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Old 04-24-2016, 11:30 AM
 
Location: Foot of the Rockies
86,889 posts, read 102,319,187 times
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^^Thank you. I will add, nurses are not "trained", we are educated. That was a big deal at my university.

I am actually in favor of a UHC. It will not be cheap, or even necessarily less expensive than what people are paying now. More coverage almost always means higher cost. And someone has to administer a system. It's not going to administer itself.

 
Old 04-24-2016, 11:39 AM
 
285 posts, read 272,507 times
Reputation: 286
Quote:
Originally Posted by Katarina Witt View Post
^^Thank you. I will add, nurses are not "trained", we are educated. That was a big deal at my university.

I am actually in favor of a UHC. It will not be cheap, or even necessarily less expensive than what people are paying now. More coverage almost always means higher cost. And someone has to administer a system. It's not going to administer itself.
I apologize. I did not realize there was that much of a distinction in the minds of nurses. I regularly use education and training interchangeably at the level of nurses/doctors/PAs/NPs/etc.
 
Old 04-24-2016, 11:42 AM
 
Location: Foot of the Rockies
86,889 posts, read 102,319,187 times
Reputation: 32951
Quote:
Originally Posted by philberf View Post
I apologize. I did not realize there was that much of a distinction in the minds of nurses. I regularly use education and training interchangeably at the level of nurses/doctors/PAs/NPs/etc.
No prob. Some of it, doing specific skills like starting IVs, is "training". But "trained nurse" sounds like "trained seal".
 
Old 04-24-2016, 01:16 PM
 
93 posts, read 53,185 times
Reputation: 92
"There is no country which has had "universal care... for all" for more than a few decades."

Germany has had it since the middle of the 19th century. Ironically, it was the autocrat, Otto Von Bismarck, who instituted it in 1883 in order to ward off the socialists of the time. It was not called universal care then, of course, and was not the same thing as it is today in that nation. Other nations like Britain, New Zealand, and the nordic nations began instituting it in steps, working on it gradually toward it. Britain started Universal primary care in 1911, for example. The NHS began in earnest in the 1940's, and many followed suit in the 1950's. Denmark, for example, had the beginnings of a universal care system in the 1890's. Canada began in the 1960's.

"For example, the NHS in the UK does not offer long term dialysis for the elderly. I'm sure that some people would like to get it through the NHS, but the NHS will not offer it. A lady a while back wanted a drug called perception from the NHS for her breast cancer."


Having been to England and seen the NHS in action and talked with many English as well Canadians, australians, New Zealanders, Germans, etc. about their universal systems, I have heard some stories like what you quoted above. These universal care systems are always a dichotomy between the public and the governments. Lately, the conservative governments of Britain and Canada (until Harper lost the election because of it) for example, have been trying to privatize them as much as they possible can and this has caused these systems some anxious moments. I cannot comment on the above example because I do not know the incident or what produced it and why the various parties involved made their decisions. I have also heard the stories of lives saved because of these universal systems or how they spared people with cancer or other diseases from bankruptcy.

I have also experienced the mess of our free-market health care, where your health and care are decided upon by insurance company bureaucrats organized around preserving their profits and CEO salaries over your health. This is what hell must truly be like.


"The reasons for costs is complicated. But yes, part of the reason is that we do NOT have an agreeement about what health is, what health care is, what should be paid for by whom, and so on. Some say that's part of what being in a large and diverse country entails - difficulty coming up with truly common expectations, common desires, and agreement on what to do to have those desires met in the public sphere."

First, All universal care systems are all inclusive around a core of benefits. All members of that society pay for those benefits; all share in them. This core is broad enough, however, to cover most aspects of health care. Those outside of this core can be covered by purchasing private policies. The purpose of universal systems is to protect the citizens from financial disasters and to provide better overall health of the population. I disagree that this nation has not had an agreement about "what health care is, what should be paid for by whom, and so on." This debate has been going on for over a century. To date, we have a made a conscious decision about these questions, who is included and excluded, and why, and that we do not care about millions of Americans uninsured or that the medical bankruptcies still account for over half of the national bankruptcies in the USA. We have not had the courage within us to separate Wall Street from health care, as well as using it to divide certain groups from each other.

Yet, we do have a universal system "truly common expectations, common desires, and agreement on what to do to have those desires met in the public sphere." We actually have three of them. You are right about Medicare, but the plans and all that are a result of the government siphoning off parts of medicare to the private sector, which has long wanted to get its hands on Medicare. The recent and numerous government (Republican) attempts to privatize Medicare are a result of this pattern. No doubt this has been in return for campaign contributions and other forms of financial assistance. These private plans and all are the most expensive parts of Medicare. We can offer a "truly common expectations, common desires, and agreement on what to do to have those desires met in the public sphere" if we want to. Because health care as a public good, like it is in every other democratic nation, is not necessarily a tradable commodity on the stock exchange and does not profit investors, we as a nation have not had the fiber to offer a universal, medicare-for-all plan for the public sphere.

We could if we wanted to. ColoradoCare can show us how to do it.
 
Old 04-24-2016, 01:26 PM
 
93 posts, read 53,185 times
Reputation: 92
"I am actually in favor of a UHC. It will not be cheap, or even necessarily less expensive than what people are paying now. More coverage almost always means higher cost. And someone has to administer a system. It's not going to administer itself."


I agree with you on UHC, though if you look at UHC systems in other nations, they pay far less per capita and per person than we do and have the added benefit of all covered at the same time with the same benefits package. A big part of the difference here, of course, is that the administration and how they go about administering it, as well as that they do not have to spend tons of cash on non-health care expenses like CEO salaries, marketing, and all the rest of it.
 
Old 04-24-2016, 02:14 PM
 
1,246 posts, read 919,712 times
Reputation: 1433
Quote:
Originally Posted by Katarina Witt View Post
I don't think you looked at the link. It's about nursing salaries, not physician's. The US is #2, even though most all of those other countries have higher COL. Nurses have worked hard to get decent wages commensurate with education. They're not about to take a pay cut "for the team". And while there are a few specialist physicians who make a lot, the average primary care doc's salary isn't that high. Not to mention, in a lot of these countries, the average physician's education is more comparable to a nurse practitioner here in the US.
16 Highest Paying Countries for Doctors - Insider Monkey
If you are going to compare US vs Europe some things to note.

Most salaries across the board are much lower job vs job.
Taxes are higher across the board in Europe
almost all goods are more expensive in Europe
Most people can't afford to buy a home and most rent
Most can't afford a car
Fuel is $6-$10 gal
COL across the board is much higher
Education is much less expensive in Europe
Health Care is much less expensive
If you can afford private health care you buy it (William and Kate)
Health coverage is not apples vs apples.....its cheaper but not as specialized
Forget about Dental (British teeth)
Corporations dont pay nearly as much income taxes vs US. So they tax the individual not the corporation
They are 100% dependent on NATO (US Funded, manned) for national defense

So in short if you want to be a renter with no car, less take home pay, pay more for everything you need and dependent on a foreign country for defense but have health care thats not as good but at least have it, and a cheaper degree thats not on par with the US university system......Single payer is for you but you should probably just move to Europe you will never be happy in the US.....Or you can not go to a private university for a liberal arts degree that never would have gotten you anywhere in the first place.
 
Old 04-24-2016, 11:01 PM
 
285 posts, read 272,507 times
Reputation: 286
Quote:
Originally Posted by asusual View Post
Germany has had it since the middle of the 19th century. Ironically, it was the autocrat, Otto Von Bismarck, who instituted it in 1883 in order to ward off the socialists of the time. It was not called universal care then, of course, and was not the same thing as it is today in that nation. Other nations like Britain, New Zealand, and the nordic nations began instituting it in steps, working on it gradually toward it. Britain started Universal primary care in 1911, for example. The NHS began in earnest in the 1940's, and many followed suit in the 1950's. Denmark, for example, had the beginnings of a universal care system in the 1890's. Canada began in the 1960's.
I am not familiar with Germany's system, but I have studied other systems quite a bit, both in europe and in other places around the world. I would argue that they are NOT the same across the board, and in some cases, quite different in how the different systems incentivize various aspects of health care and its financing, as well as what counts as basic minimums in various systems. That is also impacted to a large degree by the amount of research that occurs in those systems as well as the expectations of the populace re: higher end/advanced tech/expensive tech treatments. It is disingenuous to say that the various attempts at "universal health care" (which needs to be better defined in this conversation) are all equal. I will admit that there have been a number of attempts, before the NHS, but I pick on it because it is probably the most similar to what many in the US advocate for in terms of a single payor system

Quote:
Having been to England and seen the NHS in action and talked with many English as well Canadians, australians, New Zealanders, Germans, etc. about their universal systems, I have heard some stories like what you quoted above. These universal care systems are always a dichotomy between the public and the governments. Lately, the conservative governments of Britain and Canada (until Harper lost the election because of it) for example, have been trying to privatize them as much as they possible can and this has caused these systems some anxious moments. I cannot comment on the above example because I do not know the incident or what produced it and why the various parties involved made their decisions. I have also heard the stories of lives saved because of these universal systems or how they spared people with cancer or other diseases from bankruptcy.
I fully agree that a single payor system well definitely help prevent, or at least markedly decrease, the rate of personal bankruptcy due to health care expenses. That is one of the benefits that is quite appealing. That said, as mentioned before, there is rationing of care. There is rationing of care in every system, including ours. The question isn't should we limit health care usage - it's HOW should we limit it? What criteria are the right criteria to use to guarantee OR limit what health care people get? What should be guaranteed for all, and how is it going to be financed, and on what moral authority are those decisions being made?

Quote:
I have also experienced the mess of our free-market health care, where your health and care are decided upon by insurance company bureaucrats organized around preserving their profits and CEO salaries over your health. This is what hell must truly be like.
I won't go so far as to call it hell, but I agree that our system is quite broken and hideous, and I am not at all trying to defend the status quo. But I am also not trying to defend the current state of discussion around this issue. I find both the right and the left to be equally unrealistic both in their criticisms and praises, at least as it's presented in the general public sphere.


Quote:
First, All universal care systems are all inclusive around a core of benefits. All members of that society pay for those benefits; all share in them. This core is broad enough, however, to cover most aspects of health care. Those outside of this core can be covered by purchasing private policies. The purpose of universal systems is to protect the citizens from financial disasters and to provide better overall health of the population. I disagree that this nation has not had an agreement about "what health care is, what should be paid for by whom, and so on." This debate has been going on for over a century. To date, we have a made a conscious decision about these questions, who is included and excluded, and why, and that we do not care about millions of Americans uninsured or that the medical bankruptcies still account for over half of the national bankruptcies in the USA. We have not had the courage within us to separate Wall Street from health care, as well as using it to divide certain groups from each other.

Yet, we do have a universal system "truly common expectations, common desires, and agreement on what to do to have those desires met in the public sphere." We actually have three of them. You are right about Medicare, but the plans and all that are a result of the government siphoning off parts of medicare to the private sector, which has long wanted to get its hands on Medicare. The recent and numerous government (Republican) attempts to privatize Medicare are a result of this pattern. No doubt this has been in return for campaign contributions and other forms of financial assistance. These private plans and all are the most expensive parts of Medicare. We can offer a "truly common expectations, common desires, and agreement on what to do to have those desires met in the public sphere" if we want to. Because health care as a public good, like it is in every other democratic nation, is not necessarily a tradable commodity on the stock exchange and does not profit investors, we as a nation have not had the fiber to offer a universal, medicare-for-all plan for the public sphere.
You make my point. The fact that we haven't agreed is evidence that we don't agree. I understand the basic two-tier system in principle. As I mentioned before, I am not inherently opposed to single payor systems (or a number of other non-single-payor options), but I do think the details matter, and that is where we often fail in our public conversations.

You talk in generalities of a common set of core values, definition of health, health care, how much people ought to get in a single payor system, etc, but even in Oregon when they tried a similar system in the past, there were still plenty of disagreements about how to rank services, and where the line was to be drawn each year. That experiment has also changed significantly since it was originally embarked upon decades ago.

If you're so certain we've agreed on what health is, I would say that you haven't talked with very many health care providers and patients, or read much in the sociology or medical literature about how different cultures, and individuals within those cultures, conceive of health, illness, treatment, etc. Any single payor system is, by definition, going to use a specific notion of health, health care, rights language (usually) and so on that will not be shared by all. And that might be ok. We do live in a society where there are aspects of the public sphere that lots of people don't like for one reason or another, and we learn to live with it. The question is whether or not a single payor system and its benefits (of which they are not small) are worth the drawbacks (of where they are not small). That sort of cost-benefit analysis is going to be very different for different people in different stages of life from different backgrounds.

Any number of issues can be used to demonstrate that notions of health and health care (even if we got everyone to agree that it is a public good) are not monolithic in our country, state, or whatever culture you choose. Between vaccine refusals, any number of alternative models (homeopathy, naturopathy, ayurvedic, etc.), differences in what the minimum acceptable level of health care is, or how public health emergencies (like ebola, flu epidemics, etc.) should be handled, we've got lots of real world evidence that we do NOT agree on much when it comes to health care. We need to admit that and be clear about that, and then have ongoing civil discussions, instead of assuming that the opposing side is morally or educationally deficient (e.g. greedy, don't believe in science, selfish, just want to take from the hard-workers to give to the leeches, etc.).

Again, please do not assume that because I challenge assumptions about single payor systems that I am de facto defending the current system. I think the same questions I'm leveling against single payor systems are equally applicable to the current system, and the answers are so far inadequate from most corners.
 
Old 04-25-2016, 10:51 AM
 
93 posts, read 53,185 times
Reputation: 92
I am not familiar with Germany's system, but I have studied other systems quite a bit, both in europe and in other places around the world.

Due to lack of time here, I only have a few moments so will discuss this point, then come back later to the other ones you raised in your reply to my last post. Sorry about that. Hope you do not mind. I do enjoy the discussion.

I also have studied other systems in Europe and around the world. I talk with people who live in these systems. I hear the ups and the downs of them. Each one is different in their own way, though there are a couple basic models of universal care systems.

Without getting into the definition of what health care is, which can go on for eternity, and how it is defined in each system, as it has come to us from eternity the difference between our broken non-system and the universal care systems is essentially one of access. Who has access? Who does not? How much does it cost for this access? And so on, but the primary difference is one of access. Now, of course, there are more differences, such as finances, pay, and all that, but for now I will just stay with access.

Universal care systems work under the belief that health care is a public good and that it is beneficial to a society as a whole to have this for everyone. We work differently. For us, access is generally determined by the profit motive/corporate mode, with the results that we are all now familiar with. I am not sure about the experiment in Oregon that you speak about, though I will try to read up on it in the future. The point to remember is that, despite the definition of health care, the main difference is access that does not cause financial ruin.

I'll get back to this later. Thanks again.
 
Old 04-25-2016, 10:56 AM
 
93 posts, read 53,185 times
Reputation: 92
"Most can't afford a car"

I am not so sure about this. In the times I have been to Europe, everyone I knew there had a car of their own. Yet, public transportation systems are so good there that people in the cities, suburbs, and even out in the countryside often do not necessarily need one.


"Taxes are higher across the board in Europe"

They also pay for much more.
 
Old 04-25-2016, 12:59 PM
 
285 posts, read 272,507 times
Reputation: 286
Quote:
Originally Posted by asusual View Post
I am not familiar with Germany's system, but I have studied other systems quite a bit, both in europe and in other places around the world.

Due to lack of time here, I only have a few moments so will discuss this point, then come back later to the other ones you raised in your reply to my last post. Sorry about that. Hope you do not mind. I do enjoy the discussion.

I also have studied other systems in Europe and around the world. I talk with people who live in these systems. I hear the ups and the downs of them. Each one is different in their own way, though there are a couple basic models of universal care systems.

Without getting into the definition of what health care is, which can go on for eternity, and how it is defined in each system, as it has come to us from eternity the difference between our broken non-system and the universal care systems is essentially one of access. Who has access? Who does not? How much does it cost for this access? And so on, but the primary difference is one of access. Now, of course, there are more differences, such as finances, pay, and all that, but for now I will just stay with access.

Universal care systems work under the belief that health care is a public good and that it is beneficial to a society as a whole to have this for everyone. We work differently. For us, access is generally determined by the profit motive/corporate mode, with the results that we are all now familiar with. I am not sure about the experiment in Oregon that you speak about, though I will try to read up on it in the future. The point to remember is that, despite the definition of health care, the main difference is access that does not cause financial ruin.

I'll get back to this later. Thanks again.
I thoroughly understand the argument re: access. My point is that we don't have agreement on those questions you ask, because we don't have agreement on what health care is (positive right? Common good? Privilege? Something else?), or what counts as adequate access. Will you force practitioners to accept whatever the single payer pays/is? Can practitioners opt out entirely and operate solely on cash/private insurance? Why or why not?

There are both upstream and downstream moral and ethical arguments that have not been adequately discussed to determine if we have enough common ground to actually get things done in a non-authoritarian manner and not tie up the project in the courts. Now, some might argue that we just need a more authoritarian approach in order to implement a single payor system and that might be ok with some, but it is likely not ok with others for any number of reasons. That goes all the way back to the arguments of the Federalist Papers.

If it were easy to get consensus on this topic, it'd be done already. It is not, and so my point is we need to continue to have robust discussions and pursue the lost art of moral persuasion while being respectful of those who conceive of their good life (e.g. how much health care for the common good should I be made to pay for) differently than others.

As for the Oregon project, see https://en.wikipedia.org/wiki/Oregon...an?wprov=sfsi1
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