Universal Health Care - what are we waiting for?

[Zero]

You may see this as heavy handed (or out of date), but there was a time when 'folks jostled to keep their piece of the pie' regarding slavery, women's rights, etc.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.

 

[Alan]

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.

 

[Alan]

That's the other issue I was thinking of, plus extra points for using 'fetter' in a sentence

-ERD50

 

[Zero]

...

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".

 

[Zero]

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.

 

[MichaelB]

Bet most US'ers would answer, "No".

I'm not so sure about that. My sense is many people would prefer a "Medicare" type system but fear it would not be affordable.

 

[Alan]

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.

It was only the Single Payer systems in this comparison, as the presenter started by saying something along the lines of, "We always assume companies are much more efficient than government agencies, but just look at the admin costs of these Single Payer countries compared to the US HI companies ... "

 

[youbet]

I picked it up the 17% in reading, coincides with the 45 million uninsured that you often hear.

That's in line with what was thinking. Having 17% of our residents without insurance is a significant problem to be solved. But it's a different problem than if we were literally denying access to 17% of our residents.

Thanks for posting the pie chart. It's very interesting to see who actually comprise the ranks of the uninsured. It makes it easy to see why the "insurance mandate" is necessary with so many folks voluntarily chosing to go uninsured.

It appears that folks being denied insurance due to pre-existing conditions are not a very large portion of the total uninsured. I was surprised by that since they're the ones usually emphasized and certainly the folks I'm personally most interested in helping.

 

[Alan]

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.

I think you can see the documentary that shows the comparison.

Zakaria: How to fix U.S. health care – Global Public Square - CNN.com Blogs

 

[donheff]

Medicare's admin expenses are low, so are Social Security's, so are the Thrift Savings Plan's. The question isn't just admin costs it remains are private insurers more likely to drive down private sector medical costs than Government could/would in some sort of single payer Medicare for all system. If you think the private HI companies can do a better job than Government you could still adopt a single payer universal system and simplify things by broadening the Federal Employee Health Benefits Program to include more insurers and extending it to the whole population.

 

[MichaelB]

Of course, in addition to the 47 million without health insurance there is another group, perhaps half that size, that is underinsured but counted as insured. That is, policies that cover very basic care but still leave the individuals financially exposed in case of more severe illness.

 

[Zero]

I'm not so sure about that. My sense is many people would prefer a "Medicare" type system but fear it would not be affordable.

That is what I think also so I posed (earlier) having Medicare just become cradle/grave and let's pay, and I'm like "who the heck doesn't want a cradle-to-grave" healthcare if we can afford it. Hey this would abide. But I just do not think Americans believe our government can do that affordably without huge tax increases.

If we all buy in to 40-50% taxes in order to have Ultimate healthcare with humanitarian goals in mind, and then it does not work, what then 60%?

 

[Zero]

It was only the Single Payer systems in this comparison, as the presenter started by saying something along the lines of, "We always assume companies are much more efficient than government agencies, but just look at the admin costs of these Single Payer countries compared to the US HI companies ... "

Thanks, Alan. I do wonder whether there was some data that combined UK's NHS 5% and your UK company's private plan's ?%, would the number might be higher but that's conjecture on my part.

I do not hold out hope for a US Single Payer System, and frustratingly, I am not sure if that makes me happy or sad.

 

[Alan]

Thanks, Alan. I do wonder whether there was some data that combined UK's NHS 5% and your UK company's private plan's ?%, would the number might be higher but that's conjecture on my part.

I do not hold out hope for a US Single Payer System, and frustratingly, I am not sure if that makes me happy or sad.

Nope, the 5% was purely the NHS figures and didn't include BUPA or other private insurers, or any of the many private clinics and hospitals in the UK.

 

[Alan]

Thanks, Alan. I do wonder whether there was some data that combined UK's NHS 5% and your UK company's private plan's ?%, would the number might be higher but that's conjecture on my part.

I do not hold out hope for a US Single Payer System, and frustratingly, I am not sure if that makes me happy or sad.

Nope, the 5% was purely the NHS figures and didn't include BUPA or other private insurers, or any of the many private clinics and hospitals in the UK.

Private companies in the UK are bound to have much lower overall costs than in the USA because the 800lb gorilla in the room is the NHS which keeps prices down. (Salaries, drug costs, scans etc).

 

[Zero]

Medicare's admin expenses are low, so are Social Security's, so are the Thrift Savings Plan's. The question isn't just admin costs it remains are private insurers more likely to drive down private sector medical costs than Government could/would in some sort of single payer Medicare for all system. If you think the private HI companies can do a better job than Government you could still adopt a single payer universal system and simplify things by broadening the Federal Employee Health Benefits Program to include more insurers and extending it to the whole population.

One might ask: If the US has a " Federal Employee Health Benefits Program", WHY?, and then compare to Alan's home country's NHS situation. Does the UK have a "Ministry Employee Health Benefits Program"? I suspect not.

 

[Zero]

Private companies in the UK are bound to have much lower overall costs than in the USA because the 800lb gorilla in the room is the NHS which keeps prices down. (Salaries, drug costs, scans etc).

Good analogy, and at this seemingly "best opportunity" in US healthcare system, there is no 800 lb gorilla, and I cannot even fathom a healthcare structure that could be in place and operating in that "enforcer" role within 20-30 years.

 

[Alan]

Does the UK have a "Ministry Employee Health Benefits Program"? I suspect not.

I'm sure they don't, but they probably have access to the private HI companies just like everyone else. The NHS is always a big topic and I'm sure it would be political suicide if the government had one system for their employees and a different one for the rest.

Prime Minister Thatcher once had elective surgery using private insurance, and when asked in the House, at Prime Minister Question Time, why she did not use the NHS, she replied that using the private system lessened the load on the NHS.

 

[Zero]

I'm sure they don't, but they probably have access to the private HI companies just like everyone else. The NHS is always a big topic and I'm sure it would be political suicide if the government had one system for their employees and a different one for the rest.

Prime Minister Thatcher once had elective surgery using private insurance, and when asked in the House, at Prime Minister Question Time, why she did not use the NHS, she replied that using the private system lessened the load on the NHS.

Alan, I am a big fan of Bernard Woolley and think Ms.Thachter may have used his ministerial support talents to prepare for Question Time. Wish our system had Question Time.

But, time for that same question in the US, do you think a party would commit political suicide (either party), if we suggested a "Universal Healthcare System" and any politician (R or D) said; "Our plans will have a basic plan for some and a glamor plan for upper-class"? EDIT: oops, with the caveat that the "glamor plan" would allow the basic when there was no need to use the glamor system, but have the glamor system if needed, similar to what Ms. Thatcher chose and what Dick Cheney chose recently evidently.

Let them eat cake.

 

[Alan]

Alan, I am a big fan of Bernard Woolley and think Ms.Thachter may have used his ministerial talents to prepare for Question Time. Wish our system had Question Time.

But, time for that same question in the US, do you think a party would commit political suicide (either party), if we suggested a "Universal Healthcare System" and any politician (R or D) said; "Our plans will have a basic plan for some and a glamor plan for upperclass"?

Apparently "Yes, Minister" and "Yes, Prime Minister" was almost mandatory watching material by MP's of all parties. I hear they are planning to make a new series.

 

[donheff]

One might ask: If the US has a " Federal Employee Health Benefits Program", WHY?, and then compare to Alan's home country's NHS situation. Does the UK have a "Ministry Employee Health Benefits Program"? I suspect not.

Of course the UK doesn't - they have a National Health System. We don't. So, just like IBM or GM, the Federal Government offers health insurance to its employees (including Congress). The approach adopted was to allow any private sector HI companies that want to compete to participate. The result is a HI exchange that could be broadened and extended to the rest of the country if we so choose.

 

[Alan]

Of course the UK doesn't - they have a National Health System. We don't. So, just like IBM or GM, the Federal Government offers health insurance to its employees (including Congress). The approach adopted was to allow any private sector HI companies that want to compete to participate. The result is a HI exchange that could be broadened and extended to the rest of the country if we so choose.

That option seems to be pretty good. Presumably there are good reasons why it won't happen?

 

[antmary]

Did you see this thread http://www.early-retirement.org/forums/f38/high-cholesterol-problem-59917.html where I gave some basic advice ? One poster questioned my credententials. Another one questioned basic guidelines. Another poster came to my rescue saying "Some of you are brutal . Have you noticed that rarely do medical people get in these discussions . Its because they are beaten up and spit out . If you really want opinions from the front line not just articles with a bias treat the medical people with the respect they deserve ."

Since then I guess I have tried to stay away from any healthcare-related question, whether Obamacare or clinical questions. It's not a problem, since I joined this board to discuss FIRE anyway...

I, for one, would like to see a single-payer system - with optional health insurance coverage.

I saw a tee-shirt that said in effect, "No Obama-care! We want Cheney-care! Free health care paid for by the government!"

Anyway, thanks OBGyn for your service. I very much appreciate you and other physicians I know - that I consider to be true healers...leaving one's comfortable home to aid those less fortunate.

Anyway, I had better get off this thread before I am dismissed...

 

[Zero]

Of course the UK doesn't - they have a National Health System. We don't. So, just like IBM or GM, the Federal Government offers health insurance to its employees (including Congress). The approach adopted was to allow any private sector HI companies that want to compete to participate. The result is a HI exchange that could be broadened and extended to the rest of the country if we so choose.

donheff, you use "could" and I wonder if that is a something you expect to happen? Ooops, and forgot to ask; Is the health insurance offered to Federal Govt employees the same as Congress or are there 2 totally different plans?

 

[Midpack]

I did not make clear but I when I was talking about "jostling for their piece of the pie", I meant HI, pharma, etc..

That's how I took it...