US Health Fare

[Spoom 8]

There was an interesting discussion about the US health insurance system on Slashdot a couple days ago; my opinion of it can mostly be found there.

The whole idea of 'co-pays' and 'co-insurance' bugs me, because like KnJ said, it's a disincentive to visit the doctor (and I think the people who visit when they don't actually have to are such a small percentage that it's not worth considering). I really want to see something like H.R. 676 pass, because it would give the US single-payer health care that might actually turn out to be better than Ontario coverage (since it covers things like dental and prescription drugs). Unfortunately it looks like we'll be saddled with a 900 page bill that doesn't really do much other than giving health insurance companies a customer base guaranteed by law.

Edited February 24, 2010 by Spoom

[Obama 2012 1,714]

There was an interesting discussion about the US health insurance system on Slashdot a couple days ago; my opinion of it can mostly be found there.

The whole idea of 'co-pays' and 'co-insurance' bugs me, because like KnJ said, it's a disincentive to visit the doctor (and I think the people who visit when they don't actually have to are such a small percentage that it's not worth considering). I really want to see something like H.R. 676 pass, because it would give the US single-payer health care that might actually turn out to be better than Ontario coverage (since it covers things like dental and prescription drugs). Unfortunately it looks like we'll be saddled with a 900 page bill that doesn't really do much other than giving health insurance companies a customer base guaranteed by law.

Single Payer = Unconstitutional in the US for one.

You cannot force the populous to buy a service. It's just not going to happen. Lawyers would have a field day.

I'm completely against socialized medecine in the US for that reason as well.

The OTHER contributing factor is our population is way too big for that to happen. It would bankrupt us even worse than we are now as a nation. We flat out cannot afford it.

Our health care system now is already overburdened. If you essentially 'give' people health care who don't already use the system, it'll send the whole thing into turmoil. That's not even mentioning the thousands of doctors who would quit under such a plan who already suffer due to the failures of medicare and medicaid. Those two programs are reason enough why a government run/single payer system would not work here.

[Spoom 8]

Single Payer = Unconstitutional in the US for one.

You cannot force the populous to buy a service. It's just not going to happen. Lawyers would have a field day.

I'm completely against socialized medecine in the US for that reason as well.

The OTHER contributing factor is our population is way too big for that to happen. It would bankrupt us even worse than we are now as a nation. We flat out cannot afford it.

Our health care system now is already overburdened. If you essentially 'give' people health care who don't already use the system, it'll send the whole thing into turmoil. That's not even mentioning the thousands of doctors who would quit under such a plan who already suffer due to the failures of medicare and medicaid. Those two programs are reason enough why a government run/single payer system would not work here.

I disagree.

First off, the argument that it is unconstitutional is tenuous at best. While you do have the Tenth Amendment, there's a much earlier section that makes something like single-payer health care constitutional: the General Welfare clause, which states that the US federal government shall have the power:

to pay the Debts and provide for the common Defence and general Welfare of the United States;

(emphasis added)

If health care doesn't count as "general welfare", I don't know what does. And if you want to say that the Tenth Amendment specifically denies health care due to not previously being enumerated in the Constitution (which it was, as I have shown), you'll also need to identify where every other spending that the federal government does is listed; I think you'll have a bit of difficulty.

Your argument that "you cannot force the populous to buy a service" is also without basis in law. The government cannot force people to buy from another person or company, but certainly can tax people to provide services like police and fire; these services are provided whether or not you want to 'opt out', and you certainly still have to pay your taxes.

I also don't believe the idea that 'thousands of doctors would quit under such a plan'. If that were true, wouldn't Canada simply have no more doctors by now? What about Britain, where they're actually employed by the government?

Yes, the health care system in the United States is already overburdened. Believe it or not, this would lift a lot of that burden simply by removing incredible amounts of overhead. By having a single payer system, you limit the number of middlemen involved in taking a cut of your medical bills. Simultaneously, you remove the profit motive from those paying for your care as the government exists only for the public benefit, not to simply gain as much revenue as possible. The result is a much smoother system where people don't have to worry about being denied medically necessary care.

[Obama 2012 1,714]

I disagree.

First off, the argument that it is unconstitutional is tenuous at best. While you do have the Tenth Amendment, there's a much earlier section that makes something like single-payer health care constitutional: the General Welfare clause, which states that the US federal government shall have the power:

(emphasis added)

If health care doesn't count as "general welfare", I don't know what does. And if you want to say that the Tenth Amendment specifically denies health care due to not previously being enumerated in the Constitution (which it was, as I have shown), you'll also need to identify where every other spending that the federal government does is listed; I think you'll have a bit of difficulty.

"General Welfare" is being bastardized in this argement and the original intention had nothing to do with domestic issues.

The 'federal government' bastardizes the 9th and 10th amendment plenty of times, but we're not going to go there on this one, eventhough they would fall under health care as well.

Your argument that "you cannot force the populous to buy a service" is also without basis in law. The government cannot force people to buy from another person or company, but certainly can tax people to provide services like police and fire; these services are provided whether or not you want to 'opt out', and you certainly still have to pay your taxes.

LOCAL issues, NOT Federal, and in most cases not even State issues for that matter. There's a huge difference.

I also don't believe the idea that 'thousands of doctors would quit under such a plan'. If that were true, wouldn't Canada simply have no more doctors by now? What about Britain, where they're actually employed by the government?

Again, apples to oranges in comparison. The amount of money doctors spend on education for one and having to repay student loans would make doctors not want to be a part of the system. Plenty of doctors are already on the brink of quitting if the current bill passes.

Whether people like it or not, doctors have to make money too and when the Federal Government already have proven time and time again that they COST doctor's money, then of course many will get out. Doctor's only accept Medicare and Medicaid out of a courtesy anymore. Plenty of doctor's throughout have stopped accepting one or the other or even both because of how badly the government screws them.

It sucks when a procedure really does cost a doctor $200 out of pocket to perform and he only gets 75% of that if he's lucky from the government, eating the other 25% or having to charge cash customers a bit more to make up for it. Private insurance companies actually work ALOT better for doctors (Hell you can ask doctors in Canada this too now days) than the government.

Yes, the health care system in the United States is already overburdened. Believe it or not, this would lift a lot of that burden simply by removing incredible amounts of overhead. By having a single payer system, you limit the number of middlemen involved in taking a cut of your medical bills. Simultaneously, you remove the profit motive from those paying for your care as the government exists only for the public benefit, not to simply gain as much revenue as possible. The result is a much smoother system where people don't have to worry about being denied medically necessary care.

#1 - You can't add people into a system and lift the burden. Do the math, it's not possible. Hell, again look to Canada and wait times for some procedures because they can't handle the case load. Canada's population is 1/8th the population of the US.

#2 - Just because government takes it over, doesn't mean it'll be efficient, nor does it mean that profit will be taken out of it. There will always be those who profit and there will always be those who suffer. As I said as well, medicare and medicaid are prime examples of overburdened/broken government systems.

#3 - and most importantly, like it or not: It's a business, period. It's a service that people choose to take on and perform and one that they take on for one of two reasons. #1 being compassion, the other being so they can make $$$ and provide for their family a good life. You take the $$$ out of healthcare, you are honestly sacrificing quantity for quality because there are plenty of talented people out there who would stay the hell away form the business if there was no money to be made.

The truth about health care that no one in the "mainstream" will admit, is government is and has been the problem with our system all along. They prevent an open-market system and regulate coverage of things they don't know a damn thing about. You want to 'fix' the system in the US? You have to open up the market and stop letting insurance companies take over individual states. Let them compete with one another and let it be an across the board item. FINE, if that fail and government wants to try and intervene reasonably, but give interstate commerce a chance first before trying to dictate how something should function.

[Pauley 2]

The truth about health care that no one in the "mainstream" will admit, is government is and has been the problem with our system all along. They prevent an open-market system and regulate coverage of things they don't know a damn thing about. You want to 'fix' the system in the US? You have to open up the market and stop letting insurance companies take over individual states. Let them compete with one another and let it be an across the board item. FINE, if that fail and government wants to try and intervene reasonably, but give interstate commerce a chance first before trying to dictate how something should function.

*highfive*

[ValerieA 350]

The funniest thing I find about the debate over tax-paid health care, is that all of these arguments have already been heard. Canada DID use to have a user pay system. Tommy Douglas introduced the tax-paid system in Saskatchewan in 1959, and all the doctors went on strike. It was ugly and brutal, but access to health care won out. In the 60's Mr. Douglas brought it to all of Canada. People in Canada can't be too unhappy about it, he was voted the Greatest Canadian of All Time in 2004.

I admit that I have never had any super-specialized care needed, but I have never had to wait more than a couple of months for a specialist's appointment. One other thought that occurred to me last night, was how the health care system here actually discourages entrepreneurism. My husband is looking at giving up his second job, and going full-time as a subcontractor, but that is the one with group health benefits. We really can't be without health care, and the cost of individual health plans is prohibitive and does not offer the coverage that a group plan does. So, there is a disincentive to move from employee to entrepreneur.

Edited February 24, 2010 by ValerieA

[Obama 2012 1,714]

The funniest thing I find about the debate over tax-paid health care, is that all of these arguments have already been heard. Canada DID use to have a user pay system. Tommy Douglas introduced the tax-paid system in Saskatchewan in 1959, and all the doctors went on strike. It was ugly and brutal, but access to health care won out. In the 60's Mr. Douglas brought it to all of Canada. People in Canada can't be too unhappy about it, he was voted the Greatest Canadian of All Time in 2004.

I admit that I have never had any super-specialized care needed, but I have never had to wait more than a couple of months for a specialist's appointment. One other thought that occurred to me last night, was how the health care system here actually discourages entrepreneurism. My husband is looking at giving up his second job, and going full-time as a subcontractor, but that is the one with group health benefits. We really can't be without health care, and the cost of individual health plans is prohibitive and does not offer the coverage that a group plan does. So, there is a disincentive to move from employee to entrepreneur.

and here I'd have to wait less than a week.

[ValerieA 350]

and here I'd have to wait less than a week.

Really? Because my MIL has been waiting almost a year for hers. A pain specialist, if I remember rightly, but I will confirm that with her.

[Spoom 8]

and here I'd have to wait less than a week.

See, this bugs me as well. This "me first" mentality. Doctors use triage in Canada; if you need something done right away, it gets done right away. Honestly, I think a lot of the defense of the existing system in the United States is so people who already have health care can protect their priority status, even at the expense of some people receiving none at all.

[ValerieA 350]

That's a good point, Spoom. You wait longer in Canada if your case is not critical. The higher the need, the sooner you get in.

[Obama 2012 1,714]

See, this bugs me as well. This "me first" mentality. Doctors use triage in Canada; if you need something done right away, it gets done right away. Honestly, I think a lot of the defense of the existing system in the United States is so people who already have health care can protect their priority status, even at the expense of some people receiving none at all.

The misconception is the 'none at all'

Nothing wrong with a 'me first' mentality either, especially when the large majority has access.

Again I'll relate to population.

Canada has 1/8th the population of the US.

So basically 1/8th of the US population might not have "coverage" per se insurance wise, but they still have healthcare if they need it....

and there again, the poor have medicaid, the elderly have medicare... --- everyone else inbetween it's usually a "choice" not to have health care more than it is a cost factor. That's the misconception. It's amusing how many people would rather buy a 60" plasma screen, when that could have paid for their health insurance for 6 months....

Edited February 24, 2010 by Paul and Vanessa

[ScooterMac 2]

Is it also amusing that I work 12 hour days 5 days a week and 2-3hrs the other two days of the week, and I can barely afford health insurance? And that's just health insurance for me. My "primary" job doesn't offer health insurance, and my "secondary" job won't add me on their plan because I'm not full time. I make too much to qualify for medicaid or gov't assistance. (And no, we don't have a 60" plasma screen TV).

My health insurance costs about $320/month. I have a $3000 deductible. Going to the doctor for *anything* costs me at least $50-$75. It costs more if it involves bloodwork (not covered), shots, etc. My perscription (single) costs over $60/month. This is the --absolute best deal-- I could get on health insurance. I was denied by 4 different healthcare companies in the course of a year due to not meeting their "height/weight ratio requirements", even though I had a complete physical (at my own expense) and a letter from my doctor with the results, the notation that I'd already lost over 100lbs and was on a weight management program, and that I had no pre-existing conditions or co-morbitities.

But yeah, there's nothing wrong with the US health care system. I like having to cough up a huge chunk of money each month to not be able to afford going to the doctor.

Edited February 24, 2010 by ScooterMac

[Obama 2012 1,714]

Is it also amusing that I work 12 hour days 5 days a week and 2-3hrs the other two days of the week, and I can barely afford health insurance? And that's just health insurance for me. My "primary" job doesn't offer health insurance, and my "secondary" job won't add me on their plan because I'm not full time. I make too much to qualify for medicaid or gov't assistance. (And no, we don't have a 60" plasma screen TV).

My health insurance costs about $320/month. I have a $3000 deductible. Going to the doctor for *anything* costs me at least $50-$75. It costs more if it involves bloodwork (not covered), shots, etc. My perscription (single) costs over $60/month. This is the --absolute best deal-- I could get on health insurance. I was denied by 4 different healthcare companies in the course of a year due to not meeting their "height/weight ratio requirements", even though I had a complete physical (at my own expense) and a letter from my doctor with the results, the notation that I'd already lost over 100lbs and was on a weight management program, and that I had no pre-existing conditions or co-morbitities.

But yeah, there's nothing wrong with the US health care system. I like having to cough up a huge chunk of money each month to not be able to afford going to the doctor.

So you're overweight and you got denied and it's the problem of the system?

You got a plan that would accept you in your condition and you're complaining about it?

Again, I might sound insensitive here, BUT fix your problems and you'd be fine.

[ScooterMac 2]

Which is something I'm trying to do. As I said, I've already lost over 100lbs, and I'm continuing to lose weight. Also, I should note, the cost of my insurance has nothing to do with my weight - that's what they charge per month, same deductible, to someone who was a stick figure. It's just a ridiculous amount of money.

That said, my doctor is concered that I have a problem with my thyroid which is causing a lot of my issues. My mother had thyroid cancer and was going through treatments while pregnant with me. He wants me to get my thyoid tested, but I can't afford to have the tests done. See what I mean?

Edited February 24, 2010 by ScooterMac

[Spoom 8]

"General Welfare" is being bastardized in this argement and the original intention had nothing to do with domestic issues.

The 'federal government' bastardizes the 9th and 10th amendment plenty of times, but we're not going to go there on this one, eventhough they would fall under health care as well.

Then please explain why health care should not be included in "general welfare". You say that it shouldn't be interpreted that way, but you don't say why. And that's fine if you don't want to come up with a rebuttal to my other point.

LOCAL issues, NOT Federal, and in most cases not even State issues for that matter. There's a huge difference.

Very well, what about FEMA? What about immigration? What about the FBI? All federal, and I could come up with a much larger list if I spent more than thirty seconds thinking about it.

Again, apples to oranges in comparison. The amount of money doctors spend on education for one and having to repay student loans would make doctors not want to be a part of the system. Plenty of doctors are already on the brink of quitting if the current bill passes.

Again, quite odd, since there's a large group called Physicians for a National Health Care Program who support the single-payer bill that I mentioned previously. But I guess you can make a baseless claim like that if you want.

Whether people like it or not, doctors have to make money too and when the Federal Government already have proven time and time again that they COST doctor's money, then of course many will get out. Doctor's only accept Medicare and Medicaid out of a courtesy anymore. Plenty of doctor's throughout have stopped accepting one or the other or even both because of how badly the government screws them.

It sucks when a procedure really does cost a doctor $200 out of pocket to perform and he only gets 75% of that if he's lucky from the government, eating the other 25% or having to charge cash customers a bit more to make up for it. Private insurance companies actually work ALOT better for doctors (Hell you can ask doctors in Canada this too now days) than the government.

If there's a true issue with how much the government pays doctors, it should be examined, but that's not a good reason to avoid single-payer health care, since that can be fixed easily by adjusting rates. (Besides which, I'm more apt to worry about the person who can't afford the care at all under the existing system than doctors that (according to you) would theoretically lose out in a single-payer system.)

#1 - You can't add people into a system and lift the burden. Do the math, it's not possible. Hell, again look to Canada and wait times for some procedures because they can't handle the case load. Canada's population is 1/8th the population of the US.

You can if you replace the existing system with a new one, as H.R. 676 would do. The bill also details how it would be funded (in this case, by raising rates on the top 5% of earners and through a payroll and stock transaction tax), so it's not like this hasn't been considered.

#2 - Just because government takes it over, doesn't mean it'll be efficient, nor does it mean that profit will be taken out of it. There will always be those who profit and there will always be those who suffer. As I said as well, medicare and medicaid are prime examples of overburdened/broken government systems.

Why? You make the claim that there will always be a profit motive without backing it up. Do you simply believe that all humans are so greedy that as soon as they are put into an administrative position they will start to corrupt it? If so, one would think you would support anarchism rather than any government at all. As to whether or not it will be more efficient, well, you can't get much worse than it is currently. The United States government paid $6,102 per capita on health care, vs. Canadian health care spending of $3,165 per capita in 2004 (source: U.S. Health Care Spending: Comparison with Other OECD Countries:Congressional Research Service), and for that they have far fewer people covered. There's a direct comparison of government spending between the existing US system and a single-payer system. Are you really going to argue that the status quo is better, even given that the US spends almost double, while people are still routinely being denied care due to either failing to have insurance or having their insurance company deny their claim? Or perhaps you'd like to eliminate all spending on health care by the federal government period, putting thousands of people relying on Medicare and Medicaid into financial jeopardy over their very lives?

#3 - and most importantly, like it or not: It's a business, period. It's a service that people choose to take on and perform and one that they take on for one of two reasons. #1 being compassion, the other being so they can make $$$ and provide for their family a good life. You take the $$$ out of healthcare, you are honestly sacrificing quantity for quality because there are plenty of talented people out there who would stay the hell away form the business if there was no money to be made.

Doctors still are quite rich in Canada, the United Kingdom, and elsewhere. They live quite comfortable lives. My own doctor wondered why the hell I would move to the United States given the Canadian health care system, and many others have said the same thing. Frankly, those doctors who value their own profit above their patients' lives should not be doctors.

The truth about health care that no one in the "mainstream" will admit, is government is and has been the problem with our system all along. They prevent an open-market system and regulate coverage of things they don't know a damn thing about. You want to 'fix' the system in the US? You have to open up the market and stop letting insurance companies take over individual states. Let them compete with one another and let it be an across the board item. FINE, if that fail and government wants to try and intervene reasonably, but give interstate commerce a chance first before trying to dictate how something should function.

Maybe you're willing to risk thousands of lives in your 'experiment'. I'm not.