Time for universal health care ? (wages, lawyer, weapons, suspect)

[Old Gringo]

No, it's long overdue.

We should have started it decades ago.

[Ralph_Kirk]

Originally Posted by mSooner

My background is that I am the spouse of someone currently in medical residency.

1. The liability problem is a big issue. My husband sees imaging all the time that is probably inappropriate and unecessary, but should the doc ordering it be sued, you can bet they will be asked why they didn't order it. If you want Universal Health Care, you aren't going to be able to sue if things go south.

Or rather, "malpractice" will have to become a much more strict concept than it sometimes is under tort law. Even military medicine--which by law has zero responsibility to the patient--still has the concept of malpractice...because you can't win a war if doctors are screwing up your soldiers through ineptness, laziness, or stupidity.

2. Docs like my husband will be paid less. For some specialties, that is probably appropriate, though primary care really gets the shaft now. I think most would be okay with that if they were given the benefits doctors abroad get--mainly, limited liability, free medical school (and usually on a faster track), pension retirements, and other allowances. Right now that is all being funded by the income doctors make now. Consider that the average doctor leaves medical school with $250k of debt (not including any undergrad) and spends 4 years in medical school and then 3-10 in residency training depending on specialty.

And that is why some doctors go into the military. It does all that.

3. In the US we are used to a standard of care that is going to be really hard to get away from. Private hospital rooms, low wait times, nice buildings. There are all sorts of crazy rules that end up with tons of money being spent that we could avoid, but people are going to scream if it goes away. For example, my husband had a French medical student rotating with him during his intern year. They had a guy in the hospital on medicare that needed to be discharged to an assisted care facility, but he was being a pain in the ass and didn't like any of his options. Legally, they could not discharge him until they worked something out and every day in the hospital was on medicare's dime. The French student asked why they didn't just discharge him and let him figure it out--that's what they would do in France.

Umm, some American patients get all that, if they have medical insurance and if their insurance is good.

4. Private health care still exists in many of these countries--you just have to pay for it. And that is probably what many would do here. But we are such an egalitarian society--you don't think people are going to cry foul when those who can pay for it enjoy much nicer facilities and have access to treatments (potentially life saving) that someone on a national plan does not? In the US we want the best, but everyone has to have it. That's not how it works abroad. You have to lower the standard of care for everyone to have access--and that may be a great thing overall. But people here are going to flip their lids if and when that system come to be.

That's already the way it is.


A couple of years ago, I was acquainted with two young women who were diagnosed with leukemia with 30 days of each other. One was on Medicaid, the other on an employer insurance plan. I watched both of them go through their cancer treatments.


The woman on Medicaid got a far, far cheaper level of care than the woman on insurance. One huge difference was that the woman on insurance did, indeed, spend much more time actually in the hospital after chemo treatments, and was able to see her doctor much more often for complications than the woman on Medicaid.


OTOH...the woman on Medicaid did get the treatment she needed to save her life. So you're describing a situation that would certainly not be any worse than the situation today, and better for most.


I've lived in countries in the Far East where they would leave you bleeding on the hospital steps if you didn't have cash in your pocket to pay for treatment.

[vladlensky]

Originally Posted by redguard57

I also have one of those plans. My employer practically begs us to choose it because the premiums are so much lower. If you can go without seeing the doctor for.... about 3 years for anything other than a routine check up, the cumulative impact of your employer's HSA contribution in addition to whatever you contribute should add up to well more than the out of pocket max.

The problem is that it's kind of like the Hunger Games in that you have to last long enough for it to be worth it. You need to have a good number of healthy years. If you can go 5 or 6 years accumulating employer contributions without drawing much from the HSA you can start investing the funds, which is kind of a cool feature.

Still, it's not exactly equitable because it only favors the healthy and problem-free. Unfortunately, the Republican / corportate approach to health care reform is AT BEST some kind of HSA-based plan.

Yes, it is a huge gamble. After having had no health insurance for a few years after college (unemployed/under-employed), I've learned to sort of estimate my average costs per year plus risking the odds of something catastrophic happening. When I was uninsured I was lucky enough to find a no-insurance general practitioner nearby who basically got fed up with the system and started a cash-only business. It worked well for a few years, but only because I remained relatively healthy and used the service for the occasional minor ailment. This Dr. actually charged by 'problem'. To see him for 1 problem was $80, 2, $150 and so forth with somewhat of a bulk discount offered.

Today, I'm basically in the exact same position, only with the employer-sponsored 'safety net' of the HSA to bail me out if I need to visit the urgent care. That HSA will quickly go away if something truly serious happens, but for now I have it as a cushion against the high deductible. If you look at plans like this, you really have to be in for more than several thousand dollars in premiums and deductibles before insurance means anything at all. And, even after the payments kick in, you're still on the hook for 10-20% of the remaining balance under most plans. It's quite easy to see how someone with even adequate health insurance could quickly end up in major financial trouble after even 1 major illness. I've known several older folks who've had heart attacks which quickly crossed the half-million mark. My friends just had a baby several months ago and received a bill for $15,000 (after insurance!) from the hospital. These kinds of healthcare costs are just not realistic for the vast majority of people.

[vision33r]

Universal healthcare means you can't sue, no insurance, and no safety checks. Every other country have malpractices all the time and no lawyer to sue. Everything cost more here because of lawsuits.

[snowtired14]

Originally Posted by sonofagunk

As long as the middle class is willing to pay 50%+ in income taxes, I see no problem with it. The money has to come from somewhere, and there are not enough "rich people" to pay. Check out the tax rates of the above countries

I haven't read all of the posts, but if you consider what many people actually pay in premiums and deductibles, we're probably paying the equivalent of 50% out of our pay for too many of us. Employers used to pay more, but now they limit their contribution and leave the rest up to us. The other thing to consider is the quasi- social medical system as it is, if you fall under a certain income or are within a particular demographic, you get free medical. How is that fair? If you work, you pay, if you lose your job, you go without, if you have nothing, you get free medical. HUH???????

[snowtired14]

Originally Posted by vision33r

Universal healthcare means you can't sue, no insurance, and no safety checks. Every other country have malpractices all the time and no lawyer to sue. Everything cost more here because of lawsuits.

But how do lawsuits improve our system of healthcare? We no longer rank number one in a number of benchmarks of national health. Seems lawyers, big pharma, healthcare for profit is able to lobby in their best interest over our ability to elect representatives who might look out for us.

[mSooner]

And that is why some doctors go into the military. It does all that.

I don't get it? Obviously that isn't a solution to the problem. You also have to give years of your life to the military in order to get the training. It's a great option for some, but I don't really get your response in the context of this thread.

[snowtired14]

Originally Posted by mSooner

I don't get it? Obviously that isn't a solution to the problem. You also have to give years of your life to the military in order to get the training. It's a great option for some, but I don't really get your response in the context of this thread.

Obviously it's because they don't deal with insurance companies or government mandates, the VA is kind of like a micro-system for UH.

[cupper3]

Originally Posted by mSooner

My background is that I am the spouse of someone currently in medical residency.

1. The liability problem is a big issue. My husband sees imaging all the time that is probably inappropriate and unecessary, but should the doc ordering it be sued, you can bet they will be asked why they didn't order it. If you want Universal Health Care, you aren't going to be able to sue if things go south.

Who told you that a medical practitioner cannot be sued under universal health? That would be news to Canadian doctors. The comment is either deliberate misinformation or made from ignorance.

2. Docs like my husband will be paid less. For some specialties, that is probably appropriate, though primary care really gets the shaft now. I think most would be okay with that if they were given the benefits doctors abroad get--mainly, limited liability, free medical school (and usually on a faster track), pension retirements, and other allowances. Right now that is all being funded by the income doctors make now. Consider that the average doctor leaves medical school with $250k of debt (not including any undergrad) and spends 4 years in medical school and then 3-10 in residency training depending on specialty.

Doctors are among the highest paid professionals in Canada. The office cost of operations is less, as the office staff required to administrate all the different health insurances is not required. Rather than seeing the billing clerk first as happens in the US, you simply either present your healthcare card, which if you are a returning patient is already on record. Liability insurance is less in Canada. As I stated elsewhere, Canada spends 1/3 less as a percentage of GDP compared to the US, with better results; people simply live longer.

3. In the US we are used to a standard of care that is going to be really hard to get away from. Private hospital rooms, low wait times, nice buildings. There are all sorts of crazy rules that end up with tons of money being spent that we could avoid, but people are going to scream if it goes away. For example, my husband had a French medical student rotating with him during his intern year. They had a guy in the hospital on medicare that needed to be discharged to an assisted care facility, but he was being a pain in the ass and didn't like any of his options. Legally, they could not discharge him until they worked something out and every day in the hospital was on medicare's dime. The French student asked why they didn't just discharge him and let him figure it out--that's what they would do in France.

The situation you described is easily fixed. The standard of care in Canada is at a very high level, for the procedures that are urgent. Knee replacements don't count, and the wait times ARE longer than in the US, but that is usually a lifestyle problem. Critical care is immediate, and indications are that chronic care is at a higher level than in the US. Having no HMO means choice of doctors, and frankly, specialists. No deductibles, no or low insurance rates (I pay none now, but we used to pay $52 family rate 10 year ago before they were eliminated). I've had the misfortune of having to spend 3.5 months in hospital 12 years ago. I can't imagine the impact that would have had on finances in the US. In Canada, it simply was part of the care, and has no impact on personal finances.

My doctor this year wanted me to have a colonoscopy. As I am a snowbird, I considered having it done in the US. That quickly changed when I found out it would cost me $1500-2500, PLUS my wait time was longer! Talking to friends down in the US, the wait time quoted in the US was standard. I instead made my Canadian appointment, and it cost me $415 to fly back, return.

4. Private health care still exists in many of these countries--you just have to pay for it. And that is probably what many would do here. But we are such an egalitarian society--you don't think people are going to cry foul when those who can pay for it enjoy much nicer facilities and have access to treatments (potentially life saving) that someone on a national plan does not? In the US we want the best, but everyone has to have it. That's not how it works abroad. You have to lower the standard of care for everyone to have access--and that may be a great thing overall. But people here are going to flip their lids if and when that system come to be.

There is no private healthcare allowed in Canada, with some exceptions. Suffice it to say, 99.9% is covered by universal healthcare. This does not include pharmaceuticals, dental or woo stuff like chiropractors. When I was in the hospital I mentioned, I had world class specialists take care of me. Again, Canadians live longer, so the overall quality of care obviously is high. And yes, I know of anecdotal areas you will hear so often in the US about negatives of the Canadian system. The key word is "anecdotal".

I have a cousin who is a GP in Germany. They have a rather strange system to you and me, even though it does have universal health. Over a certain income level (which I don't know the cutoff), many go onto a private insurance scheme. My cousin operates a 3x a month Saturday triage system for his private patients, which constitutes over 70% of his income!

I've been there... he has a caterer set up a buffet of smoked salmon, lobster salad, caviar, and other high end 'goodies'. He also has a number of cabs parked outside, and as he triages his patients for various issues, and then sends them by cab to various specialists he works with. His patients love him and this concierge service, as do the specialists and his banker. In fact, he says he could not operate with out that private income, but then, his standard of living expectations is a lot higher than mine.

I have no idea if universal healthcare could ever be implemented in the US for various reasons. One is the built in prejudice propagated by decades of agitprop by special interests, especially by insurance companies, against it. The FUD factor is huge.

Secondly, because of the Constitutional setup of power of the States versus the national government, I see all sort of obstacles, regardless of the SCOTUS rulings on the ACA. What may be acceptable in South Dakota may not be in Alabama.

I hope I gave you a perspective you may not get from within the system.

[cupper3]

Originally Posted by vision33r

Universal healthcare means you can't sue, no insurance, and no safety checks. Every other country have malpractices all the time and no lawyer to sue. Everything cost more here because of lawsuits.

Who told you that one can't sue because of universal healthcare?

That would be news to Canadian doctors.