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The rest of the civilized world manages to achieve 100% health coverage at roughly half the cost per person of US Health care. Some do it with single payer plans that are government run, others manage it completely with private payers and insurers and providers. But their success and our failure ultimately ties to a single difference between then and us.
They all decided that health care was not an economic issue, it was a moral one.
Only then did they make the effort to design the systems that they have today, and that almost without exception deliver better health care than our own at lower cost.
Our key problem here is that we have so many people in this nation who share the "f*ck them" attitude of the post you responded to.
HistorianDude, I read your post carefully and I believe I understand it. Here's my question: you say that the rest of the civilized world has 100% coverage. But how do you account for those who are denied treatment based on the cost/benefit analysis in the UK's system, or who are crowded out by rationing in Canada's system, etc.? Some people do die on the waiting list for cancer treatment or heart surgery; many forms of treatment that are routine in America are denied or delayed in other places. Is this really 100% coverage as we understand it?
Do you say to the 74 year old who needs bypass surgery, "Sorry, you cannot have it because we decided as a society that health care is a moral issue, not an economic one?"
Before anyone gets antsy, I am sympathetic to the argument that we spend too much money on procedures that are foolish by any measure. The President's own grandmother, in the end stage of dying of cancer, received an artificial hip. Two weeks later, they buried it. We do not have money for that, in my opinion.
All I am arguing for is greater realization that there are shades of grey in this debate, and the "moral" high ground does not automatically belong to either side.
HistorianDude, I read your post carefully and I believe I understand it. Here's my question: you say that the rest of the civilized world has 100% coverage. But how do you account for those who are denied treatment based on the cost/benefit analysis in the UK's system, or who are crowded out by rationing in Canada's system, etc.? Some people do die on the waiting list for cancer treatment or heart surgery; many forms of treatment that are routine in America are denied or delayed in other places. Is this really 100% coverage as we understand it?
Do you say to the 74 year old who needs bypass surgery, "Sorry, you cannot have it because we decided as a society that health care is a moral issue, not an economic one?"
Before anyone gets antsy, I am sympathetic to the argument that we spend too much money on procedures that are foolish by any measure. The President's own grandmother, in the end stage of dying of cancer, received an artificial hip. Two weeks later, they buried it. We do not have money for that, in my opinion.
All I am arguing for is greater realization that there are shades of grey in this debate, and the "moral" high ground does not automatically belong to either side.
Of course this ignores the fact that health care is rationed now in the name of health insurance company profits. Do claims get denied under the current system? Of course. Can an insurance company dictate (not your doctor) treatment modality based on cost, not effectiveness (yup)...
All of these things that you describe, happen, here, now under the current system.
HistorianDude, I read your post carefully and I believe I understand it. Here's my question: you say that the rest of the civilized world has 100% coverage. But how do you account for those who are denied treatment based on the cost/benefit analysis in the UK's system, or who are crowded out by rationing in Canada's system, etc.? Some people do die on the waiting list for cancer treatment or heart surgery; many forms of treatment that are routine in America are denied or delayed in other places. Is this really 100% coverage as we understand it?
Yes... it is absolutely 100% coverage as we understand it.
1) 100% coverage does not mean, and never has meant unlimited access to any health care whatsoever; not in other nations and certainly not here. There is no country in the world that offers that, yet the US is further from it than most. When you write that "many forms of treatment that are routine in America are denied or delayed in other places" you are not being completely honest. A more accurate assertion would be that "many forms of treatment that are routine in America for the wealthy or those with particularly good insurance plans are denied or delayed in other places." This is after all how we ration health care in this country. We have the best health care in the world if you can afford to pay for it. If you can't, you are often in the position where you get no health care at all.
2) It is simply a canard to pretend that other nations "ration" health care in a way that is worse than our own. Every private insurance company in this country protects its profitability by denying coverage for reasons far less defensible than a "cost/benefit analysis." Their claims processors are trained to say, "no" for reasons that generally have nothing to do with the actual medical efficacy of the procedure. I have helped take insurance companies to court because they cut off coverage for an individual 3/4s of the way through a bone marrow transplant because they "cost too much."
And lets not talk about denial of coverage for preexisting conditions.
3) Make no mistake... not only do we ration health care in the United States today but we also ration it stupidly. For example, we will not pay $25,000 for prenatal care for an indigent mother, but we have no problem turning around and spending $250,000 to treat her crack-baby. Our system seems almost calculated to drive the uninsured into the single most expensive venue of care outside the ICU, and at points in their disease state where the cheap options are no longer available.
4) People also die in the US while on waiting lists for treatments or surgeries. However, unlike those other nations, we have far more die because they never got on waiting lists at all. Treatable, chronic conditions (for example Lupus) kill people in this country that would live to a ripe old age in Canada or the UK.
Quote:
Originally Posted by marcopolo
Do you say to the 74 year old who needs bypass surgery, "Sorry, you cannot have it because we decided as a society that health care is a moral issue, not an economic one?"
As opposed to, "Sorry, you cannot have it because we decided as an insurance company that it would hurt our bottom line?" Yes, the former is by far more preferable to the latter.
Quote:
Originally Posted by marcopolo
All I am arguing for is greater realization that there are shades of grey in this debate, and the "moral" high ground does not automatically belong to either side.
When only one side is genuinely making a moral argument, yes. It does.
[Missing the point FLAG ON]
The basis for the increased cost for buying medical treatment and medicinal items is the government, first and foremost.
Government criminalized the unlicensed trade in medical and health care. That created a monopoly, scarcity, and increased the cost.
"Free" Americans have to buy permission (prescriptions) before they can buy medicine from another licensed party, who can only buy from other licensed sources.
Government is the source for inflation, which boosts the cost.
Government is the source for bureaucratic overhead, again boosting the cost.
Now, for-profit insurers can skim their share of the booty, thanks to the government.
But if you got government entirely out of the business of health care - - oh, right, no one dares utter that heresy.
Yes... it is absolutely 100% coverage as we understand it.
1) 100% coverage does not mean, and never has meant unlimited access to any health care whatsoever; not in other nations and certainly not here. There is no country in the world that offers that, yet the US is further from it than most. When you write that "many forms of treatment that are routine in America are denied or delayed in other places" you are not being completely honest. A more accurate assertion would be that "many forms of treatment that are routine in America for the wealthy or those with particularly good insurance plans are denied or delayed in other places." This is after all how we ration health care in this country. We have the best health care in the world if you can afford to pay for it. If you can't, you are often in the position where you get no health care at all.
2) It is simply a canard to pretend that other nations "ration" health care in a way that is worse than our own. Every private insurance company in this country protects its profitability by denying coverage for reasons far less defensible than a "cost/benefit analysis." Their claims processors are trained to say, "no" for reasons that generally have nothing to do with the actual medical efficacy of the procedure. I have helped take insurance companies to court because they cut off coverage for an individual 3/4s of the way through a bone marrow transplant because they "cost too much."
And lets not talk about denial of coverage for preexisting conditions.
3) Make no mistake... not only do we ration health care in the United States today but we also ration it stupidly. For example, we will not pay $25,000 for prenatal care for an indigent mother, but we have no problem turning around and spending $250,000 to treat her crack-baby. Our system seems almost calculated to drive the uninsured into the single most expensive venue of care outside the ICU, and at points in their disease state where the cheap options are no longer available.
4) People also die in the US while on waiting lists for treatments or surgeries. However, unlike those other nations, we have far more die because they never got on waiting lists at all. Treatable, chronic conditions (for example Lupus) kill people in this country that would live to a ripe old age in Canada or the UK.
As opposed to, "Sorry, you cannot have it because we decided as an insurance company that it would hurt our bottom line?" Yes, the former is by far more preferable to the latter.
When only one side is genuinely making a moral argument, yes. It does.
HD, thank you for the detailed reply. Since health care in the US is bascially unrationed for those age 65 and up via Medicare, doesn't the question really boil down to "Should we limit care of the elderly instead of the poor?"
I've got no beef with fixing pre-existing conditions, or curbing insuror abuses, or limiting care of the elderly. I'm not arguing whether people are getting shut out of the US system now. I just think the issues should be laid on the table--and one of the issues is that the elderly would lose part of the health care access that they currently have, if we could wave a magic wand and adopt any of the examples of "100%" coverage from the rest of the civilized world.
Do we want (can we afford) the status quo ante HCR? No. Do we want (can we afford) HCR as passed? No. Now let's go to work on the problems.
I didn't like the HMO back in the day when it was offered and I don't like it now that I have to have it. Well you can opt out of the HMO program even if you get medicaid medicare. You gotta call and have it removed tho and then do straight medicaid/medicare. Only problem is less and less doctor accept it because there has been so much sales people pushing HMO's.
If we agree that someone must fill the menial jobs then can we agree that those people deserve some minimum standard of living?
Yep--all the standard of living they can afford. It's a far better life than the average of a hundred years ago, and far better than the current global average. Ideally they will gain skills, knowledge or some other attribute so they can move up and a young new entrant to the labor force can take their place.
We'll make sure they don't starve to death, with food stamps or freeze to death, with government housing. The missing piece is some sort of health care.
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