Saturday, January 12, 2008

Universal Healthcare

My friend Scott Freeman has a daughter Cassie. She has a mild case of arthritis. She can't get healthcare. Because of her arthritis, she cannot get healthcare coverage. Because it will cost more to care for her than the insurance companies can make by covering her, they won't cover her.

Cassie is one of 47 million people in America without healthcare; 16% of the population of the United States. And this isn't a victimless or faceless situation. Cassie is the face of this.

18 comments:

Brian said...

Here in New Zealand, we have socialised health care, and no-fault accident compensation. These two systems mean that no one is denied health care. It is no a perfect system by any means, but it does away with the need to litigate, and it ensures that even the poorest person will get adequate medical care. Several years ago, my mother spent three days in ICU after a major heart attach - it cost us nothing! You gotta love a system like that.

I happily pay taxes for this type of health system.

Scott said...

Thanks for talking about this. There is where my political idealism comes out. I believe that all organizations and structures should be first and foremost good and care for the wellbeing of its people. When there are those who are unable to provide healthcare for their children then there is no claim that can be made for goodness.
One of the amazing things about our situation is that all of Cassie's care for her arthritis is free. We have documentation from her physician that it is a minor case and no escalation of the illness is expected. We got that letter in hopes that they would consider a rider that excluded all arthritis care. But that is not good enough.
It's amazing how universal health care is such a hurdle in this country when so many developed countries have it.

Tony Arnold said...

To me this is not about the need for Universal Healthcare or government provided healthcare, it is about greed which in the long run costs us all more and forces inefficient behavior in the long term.

The Healthcare companies refuse to insure certain people, at any cost, because it does not help there short term profits or stock price.

Eventually, these insured have to be taken care of, but not until we have let it go to the point where such costs are much higher due to inflation or due to the disease progression and patient deterioration

The burdern of this much greater cost (measured in more than just $) is then shared across the healthcare provider, drug companies, the bulk of the insured, the patient and family so that everyone loses.

If we go to socialistic solutions the cost are higher both in money and expedience/convenience of treatment. I suggest that any government cannot manage healtcare as efficiently has a healthcare industry focused on long-term profits and to be in business 20 years from now.

The real problem is such short-sighted behavior by our current healthcare insurers and providers. If they did not act unreasonably then we would all be better off. Scott just showed a perfect example of their unreasonableness. He wasn't trying to get healthcare for free from anyone and they still would not be reasonable.

Insanity that breeds higher, long-term costs for us all.

Red_Cleric said...

You've opened a BIG can of worms with this debate. There is NO easy answer. The issue in Great Britain, Canada, New Zealand etc. is different than the U.S. for a number of reasons. Number of people being covered, quality of care issues etc. [ask someone on a waiting list for elective surgery in England].

The U.S. has a strong "profit motive" ingrained into it's culture and you're as likely to expunge that as you are getting "tea" out of Britain.

Let me suggest that one problem with US health care is the current state of Tort law. When attorneys can get astronomical settlements 40% of which go in their pockets, the risk of that is passed along to everyone via malpractice insurance.

Here's a scenario worth considering. First, police the medical profession so that there is "national license to practice medicine, sort of like driving a truck. Bad doctors can't leave Oregon and go to Texas, then Nevada etc.

Get rid of the cranks once and for all. Secondly, limit the amount of money an attorney can make on a lawsuit. Let's say a top end of $25,000 or maybe $50,000 if it's a class action suit. It could even be a percentage say 6% but it is the "lessor" of the two amounts.

Suddenly, the mismanaged surgery, and accidental deaths that DO happen are no longer profitable for lawyers. They will not be too willing to take such cases if they are going to settle out of court for $25k and only make $1,500 bucks.

That would go a long way to reducing the horizon of risk the companies face and make health care affordable.

BTW in Abilene Texas there is clinic that was opened in the early 80's to serve under-insured people; those in between the cracks.
Once more it was begun by First Central Presbyterian Church.

Peace
Alan
PS. sorry for the long post...

Justin said...

This is a hard thing to talk about, especially because its so personal for many people. How do you have a discussion with someone about the merits or problems associated with Universal Health Care when they have been screwed by the corporations for whatever reason? I don't know that there is a way.

Things we should be careful of (in my opinion):

What are our definitions of socialized medicine? Is it government having complete control over all things health related; where you doctor is a government employee? Or is it a system where the government pays for the care, but doctors and hospitals are still privately owned?

Is there a solution that will not decrease quality of care, or increase waiting times?

How much care is enough? We can do things for people that we cannot afford... if the government controls our health care, and hence our health care decisions, do they get to decide whether you stay on life support? Since the government is paying for it, it would seem that decision is left up to them. In a system like Canada's, you cannot pay for healthcare yourself. It is illegal. If they decide you can't have a surgery, or that you have to wait an extraordinarily long period of time, tough.

As much as I hate tort lawyers who get rich on poor people, and drive up medical malpractice insurance making insurance more expensive... if something does go wrong, and government is in charge of care... who is held liable. Can you sue the government? And if you can sue the government, do you think you're going to win? And if people do win, the government recoups the lost money by what... raising taxes.

There are a lot of problems with Universal Health Care, from my point of view. There are just as many, if not more problems than with our current system. I don't really have a plan, either, so I don't know if that allows me the opportunity to speak my mind on it.

If the government is going to be involved, I would say the best situation is something simliar to Mitt Romney's plan, where government pays for HSAs for poor people to get preventative care, as well as incentives for getting preventative care. And government paying for individual and family insurance for catastrophic things for those who are poor. In this situation, you would get rid of tax incentives to businesses to pay for large group plans, and give those incentives to individuals who are buying their own health care.

Still, you have an issue. Do you require by law that someone get health insurance? And if you do, do you enforce that law and how so.

And even then, if someone doesn't want to buy health insurance, do they not have that right in a free society? Must they sign a waiver saying that the government won't pick up the tab if they get sick?

I think the biggest problem in all this is that we've come up with unbelievable technology to treat illnesses. But these technologies are not cheap. Should all technology be available to all people regardless of ability to pay? If we make that law, is it possible that R and D money is deflected to cover lost revenues from forced treatment? And if that happens, would not our quality of care go down?

This is such a multifaceted issue. I can say with certainty only one thing. And that is that we've got a catch 22 with regards to health care. and I don't know that we can fix it.

Anonymous said...

I have no idea the answer to the problem, but one thing I do know...the same government that ineffectively runs other things should not EVER be allowed to control health care. There has to be a better way. I suggest looking to Romeny's plan as well.

Justin said...

anonymous,

if that is the entire basis of your argument, do you believe we shouldn't let the government run wars, cause they are ineffective at it?

If you think you're for limited government, you better bet anti war and empire.

Scott said...

It would be so much more beneficial to talk about the merits of proposed plans but it's easier to resort to the tired old arguments that the government can't do anything effectively or efficiently (which is total crap) or billing it as socialized medicine.
None of the leading democratic nominees are talking about free coverage. As Tony indicated I'm willing to pay and expect to pay for my child's health care. I just want her to be covered at a cost that is not exorbitant. And that is the feeling of most people. There is a way to make health care affordable for all Americans. Unfortunately some resort to the same old tired and uninformed arguments that fail to see the problem and fail to produce change.

Justin said...

Scott,

I really don't want to get in this discussion, cause I'm afraid feelings will get hurt, but I don't understand what you mean by affordable? I thought the issue was not being able to get coverage? I can understand how that is frustrating. But affordable? Where do we draw that line? Carrie and I are paying roughly 150 a month for health coverage, 25 of which is a minimum monthly deposit into an HSA. We have catastrophic coverage, and we will use the HSA to cover doctors visits and meds. Granted, we do not have maternity (and my dad was pissed when I told him that) but its 200 extra bucks a month that we can't afford. From what I understand, it cost around 12 grand to have a kid.

I understand that the larger your family is, the more expensive the coverage, but what does individual coverage for a family of 5 cost? And what would be affordable? Like I said, I can see how not being able to get coverage is frustrating and a problem, but what is affordable? And if an insurance company isn't making money or is forced to accept someone for whom they will likely pay more money than they will ever receive, how do they stay in business?

Like I said, I really feel for you, and I don't know exactly how I'd feel in your position. I just have trouble dealing with what the ramifications are for people at large. Who determines what is affordable for one? How much coverage is "fair"? How much of government's revenue should be spent on the health care of the nation? I'm all for eliminating most of our defense spending, but even all the money we spend on defense, I don't see how we can afford to spend that percentage of government revenue on health care, because the cost won't go down. It will continue to rise, even if just because of population increase, and new more expensive technology.

Brian said...

Justin, you said "From what I understand, it cost around 12 grand to have a kid." If that's medical costs relating to the birth, then come to New Zealand and have the kid for free. If the $12k is running costs, then we can't help you there. (Except that university costs are about $5000 per year!)

Justin said...

No Brian, its not free.

Someone is paying for it, just not you.

Scott said...

Justin, I have no desire to engage our resident economist but there are ways to provide health insurance for all people that wouldn't cripple the government, destroy capitalism and usher in Armageddon.
What is affordable? What we can afford. But it's a moot point since my daughter can't get coverage, period. Despite the fact that there is no cost for her arthritis care.

Brian said...

Justin, I do agree, there is no free lunch (or baby), but given a choice between paying $12k in a single payment or contributing in my taxes so that everyone can benefit, then I prefer the latter.

The subject of lawyers' fees has already been raised in this thread, along with the upward push in prices because of their slice. When you don't have the component of legal fees factored into the medical pricing, health care would cost a fraction of what people are paying in the US.

Here's another example. A guy I know personally, visited NZ from the US. While here, he needed hospitalisation for three days. Because he was not an NZ citizen, he had to pay full hospital fees, which came to $1200. That included the Dr fees, meals, meds - everything.

I'm saying this, and my earlier post, only to say that there are other models for providing medical care.

Thomas+ said...

I believe that basic health care should be the right of every citizen in a modern state.

I think end of life care, as well as truly elective surgery, should be the financial responsibility of the patient. They should be able to buy coverage for these items, if they wish.

Deciding between "basic" and "elective" is the can of worms, and will always be messy. That said, I don't see any good reason why the U.S. can't have the same health care as most of the rest of the Western World.

My 2 cents.

belinda said...

Is this on a state by state basis? The reason I ask is because a friend of mine is diabetic (I live in Alabama). She pays more for her health insurance than I do but she told me states were required to offer some type of health insurance. It was illegal to deny insurance benefits.

I'm all for Univeral Health Care!!! Come quickly!

Snapshot said...
This comment has been removed by the author.
Justin said...

Brian,

Why would there no longer be legal fees? My point is that winning a lawsuit against the government is nearly impossible.

You cannot compare New Zealand with America in regards to Universal Health Care for a few key reasons.

One, we have a whole lot more people here, and 50% of them contribute about 4% to total income tax revenue. That means, half the country is all ready paying the way for the other half. And we don't have Universal Health Care. Add that in, and its going to increase the expenditures of the Federal Government. Do they get that money from raising taxes even more? You can't raise taxes on the poor here. Its not going to happen. So you raise it on the wealthy. Would you work for less than 50% of each dollar (or unit of currency) that you earn? Eventually, a tax hike of that proportion will slow down the economy. When that happens, revenues to the government go down, and once again, we're struggling to afford all of our entitlement programs.

If we could cut all military spending, all other entitlement spending (social security, welfare) and various amounts of pork, then we might be able to afford it. But the truth of the matter is, that by 2040, the US will only be able to pay the interest on social security and medicare. Just the interest. And that's all. No defense. No transportation. Nothing.

The world is gonna be a very different place at the end of my life. And not in a good way. Unless something is done. And I don't care what letter follows their name. Someone has to step up and do SOMETHING. And adding more spending is only going to hurry the day where our government goes completely broke.

(Course, that might not be so bad, in the grand scheme of things. Maybe we libertarians can swoop in and start things over the way it was meant to be from the beginning.

And all this doomsday prediction will only be correct if it doesn't happen sooner because all of our government backed banks fail. The federal reserve and its inflationary policies are finally coming to a peak. It may be 1970s again. Or it may be the 30s. Or it may be worse.

Anonymous said...

There is a lot of misinformation about health care in these posts, especially with regard to how the different types of health care are funded. As someone who works for a health care provider, I find that most people don't understand how our current system works, let alone the different universal / single payor systems currently employed across the globe. Wikipedia has a very detail analysis of both sides of the universal aurgument here, and compares the different systems currenty employed in the industrialized world.

Template Designed by Douglas Bowman - Updated to Beta by: Blogger Team
Modified for 3-Column Layout by Hoctro