Politics & Current Events
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Thoughts on healthcare
I believe universal access to healthcare is a basic human right and I support paying higher taxes to fund/provide that access to everyone. But I wanted to get your thoughts on how my family in Europe and I view this issue. They just cannot understand why, in the US, health care coverage is tied to whether or not you have a job. So the thing they cannot understand is: if people in the US don't think healthcare should be free/accessible by all, why do we cover those who have jobs (and make/have money) and not cover those who don't have jobs (and probably dont have money). Just doesn't make sense.
Re: Thoughts on healthcare
This is the thinking, and it isn't unreasonable. Doctors and medical facilities cost money, someone has to pay for them. Logic would suggest that someone be the person receiving medical care.
Except the system doesn't work like that, because you cannot be denied treatment based upon your inability to pay. Then the vicious cycle of suffering through a problem until it's an emergency, expensive trips to busy ERs, prices going up to make up the difference, insurance costs rising correspondingly, etc.
What other "industrialized" countries have done, lasposa, is to acknowledge that basic fact- that receiving care is not dependent on paying for it- and made the whole system a government function and universal right, as you put it. As much as we like to rant against socialism, capitalism doesn't work in a system where benefiting from a service is not subject to paying for it- that's why our system is ineffective.
There are certainly problems with the other route too, but in terms of overall quality, France supposedly has the best healthcare system in the world so they must be doing something right. With the way the insurance industry operates in the US now though, I'm not sure we'll ever see a total revolution of the system. But something like 15-16% of Americans are still uninsured.
Have you ever looked at your Explanation of Benefits? Insurance companies never pay the full price that doctors or hospitals charge.
To correct Valgrl, Medicare is not for poor people. It is for the elderly and sometimes people with disabilities (rules surrounding that population to qualify). Warren Buffet and Mitt Romney qualify for Medicare. It has nothing to do with income. Medicaid is for poor people.
This leads me to my biggest point. Americans don't know what they need in terms of health care reform because they are so uneducated about the current system. An example from above, insurance companies receive discounts. They negotiate a rate for procedures. For example, a doctor may charge $100 for a visit. The insurance company says, if you want to see our patients we will pay you $40 a visit and tell our clients you are in network aka a preferred provider. A client visits the doctor. The client pays a $25 copayment to see the doctor. The doctor then sends the bill to the insurance company for $100 minus the $25 the client paid for a copayment. The insurance then reduces the bill to the agreed upon amount of $40. This means the insurance company pays $15 of the $100 bill. That is a discount. The system is so complicated that people don't understand how it works. Also, to run a system so complicated takes a lot of people which equals money. Imagine if we had a universal system, one place we could reduce cost immediately is advertising because companies would not be competing for business. The new healthcare law limits the amount of premiums that can be spent on activities such as advertising. That is a start. Essentially before the new law, insurance companies could raise your premiums by how ever much they wanted if they wanted to but out more ads. The system is crazy. As a result, the US has worse outcomes then other countries.
Another crazy thing is that health care systems were paid based off of the number of things they did. So if you performed 5 test you got more money compared to if you only performed 3 test. Never mind if only 3 test were needed. So now the system is moving from quantity (RVU model) to quality. Is what the health care system doing actually helping or are they just doing stuff to do it. Wow...what a concept that care should help the person. It is crazy. As a result, people wait to receive medical care and that leads to worse outcomes. This is why I don't understand people who say, "I don't want to wait to see a doctor." We do everyday in our country. It is crazy and I work at a hospital and live close to some of the best healthcare in the world. Our CEO will tell you that it is crazy.
Most people I have talked with, even fiscal conservatives, don't want people to go without healthcare. We/they aren't heartless.
I think the general population is in support of people being cared for in proper, healthy ways, using the best technology we have, with dignity.
There are those who dislike the idea of their tax dollars going toward treatments, medications, and procedures they find morally incorrect and in conflict with their personal set of beliefs.
They realize they cannot prevent someone from having an abortion or for being on BC, etc., but they don't wish to contribute their earned income to pay for it.
I can see where the opposing side just wants to say, "Suck it up and deal, this is the way of the world." But, the recognition of not forcing people into doing something opposing to their conscience has been and continues to be a tennet of our social and political culture. To be fair, it is a freedom that needs to be given to all perspectives.
Forcing a person to pay for something against their conscience is equivocal to holding them hostage. See the Hobby Lobby situation as an example.
This company was started in the 1970's, and as of August 2012, they have 514 stores in 41 states, by a Christian family...they make no effort to hide their position on their website as they are closed on Sundays, support missions worldwide, etc. And, as they are not publically held, they have a right to carry out business as they see fit. They now face $1.3M in fines DAILY from the Federal Government because they are asking to not have to pay for BC and abortion procedures, which are in direct conflict with their beliefs as a family owned and operated business.
They support healthcare. They don't support having to pay for things they cannot in their consciences support.
no i mean flat out denying the service. this has happened to us several times and we were able to get a discount off of it. Even a chiro I had to see for 6 months was not covered on my insurance, she gave me a super low price. It's like they have a price for the insurance and a price for non insurance. its stupid
This was my point exactly. Thanks for explaining it better than I did
I am not against capitalism but that idea that "I work for it, so I should have it" (and conversely, "if you don't work, you shouldn't have it") doesn't work for healthcare and in fact, as Lexi points out, it cannot work because you can't be denied service. So if that makes me a socialist when it comes to healthcare, so be it -- I don't take offense to that at all. In fact I'm proud of it. We need a socialist approach to healthcare -- it just doesn't work any other way in my opinion.
i love this counterexample; i agree 100%. if you don't mind, i'm going to steal this and use it in discussions with people who can't seem to understand what i'm talking about otherwise.
You should look up:
Religious Freedom Peace Tax Fund Act (still in the works)
People objecting to paying for war with their tax dollars might possibly have a legal "out."
http://www.peacetaxfund.org/
That's the website. Note it's for "When enacted, this law will restore the rights of citizens whose conscience does not permit financial participation in any war. This includes both individuals who are members of religious congregations as well as those who are not religious, but have ethical and moral objections to paying for war. Federal taxes of designated conscientious objectors will be placed in a non-military trust fund, enabling the government to obtain needed federal revenue without violating these individuals' right to the free exercise of their beliefs."
I see what you're saying, but the people who religiously and morally object to paying for abortions, and certain medications, ought to be afforded the same or similar distinctions.
It is a primary purpose of our Federal Government to protect the individual rights of citizens (as framed in our founding documents). Just as people claim an individual right is affordable healthcare, so others claim they have an individual right to NOT pay for certain religiously or morally incongruous (affecting their persons or privately held businesses) aspects of the government's actions and/or legislation.
I very much doubt that will ever be enacted - and I'm glad. I would never agree with legislation like that. My whole point was that we live in a diverse society - many different people with many different viewpoints. We should NOT have the choice to pick and choose on an individual basis how our tax dollars are spent other than using our right to vote. Can you even imagine the clusterfluck that would cause?
People who don't drive for ethical reasons would choose not to fund road projects. The childless may choose not to fund public schooling. Who would determine what's okay and what's not okay for a person to have a crisis of conscience over? It's too arbitrary.
And then there are people whose viewpoints change over time.
An ability to deselect from paying taxes for war or for abortions, are both life and death scenarios. Lives hang in the balance. THIS is the distinction. Road projects, public schooling, and other things have nothing to do with life and death. War and abortions do...directly. It's cut and dry.
People shouldn't have to use their hard-earned income to pay for things that may cause or will cause, death. Note they don't get out of paying taxes and they still pay their fair share, they just get to state that their funds go into a non-war pot ora non-abortion pot. I'd also lump capital punishment into this category too for conscientious objectors to this too.
I think there is merit to this legislative idea and I would support it.
Our nation already recognizes conscientious objectors to war - allowing them to remain out of military service or to serve in non-combantant areas.
"There are two main criteria for classification as a conscientious objector. First, the objector must be opposed to war in any form, Gillette v. United States, 401 U.S. 437. Second, the objection must be sincere, Witmer v. United States, 348 U.S. 375. That he must show that this opposition is based upon religious training and belief was no longer a criterion after cases broadened it to include non-religious moral belief, United States v. Seeger, 380 U.S. 163 and Welsh v. United States, 398 U.S. 333. COs willing to perform non-combatant military functions are classed 1-A-O by the U.S.; those unwilling to serve at all are 1-O."
Legislation to permit taxation dollars to remain separate from war and/or abortion and/or capital punishment could happen and be organized easily. It wouldn't be that "CF" as you called it.
I wholly disagree with you on this one, ML. Again, who determines what is an acceptable issue to have a crisis of conscience about? It's too arbitrary. In order to live and benefit from our diverse society, a citizen must realize that they will not agree with the way every dime of their tax dollars is spent. Majority rules.
I think that yes, it would be a "CF". Don't people always complain that the tax code needs to be simplified? Allowing people to opt out of paying for things they find morally objectionable would certainly not simplify anything.
I can't even fathom the majority of Americans getting behind a proposal like that.
It's all very well and good to say, " Legislation to permit taxation dollars to remain separate from war and/or abortion and/or capital punishment could happen and be organized easily." However, saying something and having it actually be the case are two very different things. Organized easily? I think you are way wrong.
I agree, this is not easy to organize,
Not only that, it's not a smart thing for government to do.
If enough people are opting out of paying for the military, it leaves our country open to attack. If enough people decide they won't fund any war, our country will not be able to protect our allies. We the people of the United states do not have access to all of the information that our government does, which informs their decisions about military action. It;s not even a good idea to give average citizens access to all of that information so that they can make their individual decisions about their tax dollars.
We are given a vote in this country. That is how we choose our policy. We do not always get what we want. But we do get to let our voices be heard.
I am not entirely certain you could even say our tax dollars go towards abortion (at least not at a federal level).
But if enough people choose not to fund abortion, abortion is not available. That may seem like a great thing to anti-choice people, but on the other hand, it is taking away another person's constitutionally protected right.
clusterfvck.
France may have the best healthcare system in the world (as you say) but the fact is, they are going broke.
"The bottom line: The French government says the health system will fall ?5.1 billion short in 2013, meaning it may be forced to cut cherished benefits."
http://www.businessweek.com/articles/2013-01-03/frances-health-care-system-is-going-broke
Or perhaps we would like to go the way of England and their Liverpool Care Pathway, you know, to try and save some money on health care costs.
http://www.dailymail.co.uk/news/article-2223286/Hospitals-bribed-patients-pathway-death-Cash-incentive-NHS-trusts-meet-targets-Liverpool-Care-Pathway.html?ITO=1490
The theory behind socialized medicine is admirable. But in the real world, it is not sustainable.
I agree about France and England.
We seem to approach things like this with an "If we build it they will come" attitude but as we see in many countries like France and England, good intentions don't pay the bill when it comes due. Even in Canada where it is somewhat solvent, the mortality rates from disease are exponentially higher than the U.S. due to long wait times for treatment. Laws have recently been passed mandating certain treatment times because it is not unusual to wait 6 months+ for things like chemotherapy for cancer.
Part of the problem that I don't know how we would even begin to solve is that there's no government sponsored for-profit healthcare system that works. However, the alternative lacks a motivation for health care providers to fit patients into busy schedules and provide other benefits.
Insurance, and all of the evolutions it has gone through, have RUINED healthcare and it's affordability. When I was young you would go see your doctor and pay for it. Insurance was only when something was really wrong with you. If we did have to go to some sort of single payer system I'd like to see it be more like Israel where the govt system takes care of routine care but anything more you can purchase on the open market with deductibles and coverages of your choosing. As it stands now, we are simply trying to put our fingers in the *** instead of tearing the wall down and rebuilding. We have a system now, that as a cash payer I can't find out how much my appt is before I go. Where else in the free market does that happen?! I can't even get an estimate. We didn't have insurance for a while and since I was paying cash I wanted to get an idea of what the appt would cost. Despite 3 phone calls, no one in the office could even give me a ballpark of what it would cost. I was repeatedly told that it was up to the doctor and how they coded the appt. I wasn't using insurance so why was there a need for a code? How can people with no coverage, poor coverage or large deductibles even begin to steward their medical dollars? I realize that price should not be a #1 priority when seeking a medical provider however, until we live by trading coconuts or go completely on the dole, it IS a concern. Why shouldn't I be able to know in advance that Dr. A charges $100 to look at a hurting ear and Dr. B charges $245? We make consumer decisions like this every day in every other area of our lives. I mean realistically if we are self insured I'm making this type of decisions when I choose my plan and what type of coverages I want.
We also have a system that is designed to push industry products on us as a go-to. There are many dietary changes (aside from the garden variety low cal/low fat govt approved one) that have been shown again and again to reduce blood pressure and reverse artery damage without any medications. However, most providers will not tell you to try a vegan diet for 6 months or something similar (paleo or similar. Anything they have done research on and believe in) and monitor your progress. They will write you a prescription for some ridiculously priced pharmaceutical which you will probably need 2 other pills to counter the effects of. There are plant supplements and light therapies and all sorts of things that no one makes much money off of that get completely ignored in the slash and burn way we treat medical issues in this country.
I can't say I want to be forced to keep buying to that. These are the same people 40 years ago who told us to feed our babies formula because it was SO much better for them. I'm not saying that formula is bad, but breastmilk was painted as bad and a lousy secondary option. We now know that not to be true. I want the option to be an educated consumer who is not forced to throw good money after bad.
This is just not true. There are many countries that have universal healthcare and whose systems are running just fine - and most of those countries have far less debt than we do too. Like Sweden, for example:
http://articles.washingtonpost.com/2012-04-25/opinions/35453283_1_income-tax-tax-rates-average-marginal-rate
He also argued that Sweden has been much more successful than the United States in controlling health spending. As recently as 1980, health spending in both countries ? as a share of GDP ? was roughly equal. Now Sweden?s spending is about half the U.S. level. Among other things, he said, Sweden has relied on higher patient co-payments to discourage people from overusing health services.
And really, if you want to talk about what's unsustainable, just take one look at our system here in the United States.
I am sorry, I have to lol at that. If Sweden's system was so great, why did they adopt market-oriented reforms of the health care system in the 90's? From all I have read a single-payer system is certainly not the best answer.
A single-payer system is not the answer to our health care problems. Sweden's system does not hold down costs and results in rationing of care and long waiting periods to receive treatment. Yes, our system is nowhere near perfect, but I think we need market-oriented reforms.
I don't understand. They adopted reforms but they still have a single-payer system. And they spend FAR less money on healthcare than we do, yet have basically the same (or better) outcomes. And no, they don't "ration care" or have long waiting periods for treatment.
Well they do "ration care" but so do we - except while Sweden and other nations ration care based on making sure the people most in need of treatment get it, we ration care based on who has the most money and ability to afford their treatment. That's why we have one group of people who gets tons of treatment they don't really need while another group desperately needs treatment and doesn't get it at all. How is that a better solution?
Their healthcare costs are far lower than ours, their outcomes are the same, and everyone who needs care gets it. And the system is financially healthy and their nation has far less debt than we do. Tell me again what's wrong with this system? And why its flaws are so much worse than ours?
http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/index.html;jsessionid=as008die826bn.delta?contentType=&itemId=/content/chapter/health_glance-2011-59-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html
Didn't Sweden have to legislate how long someone can wait for care in 2010? That, to me, doesn't equate to a smashing success.
While in some countries they are a major health policy concern, others report no significant waiting times at all. Waiting times to see a primary care physician or nurse in 2010 were low in most of the 11 countries covered by the Commonwealth Fund Survey, and only in Canada, Norway and Sweden did a significant number of patients have to wait for six days or more (Davis et al., 2010).
Waiting times for specialist consultations were also higher in Canada, Norway and Sweden, with 50% or more of survey respondents waiting at least 4 weeks for an appointment (Figure 6.8.1). In Germany, Switzerland and the United States, more timely access was provided. Waiting times for elective surgeries such as cataract removal or hip replacement also show substantial differences. In 2010, a considerable proportion of patients in Canada, Sweden, Norway, the United Kingdom and Australia reported waiting four months or more for elective surgery (Figure 6.8.2) (Davis et al., 2004, 2006, 2010; Schoen et al., 2010).
So, some countries with single payer healthcare have long wait times and some don't. I don't really find waiting months for elective surgery to be that horrible, especially since here in the US, if you don't have insurance and can't afford to pay out of pocket, you can be waiting for years and years or possibly forever.
When I moved and I needed to get into see a primary care physician as a new patient (and as someone who DOES have insurance), do you know when their first appointment was? 10 weeks away. That was the soonest I could get in to see someone in my network. And it still cost me quite a bit of money once I actually was able to see someone. So the "but people have to wait a long time in other countries!" argument holds no water at all with me.
You are the one who sang the praises of Sweden's heath care system. All I am saying is that is ain't all roses and sunshine as you say. 10 weeks to see a PCP is a long time. But relatively short period of time than say 8 moths to have a hip replacement surgery. Heck, my aunt who is on medicaid didn't have to wait that long to have her hip surgery.
I don't understand why people think socialized medicine/single-payer health care is the way to go? Sounds a tad more broken that what we have currently.
No, I know it's not sunshine and roses, and I didn't say that. I said that their system's flaws are far preferable to our system's flaws. The flaws of their system include sometimes having to wait a long time to get elective care and higher taxes. The flaws of our system include sometimes NEVER getting that elective care if you can't afford it, having to choose between chemo for your child and keeping your family's house, and people dying because they couldn't afford their healthcare.
That sounds pretty effing broken to me.No system is perfect. But I would value a system that would better serve a healthy public. Not a system that serves a healthy public-that-can-afford-it.
50 million-odd people being priced out of a system that has been ravaged by the insurance industry sounds pretty broken to me. I can't imagine how I'd feel if I were unfortunate enough to be one of those 50 million. Let's factor in their waiting times when we rave about how efficient American health care is. And then let's factor in the added cost of care when they wait that long and are forced to go to the ER for life-saving care instead of potentially preventative care.
Maybe you should go to some of these countries and ask them if they want to trade their system for ours. I bet you that 99% of them will say 'hell no!!'
I've lived abroad and I can pretty much guarantee they would say that!
I guess I have strange friends - my best friend is from England (Worthing, West Sussex) and moved here about 10 years ago. He even worked for the "government" (Inland Revenue). He and I have had this conversation and he has always said without question, the US has a better health care system.
How does he feel about the fact that the majority of bankruptcies in this country are a result of medical bills? How does he feel about the fact that nearly 25% of American children go without necessary healthcare because their parents can't afford it? How does he feel about the fact that people literally die from being unable to afford healthcare?
Does he find these things an acceptable price to pay for a certain group of people being able to access excellent care?