Did anyone of you enlightened people catch the very good and highly detailed program that compares how some other wealthy nations handle health insurance? I highly recommend it for anyone who still believes that a free market health care system is also a moral system. I am more ready than ever to move abroad!! Any suggestions for how to get either Obama or Clinton to learn what so many of us already know?????
I missed it ... but have family who live overseas, so I’ve seen this first-hand. Of all the candidates still in the race, Clinton’s health care proposals come closest to what is done in Canada and Europe, FWIW. For more on this from the economist Paul Krugman read HERE for example.
I read everything Mr. Krugman writes, and so am intimately familiar with what both Clinton and Obama are proposing. However, because no one either has the knowledge or nerve to propose that American health insurance companies should not be allowed to profit (morally indefensible, in my opinion), there will only be modest improvements. Universal care is a world beyond what most Americans could even dream of, unfortunately.
MusicMommy, universal health care doesn’t mean the ban of health insurance companies, it means that you can pay for your health service or go to public hospital. When those things happens, the private companies improve their confort level.
I feel confortable with universal health care, but can I put a little noise on this thread?. I guess I wouldn’t be unfair if I said that the main innovator in science and technology are the US, an it includes medical technology. At what point the engine of this innovation is the big profit they expect to take from the US’s market?. We, in the economical margin of the world, are not attractive so we can take other’s innovations without influencing the global trend with our politics, but what could happen if the profit in the US were limited?.
I also missed the FrontLine episode. What an important topic though. I still have trouble finding significant differences between Hillary and Barack’s proposals though. Here are links to what they say about medical care on their web sites.
They both seem to be supporting equally modest improvements to our sickly bureaucratic and deeply immoral medical system. But how is either one of their proposals better than the other?
Barto- I understand what you mean about being the technology leader. But if a significant portion of our population cannot even afford the new technology, what is the morally right path? What I am saying is that I believe it is immoral for a country as rich as ours to deprive any of its citizens health insurance. I believe that the insurance companies should NOT be making a profit, I am not referring to tech. companies. If we get surpassed in technology, or worst case scenario, no other country or entity steps in to fill the void (unlikely), then I would still prefer to have a citizenry who can all be reliably taken care even minimially than a thriving techno industry in which a relatively few benefit compared to the whole. I am sure any loss of innovation will be temporary.
I believe that none of the presidential candidates can afford to embrace any kind of truly universal health insurance because they are beholden to corporate and individual donors who have strong ties to health insurance companies. This is the “sick” part and the catch 22 of politics- that intelligent people who ought and perhaps do know better, cannot be elected without significant and tainted corporate money. I hold out little hope that during tonight’s democratic debate that either moderator will dare to ask if either candidate watched the Frontline episode and could comment on it. I’m not holding my breath.
For anyone who’s interested- here is the site from this morning’s live discussion with T R Reid, seen last evening in the Frontline documentary “Sick Around the World”. Worth reading.
The major problem with Obama’s health care plan is a lack of mandates. Check out HERE and HERE for example.
You are right in pointing out that the issue of mandates is a point of difference between Hillary and Barack. I can’t say that I have a well thought out view on the matter. Ill have to think about it some more. So thanks for the food for thought.
Maybe I’m still living in la la fantasy land in that I consider genuine tax funded medical care, that is free to all patients, to be something that we should insist upon. I’m probably just being stubborn about my moral convictions because I can’t think of any good reason why any patient should have to pay anything at all. I dunno. Perhaps a mandate is pragmatically necessary. A mandated universal health insurance system would certainly be an improvement upon the complete lack of basic health care infrastructure that currently exists in the US.
I hesitate to enter into debate on this issue since I am probably in the extreme minority but I would like to point out a few things.
I would disagree with government controlled and mandated healthcare. Look at the mess we have with social security, medicare/medicaid, and other government-run programs. All are horribly managed and on the verge of bankruptcy. Our government does not manage anything efficiently. The bureaucracy and consequently the cost will explode if healthcare is turned over to the government.
Besides, the US Government already runs a healthcare system, it’s called the VA. The VA interfaces with a relatively small population yet it is awful, poorly run and inefficient. If the government cannot effectively run the relatively small VA system, why would we expand their responsibilities?
Mandates are no panacea either. In 2005 the Canadian Supreme Court struck down the ban on private insurance in Quebec finding that the system was not responsive to the needs of the people. The Court made disturbing findings people were literally dying in line waiting for healthcare. For example, it took one of the plaintiffs in that case over a year to get a hip replacement. In our current system, that procedure would take a matter of weeks. Rationing and delay are common amongst the nations with a socialized healthcare system.
The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness.
Where lack of timely health care can result in death, the protection of life is engaged; where it can result in serious psychological and physical suffering, the protection of security of the person is triggered. In this case, the government has prohibited private health insurance that would permit ordinary Quebeckers to access private health care while failing to deliver health care in a reasonable manner, thereby increasing the risk of complications and death. In so doing, it has interfered with the interests protected by of the Canadian Charter.
Canada has a much smaller, less diverse population than the US so implementing a system here would be much more complicated and expensive. Currently, the US spends more in GDP than any other nation, including Canada on healthcare. We spent $2.3 trillion on healthcare last year alone. One always hears that 47 million Americans are uninsured and that sounds terrible. But what it really means is that 233 million Americans or 6 out of 7 Americans have the best medical system in the world. The 47 million number is deceiving because that reflects the number of people who went without healthcare for some part of 2007. That does not mean that they were uninusred the entire year. The number also does not account for those who chose to be uninsured.
Shifting more and more of this money to the government insures the costs will go up and the quality of service will go down. Dragging down the overall quality of healthcare of all to improve the healthcare of a minority is not the right solution.
Actually, the VA is precisely an example of a government agency doing the right thing. For more on this, see HERE.
I would also not claim that our medical system is the best in the world; far from it. Indeed, in 2000 the WHO ranked it #37. France was #1. (Check HERE). The US certainly has the most expensive system per capita, and since outcomes are worse than those in Europe, Australia, Canada and Japan, also clearly one of the most inefficient. For example check out the data in this report, as well as HERE. (The full report is HERE).
Man, I’ve written 20 plus page papers on this and have been in more debates than I can count. A little background on me…I’ve worked in healthcare for ten years now. I currently work for a staff model HMO (we have our own physicians, PA’s, NP’s, nurses etc that provide care for our members). I’m also in nursing school.
I support a form that national healthcare run through the insurance companies (the good ones). You see, there are different kinds of insurance companies. Those that must by law guarantee coverage to everyone in an employer group, and those that offer individual coverage, and base rates on individuals. I think that the government should offer a voucher that pays for everyone to obtain basic care through insurance providers and generic drugs. All health insurance companies must have at least a good accreditation score through the Nation Committee of Quality Assurance (NCQA) or be punished in some way if that score in not increased during the next accreditation cycle. This problem would solve many but not all the issues around healthcare.
Also their needs to be tort reform, pharmaceutical reform, a reform of Medicare procedure pricing, and an increase of public health education just to name a few.
I encourage anyone looking into this, to go to the Kaiser Family Foundation’s website. They have done a ton of research into this.
This is an incredibly complex issue. As squid said you could write a 20 page paper on this. I would extend that. You could write an encyclopedia on this and still not do justice to it. Comparing America to other countries is a valid starting point only as long as you recognize the limitations of this exercise. The U.S. is very different from many other countries. Most European countries don’t have the same diversity as we do. They don’t have the same level of immigrant influx. Diets are different. Teen pregnancy rates are different. There are far too many differences to do this subject justice here, but suffice to say that any accurate comparison of lifespan, disease incidence, infant mortality or any other measure of medical care is woefully defective unless it can accurately account for all these things.
That being said there are obviously major problems with our healthcare system. As a physician who has worked in this system for 20 plus years I have a few observations of what needs to be done if we are ever going to be successful.
I don’t think we can continue providing healthcare to our population through the current mix of private and public health plans as it exists now. It is maddeningly complex and inefficient. My patients are insured under scores of different health plans; each with its own set of rules and restrictions. My staff spends endless hours trying to untangle this morass of red tape just so we can provide the basic care and get paid for it. All of this manpower could be put to much better use taking care of patients if there was a single consistent set of rules to follow. As much as I don’t like government involvement in our lives ( they do tend to screw things up most of the time), I don’t see any other way of providing universal coverage and access. I don’t think Americans are ready for a fully government run program, but if there was a program that acted like a safety net and others could opt out and purchase a limited number of private plans on their own that might be workable. All the private plans would have to be standardized though. There would have to be a standard set of rules they all had to follow, a single drug formulary, they would all have to have the same physician network, have the same method for submitting claims, use the same clinical labs and so on.
One hot button topic that all the candidates avoid completely but which ultimately is unavoidable is rationing. We do not have unlimited healthcare funds. We currently spend 16% of GDP on healthcare, and by 2016 its projected to be 20%. This is unsustainable. As medicine becomes ever more complex the cost of new and more sophisticated treatments becomes ever greater. 30 years ago when you had a headache you took two aspirin, 20 years ago you went to the doctor and got a $400 CT scan, and now you get a $1000 MRI. If someone had heartburn they took a couple of Tums worth about 10 cents, now everyone demands Nexium at $3 a pill. The benefit realized by this increased use of technology is debateable, but there is no debate that the cost is very high. When all we could do was offer the patient the bark of a willow tree or a leach the production costs of treatments was low. These days we have treatments like bone marrow transplant that may require the labor of dozens of highly trained physicians, nurses, and technicians. Down the road we are talking about treatments that are custom tailored to a specific individuals genome. As treatment becomes ever more specialized and labor intensive the costs will spiral ever higher. If you have an entire team of highly trained individuals devoted to creating a treatment for a single individual the cost is going ot be enormous. We can’t just keep saying “money shouldn’t matter” and save the patient at all costs. 20% of GDP means roughly 20% of the population will be involved in healthcare. At some point if everyone in the community is involved in providing healthcare there is no one left to grow the food, build the houses and roads, and defend the country. We have to sit down and decide what treatments we can afford and which ones we can not however distasteful that is to us all.
There are a lot of points I have not even touched on here. I only mention these two because I have a personal perspective on the first point from working in the field, and because the second point has been completely ignored by those people who are making the decisions and the headlines in healthcare issues. If society continues to ignore the need for rationing then there is no hope of ever getting control of costs. We will no longer be able to compete in the world and our economy will collapse.
P.S. If anyone is interested in seeing the show mentioned in the OP’s opening comments you can wacth it online at this link
But if a significant portion of our population cannot even afford the new technology, what is the morally right path? What I am saying is that I believe it is immoral for a country as rich as ours to deprive any of its citizens health insurance.
I understand it as a moral issue, and I can agree that a rich country should take its citizen’s health a a important topic. I was trying to express my doubts (I don’t have an answer) about the fact that maybe some beautiful public health systems wouldn’t be possible without the innovation produced in places where the system is private.
I live in a poor country, and depending on the district in this country, you can get decent public (and free) health care or not (the most common case is the later, and believe me that health conditions in some areas are really terrible). As a anecdotal evidence, in those places with decent public health care the privates companies tend to offer better plans.
I have to disagree with macgyver Regarding the impact of immigration on healthcare in the US. I base this on a recent report by the Kaiser Family Foundation. http://www.kff.org/medicaid/upload/7761.pdf
