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Universal Healthcare?
Old 09-10-2014, 09:47 PM   #1
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Universal Healthcare?

This is asked as a hypothetical question, fully realizing that it will not happen in our lifetime, but:

Do you think you would approve of a Universal Health Program similar to the ones currently in effect in:

The Soviet Union, New Zealand, United Kingdom, Sweden, Iceland, Norway, Denmark, Finland, Japan, Canada, Australia, Italy, Portugal, Greece, Spain, South Korea, Taiwan, Israel Austria, Belgium, France, Germany, Luxembourg The Netherlands and Switzerland.

Plusses? Minuses? Good or Bad?

If this is seen as a political question, ok to delete, but there is a lot of experience here in ER with some of the different programs, and the good and bad.

For instance, I hear a lot about Canada and a long waiting list to see a doctor, but I have relatives there, who find the wait times for procedures, the same as, or even shorter than those in the US. My BIL is quite satisfied with what we might call "triage'... as procedures are scheduled. YMMV. Would like to hear about specific situations.

Also, it would be interesting to hear about situations where Americans visiting foreign countries are treated in the Universal Health Care systems.

Funding sources vary in the different countries.

Thoughts on physician and hospital charges, and accordingly the incomes of same.

Our system isn't going to change in the near future, but the difference between healthcare costs in the US will eventually be compared to those in the above listed countries.

If not a subject for discussion, certainly something to watch in the coming years.
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Old 09-10-2014, 09:56 PM   #2
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No.

Americans want 'choice' and for their employers to pay the premiums

Universal Health Care will be accepted in the US only when the over whelming majority of the population is uninsured, IMHO.

Until then, any one who mentions Universal Care will be slapped down with "So you are OK with the government mandating that grandma must be placed on a waiting list for her hip replacement?!?"

Americans scream bloody murder about the cost control measures employers implement. How would they react to Universal Coverage?

Not very well opines Lance

PS- I use the VA for my health care in the US, so, I'm a Universal Health Care guy in a way. I personally wouldn't have a problem with UC, as you pointed out it is successful in other countries. I feel that health care in the US is excellent. The problem is that as a society we just can't agree on who will pay for it
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Old 09-11-2014, 12:16 AM   #3
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Originally Posted by imoldernu View Post
Do you think you would approve of a Universal Health Program similar to the ones currently in effect in:

The Soviet Union, New Zealand, United Kingdom, Sweden, Iceland, Norway, Denmark, Finland, Japan, Canada, Australia, Italy, Portugal, Greece, Spain, South Korea, Taiwan, Israel Austria, Belgium, France, Germany, Luxembourg The Netherlands and Switzerland.
Heh, heh. I see what you did there.

I like the Swiss system. Simpler copay/deductible rules than we have, and fewer in-plan/out-of-plan shennanigans. Harsher penalties for not being insured, too. (The canton signs you up with whichever insurer they please if you are found not to have coverage, and you get billed. Backdated.)

The US model for individuals not insured through employment is the Swiss model, with extra complexity to please assorted parties.
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Old 09-11-2014, 06:51 AM   #4
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There are no programs currently in effect in the Soviet Union.

In addition to the Swiss system, I think the German model could eventually become somewhat palatable, especially if more and more people lose employer coverage or can no longer afford it. But what do I know?

That all said I think a new US model would need to have many of its own ideas, just to overcome the opposition from people not wanting to become more "like Europe". We're 'Murkins, dang it, and we do things OUR way!
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Old 09-11-2014, 07:16 AM   #5
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Universal healthcare is inevitable. As people see it as a 'free' system, they will gravitate to it. Most people are healthy, by the time they see the disadvantages of a 'free' system, it is too late.

Like any government system, if you have no money, you get the most benefit without any consequences. If you have no money, you do not have to pay for anything.
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Old 09-11-2014, 07:16 AM   #6
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I like the Medicare system. So do most others, it is by far the most popular and widely admired of all healthcare access systems in the US and pretty close to "universal".

Every one gets the same basic coverage, there is just one price, the provider service network includes >95% of all providers, who must completely opt in or out. Additional coverage is available through private policies that are standardized.
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Old 09-11-2014, 07:17 AM   #7
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Yes, I would prefer any of several universal health schemes. I suspect we will slowly drift and jerk toward a somewhat Swiss like model. The most difficult (possibly impossible) hurdle will be getting away from an employer based approach. We may blunder through with our messed up mismatch for decades.
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Old 09-11-2014, 07:19 AM   #8
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It won't happen soon or easily, but some version of universal health care is inevitable IMO. Health care in the US already costs twice as much on average as ALL other developed countries YET we have poorer outcomes. I'd love to elaborate, but I've done so at length several times before - there are lengthy threads on this topic here already.

The chart that shows not just how, but why other countries spend less on health care than we do - The Washington Post

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Old 09-11-2014, 07:20 AM   #9
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The ACA in its own deranged way mandates a sort of universal coverage. For the states that accepted it, their Medicaid rolls have swelled with only the impact on their spending to be determined once the federal coverage ends. Anyone not on medicaid is required to have another form of coverage. The VA and Medicare take care of some of us but the great unwashed masses depend on their employer or a private plan. Those with a low enough income can get the premiums and copays subsidized.

Case closed. We have universal health care. Right?

Wait a minute. People are still going to emergency rooms without insurance. Articles are regularly in the press about how even if people have subsidized insurance they can't afford the copays.

Every country, in one form or another, rations health care. That's the question to answer. How do we want to ration health care? Income? Employment? Ability to pay? "Social worth?" Do we need to nationalize all health care facilities to control costs?
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Old 09-11-2014, 07:24 AM   #10
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Every country, in one form or another, rations health care. That's the question to answer. How do we want to ration health care? Income? Employment? Ability to pay? "Social worth?" Do we need to nationalize all health care facilities to control costs?
The German system manages to do a pretty good job of avoiding "rationed care". But it, like anything, requires tradeoffs. Basically ALL systems come down to the following choice, to one degree or another:

Affordable, available, high-quality. Pick any two.

To expect a high quality, affordable system with no rationing or excessive "gatekeeping" toward getting care is to expect an exemption from the laws of economics, IMO. But removing adverse selection from the equation is an important part, as is (IMO) getting employers out of the game. The ACA takes baby steps toward these things in some ways (but strengthens the employer link in other ways), but they are only partial.
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Old 09-11-2014, 11:57 AM   #11
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The main difference between the Swiss model and the ACA is that the Swiss tightly regulate insurance companies which are maintained as non-profit entities while the ACA provide considerably looser regulation. Since the latest estimates are that overhead dedicated to insurance company interactions is about 25% of all health care spending or roughly 4 times what Canada spends, I think that there is some room for improvement.

Of course, in Canada there is a shortage of ophthalmologists which can result in a waiting time for cataract surgery of many months. In the US I had a patient who had a traumatic eye injury at the age of 8, but was uninsured until age 23 when he had his cataract removed. Glad he only had to wait 15 years instead of several months! Seriously, in the US we have been rationing care too, just in a very different manner
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Old 09-11-2014, 12:11 PM   #12
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Some day? Most likely, but, IMHO, you can not say 'Like _________' (choose a country)

The U.S. is not like any other country! Bigger than most, more diverse than most, 50 different state governments, and the list goes on. You have to get around not only the political parties, neither wants to give the other the 'We gave your universal healthcare you love'. You have to get around the corporations that have billions invested in healthcare.

Medicare is popular, yes, (we use it) however it is also broke or going there quickly and doctors in many areas are dropping or not accepting new clients.

It will truly be a daunting task, and I do not expect it in my lifetime i.e. 25 years if I am real lucky!
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Old 09-11-2014, 12:27 PM   #13
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The most difficult (possibly impossible) hurdle will be getting away from an employer based approach.
This may well be true. IMO, a big step in that direction would be to eliminate the tax-free (to the employee) status of the insurance.
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Old 09-11-2014, 12:41 PM   #14
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Do away with exclusions, include certain minimum standards of coverage, mandate coverage for all, subsidize coverage for the poor and working poor, otherwise leave things to the choice of the individual. This works well for things like auto safety, fire and safety codes, etc. And I think it would work for health insurance.

Of course, the devil is in the details.

But, I think we can and will do it. There will be winners and losers, but that's true of many things including zoning laws, building codes, and taxes.
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Old 09-11-2014, 01:12 PM   #15
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Every one gets the same basic coverage, there is just one price, the provider service network includes >95% of all providers, who must completely opt in or out. Additional coverage is available through private policies that are standardized.
There is more than one price; the price is progressive with respect to AGI. The premia paid for Part B and part D coverages goes up stepwise from the base rate to progressively higher rates which in the case of Part B irrc top out at about 4x the base rate.

I sold some stock and popped up 2 steps, which will increase my Medicare B and D fees a fair amount in the 2016 tax year. This has happened to me before also.

Ha
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Old 09-11-2014, 01:29 PM   #16
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Also, it would be interesting to hear about situations where Americans visiting foreign countries are treated in the Universal Health Care systems.
I can address this with two examples.

My SIL was in Paris as a tourist and got the most horrific headache she had ever had. Since she'd had brain surgery the year before for a very slow growing tumor, obviously she did not want to ignore it. She went in to the clinic suggested by her hotel. They did brain scans and concluded it was unrelated to her tumor/surgery. But, she was dehydrated and it was a migraine. After resting (and an injection of something "good") she was fine the next day. Never got a bill. That's a lot of treatment for a tourist... and no charge.

We had two instances in Sicily where we had to partake in local healthcare. I had scraped/rescraped/and took yet another layer off my knee... (I'm a klutz and fall a lot.) I was worried it would get seriously infected. We went to the pharmacy, the pharmacist looked at it and sold me a strong antibacterial cream. (I looked it up later - it would be prescription here in the U.S.) The cost was about 11Euro for the cream. Later in the trip we were staying in a cottage in the countryside near Marsala - there were no screens and no AC - and we were bitten horribly by mosquitos. My son woke up the first morning with his face badly swollen. (both eyes shut - lips swollen) We were pretty sure it was bug bites - but couldn't rule out an allergic reaction to something... We asked our landlord who sent us to a clinic in town. The doctor examined my son and sent us to the pharmacy for benedryl. The doctor did not charge us. We paid for the benedryl at the pharmacy.
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Old 09-11-2014, 01:35 PM   #17
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I would like to see health insurance divorced from employment - it was a bad idea to begin with (and was the unintended consequence of a different government intervention).

Many aspects of ACA are heading in the right direction in my opinion. I think everyone should be required to have health insurance so people can't freeload off the system. I think that health insurance should be subsidized if someone's income is low and it is unaffordable and ACA does that. I like mandating that a limited number of maintenance services are included in coverage "free" so people don't have an incentive to ignore health issues.

Where I would diverge with proponents of universal health care is that I think health insurance should remain in the private sector and not be subsumed by the government like in Canada and the UK.

The bottom line is that health insurance and health care is expensive and each person needs to be personally responsible for their healthcare which means that health care for people with health issues will end up paying more than those who rate healthy.
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Old 09-11-2014, 01:41 PM   #18
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My answer is NO based on the information and ideas that are usually presented with regard to universal health care. If I was forced to "vote" on the adoption of universal health care I would go with something like the Swiss system. However, even the Swiss approach leaves something to be desired in my mind.

I strongly believe ever-increasing health care costs are due in large part because many users have little (or no) "skin in the game." Until a system evolves that puts the user/patient in charge of spending the money it seems to me costs will continue to rise because we are spending other people's money. Spending OPM is much easier to do than spending your own money. When a person thinks a doctor visit is free or costs $5 or $20 it's the OPM mentality. Sure, I don't mind going to the doctor it only costs me $X.

So... if a universal system could evolve in which user/patients are allotted money and they spend it as they see fit for their situation then I think we'd be on to something. Yes, this would require additional controls and I'm not suggesting we simply leave people by the wayside if they've used all their money but there must be consequences to doctor visits, hospital stays, poor decisions, etc. when it comes to paying for healthcare. As users/patients we need to shop around when possible, understand who provides the best service for the least amount of money. Choose a doctor who provides realistic, practical treatment rather than a doctor who simply prescribes another pill or runs another test.
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Old 09-11-2014, 01:47 PM   #19
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.....I strongly believe ever-increasing health care costs are due in large part because many users have little (or no) "skin in the game." Until a system evolves that puts the user/patient in charge of spending the money it seems to me costs will continue to rise because we are spending other people's money. ....
+1 and high deductible health insurance plans are IMO a good first step in forcing consumers of health care services to have skin in the game, but... it is very hard today to "shop" for health care services so they can control costs when the rack rate of services are heavily discounted to negotiated rates.

IOW if I needed a specific service no matter where I chose to have it I'll pay the negotiated rate assuming my deductible isn't met so it is hard for consumers to influence costs.
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Old 09-11-2014, 02:28 PM   #20
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I strongly believe ever-increasing health care costs are due in large part because many users have little (or no) "skin in the game." Until a system evolves that puts the user/patient in charge of spending the money it seems to me costs will continue to rise because we are spending other people's money. Spending OPM is much easier to do than spending your own money. When a person thinks a doctor visit is free or costs $5 or $20 it's the OPM mentality. Sure, I don't mind going to the doctor it only costs me $X.
I don't disagree at all, but have you ever tried to get the cost of a significant medical procedure in advance? It's almost impossible...by design! Not only are costs not published, if you ask, most providers refuse to share prices in advance (what other industry gets away with that?). And the cost of the same procedure varies wildly (ie, In Maine, one insurer’s preferred-provider organization has paid between $559 and $4,526 for a colonoscopy in a given year, including the portion due from patients, according to data compiled by the state). Even people who try to be responsible with OPM can't! But that will change...eventually.
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