Why not Universal Healthcare?

[Feanor]

...
Never underestimate the power of politicians, lobbyists and the media to shape the opinion of people even when it goes against their best interests. In some respects this was what this country was founded on when you consider the demographics of the Founding Fathers versus the average colonist at the time. (Please note-this is not an attack on the Founding Fathers. Just read your history and some of the deliberations that went on during the formative years of the country) The Civil War probably being the most tragic example of this; A wealthy minority convinced a mostly poor uneducated majority to go war to ostensible to fight for "States Rights" and "Freedom" when in fact the root cause was to basically maintain or improve the economic status of the wealthy.

....

Never truer words spoken, Kid.

I know it was presumptuous of me at the time (and still), but I did point out earlier in this thread that the American War of Independance was a quintessential "middle-class" or bourgeois revolution intended to further the mercantile interests of the wealthiest colonists rather than the farmers and backwoodsmen co-opted to support it. And I certainly argee about the American Civil War, fought with blood of hundreds of thousands of poor southern farmers to sustain the interests of plantation owners cotton growing with slave labor.

I dare say that at least 95% of Americans would be personally better off with a universal, single payer system, yet it's not going to happen. Why not? I hear such utterly specious reasons as that a public option would be "unfair" to private insurance companies. What the hell do you owe the private insurance companies? The human race is damned.

[ForeverAutumn]

Apologies for the lack of signature.

See? This is why it's important to own up to these things. I was all ready to blame markw...an innocent man.

[nightflier]

Kid, I share your pessimism on this issue, but what made me think a little differently is the history of good bills and ammendments. Take slavery for example, or the women's right to vote. I'm sure at the time there was widespread opposition and plenty of what-if fear mongering, but we're all better for it, now.

I agree that universal healthcare is and should be a basic human right. It really is a travesty that we are the only Western nation that can't muster the political will to pass something, anything, to alleviate the injustice of the current privatized system. Before Canada passed it's version, it wasn't all that popular either, but as you can clearly see, there aren't many Canadians today who would be rid of it.

I do hope something decent passes, so that we can get on with some of the other big issues in our world (like those two wars we're fighting, global warming, world hunger, the economy, Honduras, Cuba, Colombia, Venezuela, Panama, and the Middle East peace process, which is actually closer to some kind of resolution that it has been since the creation of the State of Israel. I'm just naming a few things that come to mind, jeez. After the healthcare bill passes, I also hope it's amended and improved to curb excessive costs, corruption, greed, and graft, and to give it some real teeth. But let's pass it first. The opposition appears to be fading. Yes, Limbaugh, O'Reiley, and the Fox News gang are still crying socialism, but who really believes those loons anymore?

Let's move on already.

[dean_martin]

In catching up on this thread, SirT's suggestion of an incremental approach jumped out at me. Indeed, we are discussing a fundamental change without an historical model to follow. An example of just how fundamental this is can be seen in the law. In 1944, the US Supreme Court determined that insurance is a business that can be regulated by Congress pursuant to the commerce clause of the Constitution. In response, Congress passed the McCarran-Ferguson Act in 1945 which essentially leaves the regulation of insurance to the states. This wikipedia link provides a very simple description of the Act http://en.wikipedia.org/wiki/McCarran-Ferguson_Act

Is this thread locked yet?

The Senate is finally discussing the McCarran-Ferguson Act in the context of health insurance companies' anti-trust exemption (probably in response to the insurance companies' release of a suspect and almost threatening report on Monday). I didn't think the debate would get this far before the health care effort died, but this could be the trump card that gets things moving.

(Is it bad form to quote yourself? If I have to ask, it probably is.)

[markw]

Is this thread locked yet?

The Senate is finally discussing the McCarran-Ferguson Act in the context of health insurance companies' anti-trust exemption (probably in response to the insurance companies' release of a suspect and almost threatening report on Monday). I didn't think the debate would get this far before the health care effort died, but this could be the trump card that gets things moving.

(Is it bad form to quote yourself? If I have to ask, it probably is.)

By loking into these contradictary acts this could be a good first step in unblocking the process that might allow better and cheaper insurance.

Again, a lot depends on what legislation is drafted to take it's place, but it could be a good start.

[bobsticks]

Anyway, I really have no problem with the rich paying a disproportionate share of taxes -- even a hugely disporportionate share, in the time when a 1% of the population controls 90% of the wealth. I made the point sometime ago to the sadly conflicted Bobsticks, that the rich would not be rich if they lived on a desert island: they are rich because they have the rest of us to server/exploit, (choose your verb)..

I am not sadly conflicted....my point of view is derived from mercy and caring...but, I refuse to be taken advantage of...

I suspect that if you were in my tax bracket you would also resent the"hugely dispropportionate" rate of taxation if you were in a situation of ridiculous litigiousness, unfair immigration rules and class warfare.

If I were on a deserted island I would still be dominant....cuz that's how I roll..."Rich" is a term derived from the belief that you can place a monetary value on social dominance....there'll always be winners and losers...

We should all take care of each other....ALL...but that's not what's happening in America...

...feel free to disagree, but given your experiences, I can guarantee that your perspective would be different if you were in a different environment or circumstance....

[Feanor]

I am not sadly conflicted....my point of view is derived from mercy and caring...but, I refuse to be taken advantage of...

I suspect that if you were in my tax bracket you would also resent the"hugely dispropportionate" rate of taxation if you were in a situation of ridiculous litigiousness, unfair immigration rules and class warfare.

If I were on a deserted island I would still be dominant....cuz that's how I roll..."Rich" is a term derived from the belief that you can place a monetary value on social dominance....there'll always be winners and losers...

We should all take care of each other....ALL...but that's not what's happening in America...

...feel free to disagree, but given your experiences, I can guarantee that your perspective would be different if you were in a different environment or circumstance....

That really is the crux of the conservative, middle class dilema. Yes, in some real sense very many, like you, 'Sticks, who genuinely believe that they are merciful and caring ... but don't want to be taken advantage of. They are on moral quicksand.

You know I'm not a religious believer, but I will point out that this is what Christ was talking about when he said the it as as easy for a rich man to get into heaven as for a camel to pass through the eye of a needle.

In simple terms so many of the wealthy believe that the biggest portion of the less well-off are "undeserving". I've always believed in equal social responsibility. Let me assert that the huge majority of ordinary, working people are not lazy & shiftless, they are eager to pay their own way and serve society, (e.g. put their lives at risk in the military), but they get little credit from the smug wealthy and upper middle classes. Sure, there is bottom rung of the population who sherk their responsibility at every opportunity -- but they aren't all ,or even predominently, poor.

'Sticks: get past your self-delusional hypocracy. Shoulder your social responsibility and drop the "don't want to be taken advantage" line. It's old, stale, wrong, and you're kidding yourself.

[blackraven]

I'm playing devil's advocate here. Why should universal health care be called a human right? Health care is a service you pay for that is provided to you by a trained person. Human rights are free, like free speech, right to bear arms, etc. You don't pay money for a human right. What people mean is that they want FREE HEALTH CARE and UNLIMITED ACCESS TO IT, SO LETS STOP USING THE TERM-BASIC HUMAN RIGHT! Its a service that is provided, just like education, municipal water and sanitation. We have to pay for those services either through taxes or fee's.

[3LB]

Its a service that is provided, just like education, municipal water and sanitation. We have to pay for those services either through taxes or fee's

You mean we can't just cross our arms and blink?

While we're at it, isn't shelter a basic human right?
and what about jobs? transportation? clothing?
food? to think that in our civilized world people still
have to pay for something as essential as food...

[blackraven]

Well, in a communist state, its all free!

[Feanor]

Well, in a communist state, its all free!

Not in China. But China today is a rigorously capitalist though non-democratic state. They aren't concerned about human rights and maybe on that account they let the people put up with pay-or-die healthcare.

BR, as you know quite well, even where healthcare is considered a human right, you don't get unlimited access on demand. There has to be some mechanism to allocate healthcare as any other scare resource. In the case of government healthcare, the allocation mechnism is some form of rationing. But consider that no HMO or any other insurance scheme can provided unrestricted access either: some combination of the following must be used:

• Strict underwriting, viz. no pre-existing conditions, age restrictions, etc.
• Coverage limitation: viz. include/excluded procedure, annual limits, lifetime limits, etc.
• Scurrilous practices such as time-of-claim underwriting and retraction of coverage
• Cost control over delivery, e.g. dictating which doctors and facilties may be used, (some much for "choice")
• Exorbidant premiums.

The moral issue is whether the rich, young, and healthy deserve better healthcare than the poor, old, and sick. If your fine this, then there is no need for public healtcare. Bear in mind that the US has already decided that some mitigation of the principle is necessary in the form of Medicare and Medicaid. Why not go the whole way?

Will it cost too much? That's rubbish. We know that equivalent healthcare is cheaper per capita in countries with universal coverage. No, the real reasons are:

• Less significantly, those who imagine themselves to be rich, young, and/or healthy are afraid that their coverage won't be as good as now; (this is largely an illusion), but
• Primarily, those with a vested interest fear that they won't make the profits they're making now. (I'm always amazed when I hear that a public option would be "unfair competition" for private insurers. WTF!?!)

[3LB]

Well, in a communist state, its all free!

mmmm....yeah....about that

Every Ruskie I ever met hated their system

[blackraven]

Jeez, lighten up! I was just being sarcastic! My point was, that health care is not a human right, its a basic service that should be available to every one.

Feanor, as far as private insurer's go, I agree, they are greedy and unscrupulous and they have played a role in driving the cost of health care up. And speaking of the cost of health care, the main cost is not Dr.'s fee's which is minuscule in the big scheme of things. The main cost is the technology and the fact that in our culture it is not ok to die late in life and that we must do every thing we can to keep terminal patients with no quality of life alive at all costs. Feanor, in the U.S. just about every hospital has an MRI scanner, not so in countries with universal healthcare. Technology, product and medical liability and the cost of drugs in the U.S. as well as inflated hospital fee's (Due to the fact that most hospitals only collect about 30% of what they bill due to people with no insurance and only partial reimbursement by insurers. We collected only 28% last year in a nice suburban community hospital) are the main reasons why health care is more expensive here.

Its not an easy fix. You just can't say tomorrow, every one will have universal health care.

As far as a 2 tiered system goes. I'm ok with it. Our county hospital system is just that. I have no problems with government run hospitals for people that can't afford or choose not to pay for private health insurance. You would get just as good medical care in a well run gov't medical facility as you would in a private hospital if they revamped the system. Let me say this. I trained in some of these facilities and that if I was critically ill that I would rather be in one of these facilities in an academic setting (which almost all are) then in a private suburban hospital where I might have to wait hours for a specialist to come and see me.

[Feanor]

Jeez, lighten up! I was just being sarcastic! My point was, that health care is not a human right, its a basic service that should be available to every one. ...

Ok, I'll lighten up.

And OK, but you're kind of splitting hairs re. "human right" vs. "basic service available to everyone". Quelle différence?

...
Feanor, in the U.S. just about every hospital has an MRI scanner, not so in countries with universal healthcare. ...

That's quite true: case in point, Canada.

And there are two reasons that complement each other: (1) overall funding for health care resources which is a political decission, (keep our taxes low), and (2) allocations made based on (we presume) objective cost vs. medical benefit criteria -- not popular demand for glamorous and therefore profitable procedures.

...
As far as a 2 tiered system goes. I'm ok with it. ....

Well, I'm not. Two-tier invariably results two levels of quality with the higher quality inevidably being the paid, for-profit tier.

[3LB]

Its not an easy fix. You just can't say tomorrow, every one will have universal health care.

This is a fact that seems to be of little value for some people, who believe the nobility of the act far outweighs any problems associated with implementing and maintaining such a system. They believe that certain ideas are so noble they deserve immediate action and implementation and any problems that could (will) arise will take care of themselves because its the right thing to do.

There is not a "let'em eat cake" attitude here. I doubt there are too many Americans who would deny anyone needing medical treatment for disease or injury, self-inflicted or otherwise. But I think its foolhardy to believe a national healthcare system won't be just as bankrupt and Social Security or anything else in 5 or 6 years. New taxes will have to be created associated with healthcare. And that wouldn't be a big deal, if taxes collected for a specific purpose were used only in the name of the program it was created for in the first place. More often than not, that's not the case.

How many states have opened the floodgates of lotteries and gambling casinos in the name of education and/or other noble intent? Just as an example, Washington supposedly uses tax revenue collected from the gambling industry and Lotto to support its education system...except the part were it gets lumped into the general fund. Washington used to collect a sky-high vehicle registration tax (equivalent to state sales tax on bluebook value) every year in the name of roadway improvement. Within a year or two of implementing that tax, it was lumped into the general fund. As its been explained by both sides of the isle, putting monies into the general fund eliminates costly legislation time, time that can be used for other important issues. Any revenue surpluses can be allocated more easily when it doesn't require legislative action to procure funds (duh). Back in the day, those 'surpluses' in the highway improvement fund were allocated for education - allegedly. But as you might have guessed by now, many of those funds went to all kinds of projects, and since the funds were now in the general fund, state officals could "allocate" to their hearts content, without permission of the public. (WA eventually, by overwhelming majority, repealed the vehicle tax).

The medical industry is just as bad as the military when it comes to waste and price gouging. The military contractors charge the gov't $200 for an adjustable wrench, the hospital charges the insurance company $50 for a plastic water pitcher, and so on and so forth.

Besides overcharging, there's a ton of inefficiency. The dental insurance won't pay for sealants on your kids baby teeth, nor will pay for extensive work of any kind on your kid's baby teeth, but they will pay for extraction and spacing device for the same, which equates to about the same money as a rootcanal, when the sealant was only $75-$85 per tooth in the first place. Stupid - no? I understand that's an extreme case, but these things happen more and more. (Incase anyone is wondering, its an inherited condition on my side that our teeth are dentin defficient. Why go through that much trouble for baby tooth that's gonna last only another year or so anyway? The dentist pulled the tooth and then expalined it to us - we changed dentists)

I know I know... we should do what's "right" and stop with these 'what if' senarios. Laws are a pretty permanent thing. Some problems won't simply fix themselves.

[blackraven]

3LB, the reason the hospitals charge $5 for a tylenol or $50 for a palstic catheter is because of the no pay patients and partial payments from insurance companies as well as 10-25cents on the dollar reimbursement from medicaid and poor reimbursement from medicare. Running a hospital is a business and bills need to be paid, employee's need to be paid. People don't realize what it takes to run a hospital. There are hundreds to thousands of employee's depending upon the size of the hospital. We have a staff of over 100 in our emergency department alone. I guess they should all work for free!

And Feanor, your mistaken if you think that private insurance would be better than gov't run insurance and hospitals. Insurance companies like HMO's already limit treatments and tests. It would only get worse it they had to lower their prices to compete with the gov't. Lower cost of insurance will = worse coverage! And I can honestly say, I'll be one of the first to sign up for gov't run insurance if and when it becomes available!

And as far as limiting resources, its won't be easy. Already we get patients in the ER daily wanting and demanding that a CT or MRI be done or they come into the ER wanting us to do the their MRI that is scheduled a week later as an out patient because they don't want to wait. The american public is so FKING spoiled and demanding because they want every thing done immediately. The public is in for a rude awakening when Health Care changes are put in place.

[Feanor]

...
And Feanor, your mistaken if you think that private insurance would be better than gov't run insurance and hospitals. Insurance companies like HMO's already limit treatments and tests. It would only get worse it they had to lower their prices to compete with the gov't. Lower cost of insurance will = worse coverage! And I can honestly say, I'll be one of the first to sign up for gov't run insurance if and when it becomes available!

....

So, you concede that government can do it cheaper??

But I agree to the extent that government and private insurers covering exactly the same coverages, it ain't going to work. Where two-tier is kicks in is where private insurance covers, in effect, enhanced versions of standard procedures.

In Canada (i.e. most Canadian provinces) it is illegal for a private insurer to cover a procedure that is covered by government insurance. The rules are more complex than I can explain: private insurers exsist here, but they cover only what is not covered by government, e.g. semi, or private hospital accomodation, or prescription drugs (in most provinces).

If private covers enhanced procedures, people who can afford it will start to buy it. These are the same people who pay most of the taxes that are funding the free-version procedures. It is human nature that the former group will constantly fight to keep taxes low, thereby reducing funding for the free, standard-version procedures. Thus there is downward preasure on the quality of the free tier of healthcare. Thus a two-tier system inevidably undermines the objective of providing everyone with good-quality healthcare.

[blackraven]

So, you concede that government can do it cheaper??

.

Lets just say that the Gov't could do it cheaper with lots of regulation and major changes that the public will not like. The real question should be do I have confidence in the American gov't to do it the right way and not screw it up. The answer is no I don't. There is too much at stake to so many people and interest groups. These days the gov't never gets it right. Too many cooks in the kitchen if you will.

I have no problems with private insurance enhancing a gov't program. I certainly do not believe that the Gov't should be paying for breast augmentation and the like. Certainly private insurance could cover procedures like this. And I don't see why pvt insurance could not cover procedures that the govt would pay for. I think that 2 systems would make each other better and give people more options. I don't buy into the whole redistribution of wealth concept. If you can afford a better product then so be it. Your are of the assumption that a 2 tier system would provide inferior coverage and thats a false assumption. You tell me what constitutes good health care Feanor. Good health care should cover preventive care, emergency care, and treatment of acute and chronic illnesses. Its not rocket science that we are talking about. Maybe from a lay persons stand point it seems complex but from my point of view as a physician its not complex to provide comprehensive health care. The complex part will be to change peoples expectations of medical treatments and limiting end of life care to keep costs down.

[thekid]

I'll chime back in here a bit...

A common tactic for Liberals is to label what some would consider a service such as Health Care as a "Human Right" because this approach gives a sense of a univeral truth and to some degree paints those who might be opposed as uncompassionate oafs. The Anti-Tax/Anti-Government side also over reaches by calling any form of universal or public program Socialistic or Communistic. Supporters of government programs or spending are oddly enough often called unpatriotic by the opposition.

As with most extremes the truth normally lies somewhere in between.

Should "basic" health care or education be considered a "human right"? Probably since society as a whole benefits from it in a variety of ways. Those who look at it in terms of dollars and cents also need to truly look at all the costs that are associated with having a large portion of your population without regular "basic" health care and other services that should not be or can not be provided strictly on the basis of a market based model.

The question then becomes what are the "Basic Human Rights" people are willing to pay towards. Should our "Health Care system provide minimum care from common diseases and ailments or should it include care for rare forms of cancer or heart disease? Should public education prepare sudents to be able to function in society or be able to attend a Ivy League institution? Should our Defense budget be one that prevents our enemies from attacking us directly or one that "projects" our power when our economic interests are threatened abroad?

These types of decisions in a democratic society (free of special interest groups) need to made by the people and their elected representatives on what/where they want their money spent. Once those decisions are made the amount of taxes paid or the size of government are more or less set.

Unfortunately in our country the two sides have pretty much stopped talking to each other Critical decisions are either not made (see status quo), avoided entirely or when one side has a overwhelming majority they steam roll the opposition and pursue their own self interests

[blackraven]

There already is basic free health care in this country. Its called the emergency department and the multitude of free and low cost family clinics and dental clinics as well as the low cost minute clinics. Any one can go into any emergency dept and get evaluated and treated and not be turned away based on ability to pay! I've said it before and I'll say it again, the emergency department is this countries safety net.
Why do you think it is taking so long to get to universal health care. The gov't knows that people can go to the emergency dept for care, even cardiac care with heart catheterizations and angioplasty. We dont and cant turn any one away ever! It's the law and its called EMTALA!

[3LB]

the reason the hospitals charge $5 for a tylenol or $50 for a palstic catheter is because of the no pay patients and partial payments from insurance companies as well as 10-25cents on the dollar reimbursement from medicaid and poor reimbursement from medicare.

I figured as much, but isn't that the crux of the matter, most people don't want to have to overpay so that others don't have to pay at all?

[blackraven]

I figured as much, but isn't that the crux of the matter, most people don't want to have to overpay so that others don't have to pay at all?

EXACTLY, FINALLY SOME ONE BESIDES MYSELF SAID IT!!!!!!!!!!!

[Feanor]

EXACTLY, FINALLY SOME ONE BESIDES MYSELF SAID IT!!!!!!!!!!!

No, 3LB wasn't first to say it. In fact it was me: I quote myself:

Will it cost too much? That's rubbish. We know that equivalent healthcare is cheaper per capita in countries with universal coverage. No, the real reasons are:

• Less significantly, those who imagine themselves to be rich, young, and/or healthy are afraid that their coverage won't be as good as now; (this is largely an illusion), but
• Primarily, those with a vested interest fear that they won't make the profits they're making now. (I'm always amazed when I hear that a public option would be "unfair competition" for private insurers. WTF!?!)

• But the notion is invalid that the middle class must necessarily be worse off on account of subsidizing healtcare for the poor. Yes, it might be true that the sort of half-measures presently under consideration by Congress. However at least 95% of Americans would personally have better health care for lower cost under a universal, single-payor system.

[blackraven]

http://www.comcast.net/articles/news...e.Public.Plan/

I wonder how they arrived at the 2%, I have to believe that the actual numbers would be much, much higher.

[bondsam123]

Hi guys,
Some good points made here today. i would like to add that i have tried to stay non-partisan in this and believe blame is to be laid at the feet of both political parties.

I am not buying the arguement that alot of the medical testsare "defensive' because of the fear of malpractice suits. I think it is a redherring to deflect the fact that alot of the labs who conduct these tests are either directly or indirectly owned by many of the doctors who use them. They are just lining their pockets further.