Socialized Medicine

[ziggy29]

The difference that I see coming is the GOVERNMENT is going to care what you have done and I guess they can if they will be paying for it.

Probably. One scary (to me) side-effect is that when "we the people" start paying for everyone's health care, "we the people" will start demanding the right to tell everyone how to live, what they can put in their bodies and what they can, can not and MUST do with their bodies.

 

[Trek]

I favor a hybrid system: national healthcare insurance as a default (premiums commensurate with incomes) with the option to opt out in favor of private health insurance for those who want it and can afford it.

That's more or less how it works here in Germany and it seems to work quite well. My wife recently had surgery on her toe here and it cost a one time administration fee of €10 (something new they recently started). And there was no wait, though we're in a smaller city. Follow up care was excellent! She's not even insured in Germany itself, but we all have the EHIC (European Health Insurance Card) which guarantees us treatment in any other EU country and we will be treated the same as it's citizens are. Very cool!

Estonia as well has a dual system, though it works a bit different from Germany. There is both the "universal system" or the option to go with private insurance if you so choose. I've never had to wait there more than a week to see a specialist. In Florida I've had to wait up to 3 months to get an appointment with a dermatologist.

I agree a hybrid system is the best. If I'm not mistaken, in Canada or in some parts anyway, there is no private option which I think is what makes people squirrelly about it.

 

[jug]

Look, if you are poor you're gonna get good care if you break some balls a bit, if you are wealthy, that speaks for itself. Most of us are in the middle, so we have to be "street wise", know how to play the system of insurers given us and examine our own situations.

Health insurance is essentially weath insurance for the middle class. HMO's are good for the nickel and dime stuff, but not good for the big stuff where they tend to ration it out. I found that out the hard way using an HMO for my pops medicare. Went back to tradional medicare. One large nasty illness and the HMO's would try to find a way to bury you to keep costs down.

jug

 

[Rich_by_the_Bay]

If you're affluent or even middle income, and if you have group-based insurance, or even good individual insurance without carve-outs for pre-existing disease the current system gets the job done.

If your job is insecure, or if you get sick enough to lose your job, it can be troublesome. If you are entrepreneurial or want to ER and don't have access to continuation insurance other than COBRA, or if prior illness makes you uninsurable, it's also potentially awful. In such cases it's occasionally catastrophic, leading to personal bankruptcy combined with illness.

If you are poor everything sucks, but at least you get Medicaid style care.

I'd like to see more consistency under the umbrella of basic universal coverage. I'm disinclined toward socialized medicine in the USA, since we seem too culturally individualistic to support it as a nation. I'm OK with basic coverage for all, with add-ons if you are willing to pay more, but the definitions of what is basic coverage can get tricky.

Working in this domain for 35 years gives me a different perspective from most, but I'm pretty sure the current scenario is dysfunctional beyond repair for large numbers of people, and it doesn't take much in the way of misfortune to take you from "works for me" to a life ruined by illness (even if you take care of yourself) and relative poverty.

Just some observations from the street.

 

[FinanceDude]

Things have changed at the VA. Now it is pointed to as a good example of care and followup.

Based on recent trips to two different ones, I beg to differ. My retired pharamcist father is a consultant to the VA, and has allowed me to tag along on some recent visits to VAs.

If that is the future, I am very concerned.

 

[ziggy29]

If your job is insecure, or if you get sick enough to lose your job, it can be troublesome. If you are entrepreneurial or want to ER and don't have access to continuation insurance other than COBRA, or if prior illness makes you uninsurable, it's also potentially awful. In such cases it's occasionally catastrophic, leading to personal bankruptcy combined with illness.

Indeed, one of the worst things I see about the U.S. health care system is the side-effects of over-dependence on the link between health care and being employed.

I think this results in a stifling of the entrepreneurial spirit. A lot of people with good ideas and the work ethic to succeed on their own, who would love to go it on their own, might hesitate because they NEED Megacorp's health plan. They may decide not to do it, they may not create the "next big thing" and be the next engine of job creation. And that's a shame.

I don't know what the specific answers are, but in general I think the more we can achieve "separation of health care and employer" -- without having the loss of employer-provided health care be a huge net takeaway for people -- the better we may well be.

 

[Trek]

Why do people still tolerate Social Security? Heck, that has Social (an apparently evil word) built right into it?

I know how to pay for Universal Healthcare, scrap the evil Social Security and use that money. Maybe healthy productive people can work out their own retirement plan.

 

[Rustic23]

Trek,
If healthy productive people can work out their own retirement plan, but shouldn't they also be able to work out a health care plan? Both roads have pot holes.

 

[Trek]

Trek,
If healthy productive people can work out their own retirement plan, but shouldn't they also be able to work out a health care plan? Both roads have pot holes.

Well really, I think it should be all or nothing. If you can get free money for being old, you should get free health care for being sick. Or, you should get to keep all your money, not pay into either and work it all out yourself.

* - when I say free, I mean said person and other citizens paid the tab, but point of service was cost free.

To address your particular question though, I think there is a big difference in the current setup. It is difficult or near impossible for many people to work out a health plan because the insurance companies can reject you (or quote a payment only Bill Gates could make) due to anything from age to pre-existing conditions. Good luck affording the rates that the state health pools offer when private rejects you. My point is many variables beyond your control are involved here (assuming one doesn't blame people when they become ill).

But if I don't tax you for the evil Social Security money, you keep that money and you're free to do with that money as you please. No middlemen in the way. No one turning you down to invest it because you don't feel good. Stick it in the mattress if you want and just save it and screw inflation.

 

[Bestwifeever]

I want free money for getting old! Where do I go?

 

[donheff]

if you have group-based insurance, or even good individual insurance without carve-outs for pre-existing disease the current system gets the job done...

If you are entrepreneurial or want to ER and don't have access to continuation insurance other than COBRA, or if prior illness makes you uninsurable, it's also potentially awful. In such cases it's occasionally catastrophic, leading to personal bankruptcy combined with illness...
.

I'd like to see more consistency under the umbrella of basic universal coverage. I'm disinclined toward socialized medicine in the USA, since we seem too culturally individualistic to support it as a nation. I'm OK with basic coverage for all, with add-ons if you are willing to pay more, but the definitions of what is basic coverage can get tricky.

+1 The only thing the [moderator edit] want out of this is a system that doesn't confiscate your life's earnings and toss you in the gutter based on chance. This is America for God's sake -- do you think we will end up with a system that doesn't permit those of us who so choose to supplement universal coverage with pricey add-ons?

PS: good to see the soap box slipped its nose under the life after fire tent. Maybe the mods will come to the conclusion that people want to talk about controversial topics.

 

[REWahoo]

PS: good to see the soap box slipped its nose under the life after fire tent. Maybe the mods will come to the conclusion that people want to talk about controversial topics.

You can talk about "controversial topics" until your heart is content - as long as they are related to FIRE (as we've said, over and over and over) as is this topic. What you cannot do is use inflammatory political language.

 

[donheff]

+1 The only thing the [moderator edit] want out of this is a system that doesn't confiscate your life's earnings and toss you in the gutter based on chance. This is America for God's sake -- do you think we will end up with a system that doesn't permit those of us who so choose to supplement universal coverage with pricey add-ons?

I hope you editors had the sense to understand that I was not dissing the "crazy xxx" category I referenced since everyone here knows I am one of them. The word you are looking for is sarcasm. Lets try a politically correct version:

"The only thing [the people who support what is being derided as "socialized medicine"] want out of this is a system...

 

[ziggy29]

I hope you editors had the sense to understand that I was not dissing the "crazy xxx" category I referenced since everyone here knows I am one of them. The word you are looking for is sarcasm.

Part of the problem is that sarcasm doesn't always come through as obvious, which leads to misunderstandings (and is one of the reasons why sarcasm is discouraged, particularly with hot-button subjects such as political issues). That's especially true if someone doesn't know your political/ideological leanings. Many of us may well know you're a lefty, but despite intent it doesn't always come out as clearly to some of the audience as we may expect.

Some people may think you're a conservative throwing names and labels at liberals, and they could object, start throwing insults at conservatives and Republicans, and it gets ugly. I don't think it's a safe bet that "everyone" knows your leanings. Most people who have followed political subjects here for a long time do, 'tis true, but that's still not everyone.

It's really not a desire to squelch relevant and civil political discussion. And there's little more relevant to the FIREd and FIRE wannabes than the health care [-]clusterfrack[/-] conundrum, which is why respectful discussion of this issue is very much within the rules. But these subjects are touchy and laden with a potentially flammable cocktail of gasoline, nitroglycerin and fertilizer. It often doesn't take much to hit a flash point. Our decisions may not be perfect or always popular, but we are trying to avoid reaching that flash point. And I, speaking for myself alone, hope that it's accepted that this is the spirit with which we approach this even if you don't agree with the decision.

 

[samclem]

deepc,
Socialized medicine does not provide medical care for free. If you re-read your post and insert "paid for by others" for every instance of the word "free," I think it will be more accurate.

Food, lodging, water--for almost every human need we allow people to go to the free market and make decisions about what they want. If the expenses are large, they generally get a loan. It works darn well--we might all want steak and lobster, but we buy food, houses, and other goods and services that aren't the top of the line, but which provide the highest marginal utility. If we have expenses that are unpredictable but catastrophic, we buy insurance. For the those in society who are unable or unwilling to provide for themselves, we have decided to forcibly take assets from some people in order to provide a low safety net. Section 8 housing and food stamps ain't great, but it's something.
For whatever reason, many people want to turn their back on this model when it comes to health care. They either want the government (e.g. other taxpayers) to give it to them for "free," or they want their employer to provide it for "free." For health care, many people want to turn to the model that has historically done the very poorest job of providing needed goods and services.

 

[Bestwifeever]

I hope you editors had the sense to understand that I was not dissing the "crazy xxx" category I referenced since everyone here knows I am one of them. The word you are looking for is sarcasm. Lets try a politically correct version:

"The only thing [the people who support what is being derided as "socialized medicine"] want out of this is a system...

Don, I like to think I'm a pretty funny gal and enjoy a good bout of sarcasm whenever possible but when I read your original post I didn't realize you were being sarcastic. And I really don't know most people's political leanings, including yours. And the other mods have a lot of sense and understanding.

I think this is a really good thread with a good discussion going. I don't think it's soapbox-ish in the least.

 

[FIRE'd@51]

I'm OK with basic coverage for all, with add-ons if you are willing to pay more, but the definitions of what is basic coverage can get tricky.

That is what concerns me, too.


From the Bloomberg article:

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.


Bolded type is my emphasis.

 

[donheff]

Food, lodging, water--for almost every human need we allow people to go to the free market and make decisions about what they want...
For whatever reason, many people want to turn their back on this model when it comes to health care. They either want the government (e.g. other taxpayers) to give it to them for "free," or they want their employer to provide it for "free." For health care, many people want to turn to the model that has historically done the very poorest job of providing needed goods and services.

Substitute defense, police service, fire service, schools, roads, electricity and, yes, social security, and it is clear that as a people we choose to support many essentials collectively. Just read the worries expressed on this forum about the precarious state of access to health insurance in ER and it is easy to understand why many of us believe universal access is an imperative. It does not automatically lead to substandard care delivered by faceless bureaucrats.

 

[ls99]

Just read the worries expressed on this forum about the precarious state of access to health insurance in ER and it is easy to understand why many of us believe universal access is an imperative. It does not automatically lead to substandard care delivered by faceless bureaucrats.

Universal access is kind of like the right to pursuit of happiness. Results are highly variable.

 

[armor99]

By and large most people are selfish. And this is a good thing.... it is a HUMAN thing. It is about preserving yourself, your life, and perhaps the well being of your family. By the previous definition, most people that I know would say it is a fairly positive thing.

People become doctors because they truly want to help people, but doctors are people too, and as such want to be highly compensated for their rare skills. After all not EVERYONE is metally skilled enought to achieve that. Are any of us here in the forum any different? If there was suddenly some urgent govt need for engineers and they were not willing to pay something agreeable to most engineers, should they be "forced" to perform their services?

If you remove the profit motive from heathcare it will inevitably reduce the quality of healthcare. Why is that? Well... when doctors can charge what they wish... it then becomes a choice if people want to use their services or not. Doctors that are truly "a cut above the rest" may actually get that higher rate. Lesser doctors may not, and will have to lower their rates to survive. If the govt via nationalized healthcare declares that all doctors doing heart surgury for example will make the same, then why would those truly exceptional doctors wish to stay in a profession that does not reward their greater skill? The only doctors that will stay, will be the average and the mediocre caliber.

That is unless you really belive that most doctors are 100% altruistic and only think of others and never themselves. You might find a very few like that..... but I personally have never met anyone like that.... ever.

 

[donheff]

If you remove the profit motive from heathcare it will inevitably reduce the quality of healthcare. Why is that? Well... when doctors can charge what they wish... it then becomes a choice if people want to use their services or not. Doctors that are truly "a cut above the rest" may actually get that higher rate. Lesser doctors may not, and will have to lower their rates to survive. If the govt via nationalized healthcare declares that all doctors doing heart surgury for example will make the same, then why would those truly exceptional doctors wish to stay in a profession that does not reward their greater skill? The only doctors that will stay, will be the average and the mediocre caliber.

There isn't much call here for a totally nationalized health care system - the profit motive isn't going away. The types of systems people are looking at work well elsewhere. Are French, Dutch, Canadian, British doctors a different species than ours?

And riddle me this, why do we have the best military system in the world with no multi-million dollar CEO style bonuses for the Generals?

 

[ziggy29]

There isn't much call here for a totally nationalized health care system - the profit motive isn't going away. The types of systems people are looking at work well elsewhere. Are French, Dutch, Canadian, British doctors a different species than ours?

I do think that some of the claims that universal health care is "socialized medicine" are overblown. It's not really "socialized" unless insurance companies are gone and health care workers are employees of the government.

I do think opponents of universal health insurance/care should be a little more careful about their misuse of terms.

 

[Rustic23]

Donheff
Let me know if you think we can get by with the same number of generals as doctors. That last statement is just about the most absurd thing I have seen someone post. Maybe it is just your sarcasm showing through again.

By the way there are 30 in all the services. So it is like comparing doctors to cabinet members or Senators or say the president.

 

[donheff]

Donheff
Let me know if you think we can get by with the same number of generals as doctors. That last statement is just about the most absurd thing I have seen someone post. Maybe it is just your sarcasm showing through again.

Sorry, I didn't learn my lesson. I was being sarcastic. I will try not to pop off with those bon mots anymore My point was that we have an excellent military and we are not paying them big, market driven salaries. We leave that to Blackwater. Oh, darn, there I go again.

As an aside, I think you must have meant 300 something for the number of generals, not 30. Unless my CEO reference made you think 4 stars or something. Once again, sorry for the sarcasm, I am beginning to see that it can lead the conversation astray.

 

[Rustic23]

There are 306 Army generals according to Google. However there are only 30 4 stars in the services. By the way, while all are called General, only the 4 stars are Generals. Accept for the Navy and they are Admirals. All others or Major, Lt, Comodore or some other qualifier. Just to pick nits.