europe and Canada goes back to the end of WWII and was made possible to a large extent by the Marshall Plan. Both approaches effectively ration care. The US does it by employment status and income. The single payer systems have prioritization policies. Of course, the rich from these countries have ways around the rationing aspect.

I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.

I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.

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.

When I lived and worked in the UK I was never rich, just an average income from normal jobs. However, the last 8 years I worked there ('79 - '87) the 2 companies I worked for provided HI as an employee benefit. The first company had it as an option you could pay for, the second had it as part of the benefits package. It was primarily used for elective surgery to avoid waiting lists - I had foot surgery when I was age 29 and used the HI to have it done at a time of my choosing to fit into work projects.

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).

 

[Zero]

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.

 

[Midpack]

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...

 

[Zero]

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.

 

[Zero]

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.

 

[Alan]

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).

 

[Zero]

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.

 

[Midpack]

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.

 

[Alan]

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.

 

[Midpack]

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.

 

[ERD50]

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.

-ERD50

 

[Lancelot]

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...

 

[Alan]

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.

-ERD50

... plus the exemption HI companies enjoy from the Anti-Trust regulations which fetter the rest of the business world.

 

[Gone4Good]

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).

 

[Zero]

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%?

 

[ERD50]

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.

... 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

-ERD50