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"As a side note, there are some things that even our gov't pays for that other nationalized systems do not - specifically long-term chronic hemodialysis for those with kidney failure. If you qualify for that, medicare will pay for it for the rest of your life. I know of no other system in the world that will provide that."
"qualify" is the main word here. While I cannot as of yet vouch for which systems will and will not pay for it (not time to go through and try to find out right now), qualify is the problem. I doubt that a private insurance system would pay for it for life, or that an uninsured person could get this treatment for the rest of their lives.
"Is it "fair" or "just" (depending on how you define those terms) that patients in one country has access to a newer technology while another patient in a different country does not? Why or why not?"
Is it fair or just that patients in the same country have access to the newer treatments and others do not simply because their kind of insurance dictates what they can have versus what they cannot have in newer treatments? Since we are talking about the same country, I thought I would bring it back here
"This is why I'm not a big fan of current efforts by either the left or right because they fail to see the true issues underlying the system. Both just try to gloss over the very real issues we have with expectations of patients, of health care systems, of expectations of what money can and cannot get in terms of health, and so on."
The main differences between our broken system, whether in Colorado or in any of the other states, and a UHC system are access and cost. The UHC systems are for the good of the public; ours is for the good of the insurance company. If we try to parse it down into definitions or issues of health care, we lose sight of this difference. I do agree that there are issues underlying each kind of system that are not always on the surface. I have heard all those horror stories about shoddy hospitals and long wait times in UHC countries. I have also experienced both here There is, for example, in Michael Moore's movie "Sicko," a gut wrenching scene where a hospital in Los Angeles dumps an afro-American woman off in the street by a shelter to get her out of the hospital because she did not have insurance. This would not happen in a UHC system.
This does not mean that those underlying issues you mention are not important. They are. Yet, those issues do not do any good unless everyone has access across the board. When you say the US has made the "sacrifice in #2," (care for all), "but starting to lose on 3 as well because of the emphasis on #1)," it is not only starting to lose, but has lost. And the US does not always emphasize #1, even for those with insurance. No matter how it is defined, health care does no good unless one can access it at a cost that does not cause financial ruin. This is where UHC has it over us.
"It would have cost too much. It was poorly conceived on a premise of "If what you have costs too much for us to treat it, sucks to be you". People moved out of Oregon to get certain treatments covered."
From what I read on the link that philberf posted here, the Oregon experiment simply did not go far enough, was trying to do too much with too little, while keeping the problems in place.
"It would have cost too much. It was poorly conceived on a premise of "If what you have costs too much for us to treat it, sucks to be you". People moved out of Oregon to get certain treatments covered."
From what I read on the link that philberf posted here, the Oregon experiment simply did not go far enough, was trying to do too much with too little, while keeping the problems in place.
I hate to sound know-it-allish, but I know far more about this than what is contained in that link. I worked in health care for a long time, just recently retired. I can tell you this Oregon plan was supposed to be the Holy Grail. It didn't work. It's hard to find links for something that happened 20+ years ago. Here's something:
Health Reform Interrupted: The Unraveling Of The Oregon Health Plan "Put simply, Oregon intended to expand Medicaid to more people by covering fewer services. Expanding coverage for the poor—all Oregonians with incomes below 100 percent of the federal poverty level were made eligible for Medicaid—would be made affordable by offering recipients a basic health benefit package, one more limited than traditional Medicaid. A prioritized list that ranked medical conditions and treatments based on clinical effectiveness and “net benefit” was developed. Depending on how much it decided to spend on Medicaid, every two years the state legislature would literally draw a line in the list, with Oregon Medicaid paying for all services above the line and no services below it."
I've exceeded my limit, you'll have to read it.
Here's another one, an opinion piece: The Guinea Pig State | The Weekly Standard "Then there were two important secondary issues that Oregon had trouble addressing. First, ranking medical procedures by their cost, effectiveness, and necessity is a complicated and imperfect process. How do you compare two potentially lifesaving procedures and decide which should be ranked higher on a list? Indeed, the state’s first attempt at ranking medical procedures was alarming. "
LOL Asusual......You reference a Michael Moore movie which all are largely fiction. Using his movie which promotes Cuba of all places to make your point is hilarious. Yes Cuba where their health care is so great thousands of people every year literally try to float their way through shark infested waters for the horrible system the US has.
You do realize a major reason why hospitals bill so much is because people actually use ER's for primary care physicians? People literally think the ER is for common ailments like fevers, flu, sprained ankle......Why do you think 24 hr health clinics are popping up everywhere? They're cash cows and people are too stupid to realize they charge a 5x premium of their services.
Colorado Care might pass in CO, it might not. If it does companies with satellite offices in CO will close. It will draw people that really can't contribute much to the economy because it's free!!!! For them at least but people like me will have to pay for it with my taxes and I will move out. I dont ask you to pay anything for me.
"You do realize a major reason why hospitals bill so much is because people actually use ER's for primary care physicians?"
Surprisingly, I do understand this and it speaks loudly to why we need a single-payer type system. They use the ER for their primary care physician because they cannot afford to go to a primary care physician. In nations with single-payer systems, they do not have to use the ER for their primary care physicians.
"People literally think the ER is for common ailments like fevers, flu, sprained ankle......Why do you think 24 hr health clinics are popping up everywhere? They're cash cows and people are too stupid to realize they charge a 5x premium of their services."
You're right that these clinics are cash cows for those who run them and profit off of them. I am not sure if the people who go to them are too stupid or too desperate, but I also suspect you are right in that they do not know how much these clinics are ripping them off.
"You reference a Michael Moore movie which all are largely fiction. Using his movie which promotes Cuba of all places to make your point is hilarious. Yes Cuba where their health care is so great thousands of people every year literally try to float their way through shark infested waters for the horrible system the US has."
Well, for one, if thousands of people are fleeing Cuba every year, are they fleeing just for the health care in the USA. I would like to see the basis for that. And Mike Moore's film was not fiction. In fact, health insurance companies were deathly afraid of that movie because it told the truth and did what they could do to discredit it. The fiction you say that it is, is a result of that campaign. Here is a former CEO of an insurance company apologizing to Michael Moore for his role in trying to damage Moore and his movie.
"Put simply, Oregon intended to expand Medicaid to more people by covering fewer services. Expanding coverage for the poor—all Oregonians with incomes below 100 percent of the federal poverty level were made eligible for Medicaid—would be made affordable by offering recipients a basic health benefit package, one more limited than traditional Medicaid."
Why did you exceed your limit with this? Again, from what you've said here, it sounds like it was trying to do too much with too little and succeeding imperfectly in both because Oregon did not address the problem, just skirted around it. That line in the sand sounds crazy. If I get time, I will try to read up on that experiment.
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"qualify" is the main word here. While I cannot as of yet vouch for which systems will and will not pay for it (not time to go through and try to find out right now), qualify is the problem. I doubt that a private insurance system would pay for it for life, or that an uninsured person could get this treatment for the rest of their lives.
...
Is it fair or just that patients in the same country have access to the newer treatments and others do not simply because their kind of insurance dictates what they can have versus what they cannot have in newer treatments? Since we are talking about the same country, I thought I would bring it back here
I'm not sure if I'm being clear. Every system has criteria on who gets in, and what they get. You have to make the case for your criteria, just like defenders of the current system have to make the case for their criteria, and why those criteria are better (more just, more fair, etc.) than others.
In the current system, if you can pay for it, you can get it. That can be a combination of self-pay, insurance, cost-sharing plans, etc. But if you can't pay for it, there is no guarantee that you'll get it. You may still get something via any number of other parts of the health care system (e.g. public health care networks and hospitals, non-profit health care networks dedicated to serving the uninsured or underinsured, etc.). Those who support this type of system often do claim a sort of fairness. If you can get the "right job," than it is just and fair to get the benefits associated with the job, such as health insurance. That's an oversimplification, of course, but my point is that there is a sort of fairness that some would appeal to.
In a supposed single payor system, you still have to make the same decisions - who is all? All citizens? does it include green card holders? anyone who has lived in the US for a certain amount of time? how do you verify that? Once you've determined who, and justified why that is "fair" to the people you exclude, then you have to do the same thing as above - decide what is covered. Will a single payor system cover ALL possible health care items? why or why not? where will the line be drawn and why? Why is it fair to draw the line there?
I have my own thoughts on this, but they do not fit neatly into either of the two above categories, and my notions of fairness/justice are certainly not going to be shared by all, and so I will not presume that all would agree with them in a manner that would lead to a single payor scheme guided by my notions of justice and fairness (at least as it applies to healthcare).
Quote:
The main differences between our broken system, whether in Colorado or in any of the other states, and a UHC system are access and cost. The UHC systems are for the good of the public; ours is for the good of the insurance company. If we try to parse it down into definitions or issues of health care, we lose sight of this difference. I do agree that there are issues underlying each kind of system that are not always on the surface. I have heard all those horror stories about shoddy hospitals and long wait times in UHC countries. I have also experienced both here There is, for example, in Michael Moore's movie "Sicko," a gut wrenching scene where a hospital in Los Angeles dumps an afro-American woman off in the street by a shelter to get her out of the hospital because she did not have insurance. This would not happen in a UHC system.
This does not mean that those underlying issues you mention are not important. They are. Yet, those issues do not do any good unless everyone has access across the board. When you say the US has made the "sacrifice in #2," (care for all), "but starting to lose on 3 as well because of the emphasis on #1)," it is not only starting to lose, but has lost. And the US does not always emphasize #1, even for those with insurance. No matter how it is defined, health care does no good unless one can access it at a cost that does not cause financial ruin. This is where UHC has it over us.
You've made a number of assumptions that not all would agree with. A single payor system does not necessarily drive down costs unless you limit expenditures by limiting coverage. The same problem of increased utilization leading to increased costs will exist in a single payor system as in our existing system, unless we cap expenditures (like the NHS does). to be fair, it may initially drop costs as we get rid of a lot of administrative bloat (to start), but that's likely temporary, unless society has a fundamental reorientation towards how we use health care.
Again, it does matter how you define what health care is, because if you claim it to be for the good of the public, you have to define what "good" means and who the "public" are.
Is the "good" all possible interventions? why or why not? last ditch chemotherapy? homeopathy? naturopathy? reiki? anointing with oil? ayurvedic medicine? Someone still has to make these decisions and defend them in the public sphere. And again, for the record, I'm not fundamentally opposed to doing this in our country/state. I am bothered by the unwillingness to face up to the real questions that would help us figure this out.
If we want a single payor system, we need to admit that costs will go up if we don't cap what we do for people, and we have to figure out how to morally/ethically justify capping it in whatever way we end up deciding. As I mentioned before, the NHS decided there are certain things older patients just don't get. things that our older patients here in the US generally DO get. That's one way to control costs. But it requires more than simple legal decree or de facto administrative refusals to morally and ethically justify such decisions.
Lots of things are NOT on the table in Cuba. That doesn't mean it's automatically worse - it just means we really need to be clear about what is offered and to whom. Additionally, because different people have differing notions about what "good" is in general in their life, there are many people who are willing to give up the single payor system in cuba because of the other limitations on the "good life" placed on them in Cuba. Again, that makes the point that health care, even in a single payor system, may not be desirable depending on what other sacrifices/requirements are placed on the people in that society.
It is that question that we must ask and answer in the US - what are people willing to give up to get a single payor system, because we will have to give up things. We might be willing to do it, but let's not pretend that we can simply institute a single payor system and keep all the benefits we currently enjoy in our current system.
Has anyone seen polling numbers on this subject? Is it currently likely to pass? Not pass? I realize it is still very early but I'm curious.
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, I thought I would bring it back here
