How Should Americans' Health Care be Paid For?

[ERD50]

Well the results of this poll sure are interesting...

I am totally flabbergasted that single-payer has nearly four times as many votes as the next choice. I had quite a different idea from reading the comments in the various health care related threads ...

I think you are putting far too much significance to a poll like this. Any self-selected poll is questionable at best. We have no idea if those who voted are representative of those who commented in those other threads. And different people interpret comments differently. We all have a tendency to focus and remember with a certain bias (it might be that we remember the ones that agree with our view, or the ones that disagree, depending on the subject and how we feel about it).

As one example, I chose not to vote here. I had trouble understanding just what those choices really meant (it is a complex subject after all), and there appeared to be gaps and overlaps (couldn't we have tort reform in the other options?). I could pick 'other' and then point back to that summary that samclem posted way back (I should have bookmarked it).

I voted other.

All the listed options seem to cost-shift rather than cost-control. They present options for who pays....but no discussion related to decreasing the actual cost of health care. And I believe that BOTH issues must be addressed. .

+1

-ERD50

 

[donheff]

I think you are putting far too much significance to a poll like this. Any self-selected poll is questionable at best.

As one example, I chose not to vote here. I had trouble understanding just what those choices really meant (it is a complex subject after all),).

-ERD50

Of course the poll is questionable. But it is still interesting and significant. The fact that you would like to add certain features not specified in the choices doesn't mean you don't lean one way or the other. We would all add our preferences here and there. Bottom line, a substantial majority is coalescing around a Government plan with or without supplementals. that doesn't conform at all with what we are constantly told the American people want.

 

[samclem]

I don't have very strong opinions on where the biggest cost savings are available. I have extremely strong opinions, though, about denying medical care to anyone, on the basis of expense.

If a person has the resources to pay for their own very expensive care, they should be able to buy it. If they used their resources to purchase insurance that pays for very expensive care, the insurer should pay off up to the level of the agreement. But if the patient is using resources taken from "the taxpayers", then we all get a vote on how much we are willing to spend. The pot is not unlimited, and every dollar spent on very expensive care for the last 3 months of life is not available for more efficient uses (well-baby care, immunizations, public health programs, etc). Anyone not comfortable with letting others decide this issue on their behalf should carefully consider which plans really meet their needs.

 

[huusom]

Of course the poll is questionable. But it is still interesting and significant. The fact that you would like to add certain features not specified in the choices doesn't mean you don't lean one way or the other. We would all add our preferences here and there. Bottom line, a substantial majority is coalescing around a Government plan with or without supplementals. that doesn't conform at all with what we are constantly told the American people want.

Just like any other polls conducted by the so-called professionals. They all have an agenda. The questions can be manipulated to obtain predetermined results.

 

[RonBoyd]

They all have an agenda. The questions can be manipulated to obtain predetermined results.

Of course, Political Propoganda (no such thing as) helps a little:

PolitiFact Announces 2010 Lie Of The Year : NPR

INSKEEP: Okay, Bill Adair. So those are some of the finalists for lie of the year as chosen by PolitiFact.com. Here we go. The drama is intense. What, in your view, is the lie of the year?

Mr. ADAIR: The claim that the Democratic healthcare law is a government takeover of healthcare.

INSKEEP: What's wrong with that?

Mr. ADAIR: Well, it's just ridiculously false. The plan relies on private insurance companies, and in fact private insurance companies are actually going to end up with more business because of the law, and yet it was a refrain we heard again and again. It was definitely the most pervasive falsehood of the year.

INSKEEP: Let's hear that phrase as used again and again in different ways by various politicians this year.

Unidentified Man #2: People don't want a government takeover of healthcare.

Unidentified Woman: Cradle to grave government takeover of the...

Unidentified Man #3: ...the government takeover, just as they are with other aspects of our economy.

Also found here:
YouTube - The 5 Biggest Political Lies of 2010

 

[ziggy29]

Unlike some proponents of universal coverage, I do not believe health care is a "right" in the real sense. A "right" to me is something that one can exercise without taking life, liberty or property of other individuals against their consent. With that definition (I know other people have other definitions they prefer), health care is not a "right."

Heck, using that definition one can say public education isn't a right, either. But I think health care and education have a lot in common: whether a right or not, it's a compelling public good that a compassionate and prosperous society should want to provide to all its people, to at least some level.

Having said that, in terms of maintaining "domestic tranquility" and providing at least some minimally dignified quality of life for all, I think universal coverage should be a goal similar to universal K-12 education. And like education, those with means could choose to use their own means to purchase supplemental coverage or other health care items not covered by the universal plan.

I think the way health care reform was enacted was dumb. I don't like the idea of mandating that all people buy private products (this was the main Constitutional challenge, IIRC) and the way the subsidy phased out for purchasers of individual coverage amount to something like an extra 15% tax on middle class income.

To me, if we want universal coverage, we will have to make tough decisions in terms of compromising quality and/or availability. Will we accept limits to end-of-life treatments? Will we accept waiting a month or two for a routine office visit?

 

[Texas Proud]

At this point we are running 70% that want MORE government involvement than Obamacare (which relies largely on private insurance with a weak mandate). 73% if we count Tex Proud as a Gov Basic plus supplemental. So how do we as a group stack up against the underlying views of the American public?

The problem is I do not what what I proposed... so go back to 70%....


I was just putting something out that I could live with since there are so many people who seem to want universal coverage managed by gvmt...


The big problem with my proposal is with any gvmt program... creep.... sure, you set it up where there is a limit to what can be done under the plan... then another congrss gets in and mandates more... and then more more more... until you have a single payor system that does not allow private insurance...

It is this creep that has so many of us conservatives not wanting to let the gvmt get involved with anything....


What we need is a sunset provision for ALL bills.... all of them will die after a certain amount of time and have to be voted on again...

 

[Texas Proud]

So you'd be in favor of some sort of committee that was empowered to deny life-extending care to individuals under some conditions. What criteria would you like to see in place to begin this process? Perhaps we can make that slope less slippery.

Seems like a holier than though tone to me....


There are many people who as so sick and not really living life that they should be allowed to die... if you do not think so you have not experienced some of this for some reason...

And I have an example that I have given before... a worker of mine was diagnosed with pancreatic cancer... she had a few months to live... they did surgery on her within a month or two of her dying for a different thing that could have been handled by drugs since they knew she was dying... and her life was hurt because she had to recover from surgery..... not a great way to spend one month of the last two you have....

 

[Independent]

I believe in universal healthcare for everyone.

I think the point of the poll is "Who pays?". By "universal healthcare" do you mean taxpayers pay for everything from a simple antibiotic for strep throat up to a liver transplant, or do you mean something more limited?

 

[M Paquette]

Seems like a holier than though tone to me....


There are many people who as so sick and not really living life that they should be allowed to die... if you do not think so you have not experienced some of this for some reason...

And I have an example that I have given before... a worker of mine was diagnosed with pancreatic cancer... she had a few months to live... they did surgery on her within a month or two of her dying for a different thing that could have been handled by drugs since they knew she was dying... and her life was hurt because she had to recover from surgery..... not a great way to spend one month of the last two you have....

I have had some experience with this recently as well. It's not pleasant.

Silver wanted someone to make the decision to say 'no' to continuing care for some individuals. I just want to know how that decision will be arrived at. Will it be done by something like the transplant committees at many hospitals, or by a loss mitigation specialist at an insurer? What will be the criteria used to decide when care gets cut off? What sort of treatment is to be provided for those who are cut off?

Does a cutoff of care apply only to care covered by insurance? Can a wealthy, effectively self-insured person buy care without a cutoff? Could someone buy supplemental insurance to prevent being cut off?

How much cost containment are you going for? Currently, 27% of Medicare expense goes to people in their final year of life. Would palliative care for the terminally ill be a permissible expense (remember, there were severe political objections to this recently)? Would you be willing to permit a doctor receiving Medicare payment to discuss palliative treatment or hospice end-of-life care with a patient, or inform them of the availability of living wills (What noted expert Sarah Palin interprets as a 'death panel')?

If folks are big fans of the Hoche-Binding thesis, I'd really like to know, preferably well in advance.

 

[Texas Proud]

I have had some experience with this recently as well. It's not pleasant.

Silver wanted someone to make the decision to say 'no' to continuing care for some individuals. I just want to know how that decision will be arrived at. Will it be done by something like the transplant committees at many hospitals, or by a loss mitigation specialist at an insurer? What will be the criteria used to decide when care gets cut off? What sort of treatment is to be provided for those who are cut off?

Does a cutoff of care apply only to care covered by insurance? Can a wealthy, effectively self-insured person buy care without a cutoff? Could someone buy supplemental insurance to prevent being cut off?

How much cost containment are you going for? Currently, 27% of Medicare expense goes to people in their final year of life. Would palliative care for the terminally ill be a permissible expense (remember, there were severe political objections to this recently)? Would you be willing to permit a doctor receiving Medicare payment to discuss palliative treatment or hospice end-of-life care with a patient, or inform them of the availability of living wills (What noted expert Sarah Palin interprets as a 'death panel')?

If folks are big fans of the Hoche-Binding thesis, I'd really like to know, preferably well in advance.

There are many examples of decisions being made that a large percent of people would say 'this is to much' that are not done...

With this discussion, I remembered one of the news magazines who had a show on the costs that society had to pay because of the way we allow people to decide something without paying... they had two families showing the decisions...

The first one was a man who (IIRC) fell off a ladder and hit his head... they got him to the emergency center and was able to keep his body alive... but he was brain dead... the family had the decision to keep him on life support or take him off... he had private insurance, so it was not a taxpayer issue, but an insurance issue... from what I remember, the insurance would pay to keep him on machines for as long as the family wanted... they decided to take him off in a day or two... I think most of us would make the same decision....

The other was a welfare mom who had a brain dead baby... they spent millions of dollars to keep the infant 'alive'... this went on for many months.. the welfare mom coming to the hospital every day... it was not costing her a thing... but it was costing 'society' millions and millions of dollars...


Now, if she had a private insurance policy that allowed this to go on... fine by me... even though it would not be the decision I would make... but she did not... and I do not think that society has an OBLIGATION to keep a brain dead baby alive because the mother can not deal with it... all that money was wasted.. period... it could have been used to immunize many hundreds of thousands of people... and I bet if you could figure it out, there were other people who died because of this lady's decision... why Because we will go to the extreme to 'save' this one life, but will not spend the needed funds to protect healthy people who might need a vaccination for something... they catch it and die...


Sure, sure... this is an extreme example.... but if we can not even agree on these extreme examples, how are we going to get the problem fixed....


And BTW, in other countries they do not worry about it as much as we do... my wife lost her first husband to cancer... he was in a country that had 'universal coverage'... he was told to go home, they could not help him (state 4)... they did not even give any pain medication... so he went home to die... I wonder why we seem to have this big issue when others do not...

 

[Westernskies]

How Should American's Health care be Paid for?

From each according to his ability, to each according to his needs.

 

[GregLee]

Would you be willing to permit a doctor receiving Medicare payment to discuss palliative treatment or hospice end-of-life care with a patient, or inform them of the availability of living wills ...

In my singular experience, this already happens, with no reference to the source of payment (so far as I know). In the last two years of her life, when my mother was seriously ill, every time she was admitted to the hospital, she or I (when she was not able) needed to make choices about resuscitation options and needed to be informed about the advisability of living wills and how to arrange for them. Just standard hospital routine. When we were getting closer to the end, her physician and a hospital intern there as a witness spoke with her about these matters in my absence, and I was told later that what she had said (roughly, "I'm ready to die") was in accord with what I had told them. I was impressed with the care that was taken. But this was a church-owned hospital, so perhaps they are more ethically meticulous than elsewhere?

 

[dex]

I just want to know how that decision will be arrived at. Will it be done by something like the transplant committees at many hospitals, or by a loss mitigation specialist at an insurer? What will be the criteria used to decide when care gets cut off? What sort of treatment is to be provided for those who are cut off?

This is how the British do it.
How the UK rations health care | PRI.ORG

NICE's rationing decisions start with a basic premise: The government should spend its limited resources on treatments that do the most good for the money. NICE calculates cost-effectiveness with a widely used measure called a quality-adjusted life year (QALY).
In essence, NICE asks these questions: How much does a drug or procedure cost? How much does the treatment extend the average patient's life? And what is the quality of that life gained?
The calculations are complicated, but imagine that a cancer treatment costs $100,000 and that it extends the life of the average patient by four years. That means the cost of the treatment per year gained is $25,000.
Now imagine that for part of those four years the patient will be in pain and bedridden. NICE might figure the quality of that life at 50 percent of perfect health. Under NICE's formula, that would make the drug half as cost-effective. In other words, the result would be $50,000 per quality-adjusted year gained.
NICE has set a maximum that it will spend on a treatment: about $47,000 per quality-adjusted year gained.

 

[GregLee]

How much does the treatment extend the average patient's life?

But ask yourself, would you be an average patient? A treatment may cure some patients, but only a few of them, so that the "average patient" lives only a few weeks longer. This sort of formulation in terms of the "average patient" conceals that in refusing to fund a treatment which extends the life of this statistical artifact by only a small amount may deny some patients a curative treatment.

 

[Texas Proud]

But ask yourself, would you be an average patient? A treatment may cure some patients, but only a few of them, so that the "average patient" lives only a few weeks longer. This sort of formulation in terms of the "average patient" conceals that in refusing to fund a treatment which extends the life of this statistical artifact by only a small amount may deny some patients a curative treatment.

And I think that if the patient can pay for this treatment they should have the right to do so...

 

[GregLee]

And I think that if the patient can pay for this treatment they should have the right to do so...

That's very generous of you.

 

[chinaco]

+1

Universal health care sounds great on paper, but I can't see how it could ever be paid for with unlimited benefits. A line has to be drawn somewhere, the real debate is where?

In the UK, the basic doctor visits and pharmacy are covered, Chronic illness is treated, Serious life threatening problems are treated immediately.

The rationing starts with elective health care procedures that are not critical to life (example Knee Replacement). They will get the procedure, but there is a queue and one will have to wait their turn. Even with that, it is not years.

To go to the head of the line for elective procedures, one can purchase supplemental insurance. Many companies provide it to employees as a benefit.


I talked with some people about this issue when we were over there. They said much of the U.S. election rhetoric was exaggerated. Of course there were some early issues and problems to work through... like any complex system.

Those Brits told me it was working just fine.

BTW the people I talked to were mainly professionals... well educated and compensated.... the people who might actually be on the short end of the stick in such a system.


After those conversations, I was convinced that much of the rhetoric was scare tactics to try to derail any effort to address the problems.

 

[dgoldenz]

In the UK, the basic doctor visits and pharmacy are covered, Chronic illness is treated, Serious life threatening problems are treated immediately.

The rationing starts with elective health care procedures that are not critical to life (example Knee Replacement). They will get the procedure, but there is a queue and one will have to wait their turn. Even with that, it is not years.

To go to the head of the line for elective procedures, one can purchase supplemental insurance. Many companies provide it to employees as a benefit.


I talked with some people about this issue when we were over there. They said much of the U.S. election rhetoric was exaggerated. Of course there were some early issues and problems to work through... like any complex system.

Those Brits told me it was working just fine.

BTW the people I talked to were mainly professionals... well educated and compensated.... the people who might actually be on the short end of the stick in such a system.


After those conversations, I was convinced that much of the rhetoric was scare tactics to try to derail any effort to address the problems.

The UK also has a 20% VAT and $8/gallon gas...

 

[DeborahB]

I have dealt with cancer patients for many years through an online ovarian cancer support group I run. The treatments are difficult and there are often permanent side effects - peripheral neuropathy is common, among others.

I find there are different ways of thinking about it - the ones who want to see their children graduate high school (or get married, or see their grandchild born) are highly motivated to get treatment no matter what, for example. There are women whose families won't acknowledge that the cure is worse than the disease, and so the women continue treatment despite seriously compromised quality of life. And luckily some do well. But there always seems to be a point when the treatments are too much, hospice is called in, and the patient dies comfortably (for the most part).

For myself, knowing what I know about chemo and radiation - and having no children - I'm not sure I would do anything but spend money on travel and have a wonderful time while I could do it, if I knew I only had a few months left.

 

[chinaco]

The UK also has a 20% VAT and $8/gallon gas...

Yes they do. But that is not all due to health care.

But we spend more than other developed nations per capita!

In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714

Since this was about Canada vs US cost, I did not see the exact figure for the UK... But there is a Bar Chart... The US spends about double the amount per person compared to the the UK.

Comparison of the health care systems in Canada and the United States - Wikipedia, the free encyclopedia

 

[Texas Proud]

In the UK, the basic doctor visits and pharmacy are covered, Chronic illness is treated, Serious life threatening problems are treated immediately.

The rationing starts with elective health care procedures that are not critical to life (example Knee Replacement). They will get the procedure, but there is a queue and one will have to wait their turn. Even with that, it is not years.

To go to the head of the line for elective procedures, one can purchase supplemental insurance. Many companies provide it to employees as a benefit.


I talked with some people about this issue when we were over there. They said much of the U.S. election rhetoric was exaggerated. Of course there were some early issues and problems to work through... like any complex system.

Those Brits told me it was working just fine.

BTW the people I talked to were mainly professionals... well educated and compensated.... the people who might actually be on the short end of the stick in such a system.


After those conversations, I was convinced that much of the rhetoric was scare tactics to try to derail any effort to address the problems.

Since I worked on London for mega for a bit over a year.... (back in 2000).. my experience is a bit different than what you state... almost all of the people that I met (also professionals) seemed to have negative things to say about their system... most people who had something minor would not even go to the doctor since it would be weeks before they could get an appointment....

I had a lady come visit over here and while here got a bad case of strep... we were visiting Disney and I said 'lets go to the doctor and get you looked at'... she could no believe that we called and had an appointment in less than one hour... the doc ran some test etc.. gave a shot, got some prescriptons and we were out of there... lucky for her she had bought travel insurance so it was paid for...


One of the other things they have going for them.... you can get a LOT of drugs over the counter there that you can not here... I could buy my allergy steroid spray over the counter... here, I have to go to the doc to get a prescription... my sister (a nurse) was surprised what you can get over there...

 

[chinaco]

Since I worked on London for mega for a bit over a year.... (back in 2000).. my experience is a bit different than what you state... almost all of the people that I met (also professionals) seemed to have negative things to say about their system... most people who had something minor would not even go to the doctor since it would be weeks before they could get an appointment....

I had a lady come visit over here and while here got a bad case of strep... we were visiting Disney and I said 'lets go to the doctor and get you looked at'... she could no believe that we called and had an appointment in less than one hour... the doc ran some test etc.. gave a shot, got some prescriptons and we were out of there... lucky for her she had bought travel insurance so it was paid for...


One of the other things they have going for them.... you can get a LOT of drugs over the counter there that you can not here... I could buy my allergy steroid spray over the counter... here, I have to go to the doc to get a prescription... my sister (a nurse) was surprised what you can get over there...

My conversations took place just prior to the election.... not 10 years ago.

They said there were some problems that had to be ironed out.

I have no illusions... I am sure their system is not perfect. For that matter, it may not be a good fit for America. But they seemed to be happy and healthy.

On that note, ever meet anyone who didn't have a complaint? For that matter, ever see a complex system that couldn't use some improvement?


I hear a lot of complaining here in the US.... and it is getting louder as prices spiral upward.... and that is from the people that have coverage.

Those who do not have coverage really have something to complain about!

 

[Westernskies]

If you think health care in the US is expensive now, wait until it's free...

 

[RonBoyd]

If you think health care in the US is expensive now, wait until it's free...

Whooooouooo! I'm so scared.