Poll: Socialized Health Care In My Country

[Teallaura]

This is a question for those in countries that have socialized health care: How well does it work?

I'm asking because it just occurred to me that I hadn't seen any favorable discussion of it from those in nations with such programs. I'm wondering if I'm noticing an actual trend here or just missed something along the way (yeah, yeah, I know :rasberry:). But seriously, I'm curious as to what those with such systems have to say.

Thanks!

[mossrose]

It is hemorrhaging (I asked 2 people how to spell that, so if it is wrong, it isn't my fault......) money in Canada.

And the liberals just want to keep throwing more money at it.

Wait times are outrageous. You are lucky to get a specialist appointment within 6 months. And God help you if you need surgery that isn't emergency. Even if it is emergency surgery, you will be lucky to have a bed for longer than a day or two.

And this is Alberta, one of the better provinces. My mother in BC had to wait over 3 months for surgery for bowel cancer.

It stinks.

[Alien]

I haven't lived in my home country (UK) for 17 years, so I can't say how it's going now. It didn't seem too bad back then, though treatment was prioritised by urgency, so there was waiting for non essential treatment.

The reason I support some kind of universal health care system (note I'm carefully not supporting any particular method of implementing it) is that it serves need rather than ability to pay. That is the first and essential criterion from my point of view. If various sytems don't work too well in attempting that, then by all means let's fix them, but without sacrificing the principle.

The US system serves many people very well, there's no doubt, but while there remains even one person who can't get medical treatment because they can't pay for it, then it fails, in my book.

[TheOneAndOnly]

The NHS is failing. It's leaking money, falling into insurmountable debt, and hospitals are closing, and the government seems to think the solution is to pump more money into it. Of course no politician in the UK with his head screwed on would ever mention privatizing the NHS, because the public are addicted to it. Although it is inevitable that in the next decade or so the NHS will have to be privatized, for most people the inevitable hasn't dawned yet and they're happy to flutter away their money down the NHS blackhole.

[Ryokan]

This is a question for those in countries that have socialized health care: How well does it work?

I'm asking because it just occurred to me that I hadn't seen any favorable discussion of it from those in nations with such programs. I'm wondering if I'm noticing an actual trend here or just missed something along the way (yeah, yeah, I know :rasberry:). But seriously, I'm curious as to what those with such systems have to say.

Thanks!
I think it really depends on what you mean by works. If you mean provides the best care to the poorest in society, and determines services by need, so the sickest get the best care, then socialized systems work best. More cheaply, even, than our system. But.... if you want to talk abotu a system that provides the best care to the average user, ours certainly works better.

[Stabbytheclown]

I fully support having an NHS, imperfect as it may be in its current form. The most compelling argument is simply what happens to people who get sick in America. Almost half of American bankruptcies are caused by healthcare costs:
http://www.law.harvard.edu/news/2005/02/03_bankruptcy.php

I am fortunate in that I have only needed hospital treatment once since I was born (for a tonsillectomy), but I don't begrudge my taxes funding the hospitals. NHS hospitals are, in my experience (which is mostly visiting people), in no way as bad as the Torygraph would have you believe.

It's not like there aren't any private hospitals in the UK for those who have the cash. Privatising all healthcare could only result in many people suffering and/or going bankrupt.

[geochron]

I think it really depends on what you mean by works. If you mean provides the best care to the poorest in society, and determines services by need, so the sickest get the best care, then socialized systems work best. More cheaply, even, than our system. But.... if you want to talk abotu a system that provides the best care to the average user, ours certainly works better.
I've had experience of treatment for chronic and acute illnesses in the US and in the UK. I didn't see a lot of differences in treatment or results. My family is a fairly major consumer of healthcare in the UK and I think the NHS is pretty good, on the whole.

That's anecdotal, but wider statistical studies bear out my experience.

http://www.medicalnewstoday.com/medicalnews.php?newsid=27348

"THE FINDING THAT LITIGATION AND WAITING LISTS do not explain most of the higher U.S. health spending is perhaps not surprising considering previous research showing that the prices of care, not the amount of care delivered, are the primary difference between the United States and other countries.32 These higher prices are increasingly making health care unaffordable for many Americans.33 Equally troubling, the more-costly U.S. health care has not resulted in demonstrably better technical quality of care or better patient satisfaction with care.34 Future U.S. policies should focus on the prices paid for health services and on improving the quality of those services."

-From the Anderson et al study.

Socialised medicine is just more cost effective than the US system

[geochron]

The NHS is failing. It's leaking money, falling into insurmountable debt, and hospitals are closing, and the government seems to think the solution is to pump more money into it. Of course no politician in the UK with his head screwed on would ever mention privatizing the NHS, because the public are addicted to it. Although it is inevitable that in the next decade or so the NHS will have to be privatized, for most people the inevitable hasn't dawned yet and they're happy to flutter away their money down the NHS blackhole.

Hard to see why privatising is the answer to the NHS being too expensive, since the privatised US system costs twice as much per capita

[Ryokan]

I've had experience of treatment for chronic and acute illnesses in the US and in the UK. I didn't see a lot of differences in treatment or results. My family is a fairly major consumer of healthcare in the UK and I think the NHS is pretty good, on the whole.

That's anecdotal, but wider statistical studies bear out my experience.

http://www.medicalnewstoday.com/medicalnews.php?newsid=27348

"THE FINDING THAT LITIGATION AND WAITING LISTS do not explain most of the higher U.S. health spending is perhaps not surprising considering previous research showing that the prices of care, not the amount of care delivered, are the primary difference between the United States and other countries.32 These higher prices are increasingly making health care unaffordable for many Americans.33 Equally troubling, the more-costly U.S. health care has not resulted in demonstrably better technical quality of care or better patient satisfaction with care.34 Future U.S. policies should focus on the prices paid for health services and on improving the quality of those services."

-From the Anderson et al study.

Socialised medicine is just more cost effective than the US system
I suspect, as a major user, you would have a better experience than people with minor problems. Also, similiar overall satisfaction rates doesn't lead to the conclusion the average user is equally or more satisfied. In fact, since poorer people are probably far more satified with the serivce than similiar people in the US, the middle class or median income user is less satisfied with the European system in all likelihood.
I agree though, the European system is far cheaper than our half privatised, half public one.

[James Peter]

I also have had quite a lot of experience of both NHS and private treatment and I think that, all in all, I'd certainly want to keep the NHS. Yes, sometimes waiting lists can be much too long but in those cases you can always opt to go private. If you need urgent treatment you get it. If it isn't life threatening then sometimes you have to wait a few months to see a consultant. There are ways around that that are very affordable though (the two schemes that I'm covered by, HSA and Beneden, cost me a total of about $30 a month). At the end of the day even just paying to see a consultant only costs a couple of hundred and I can then opt to have all the scans and tests I need done on the NHS.

The fact is everyone expects the NHS to be able to cover everything and to offer the very best available treatment. That just isn't a viable option. The NHS should cover most things but should it pay to give an expensive operation to a 76 year old who has a 50-50 chance of not surviving a year beyond the procedure? It may seem heartless but I'm tempted to say that beyond a certain point people should have the choice of either paying for something themselves or not having it. I think a mixed system is ultimately the best option, with a decent level of care being provided for free and then people having the option of more advanced drugs and procedures if they can afford it (or choose to take out insurance in advance to cover it).

[geochron]

I suspect, as a major user, you would have a better experience than people with minor problems. Also, similiar overall satisfaction rates doesn't lead to the conclusion the average user is equally or more satisfied. In fact, since poorer people are probably far more satified with the serivce than similiar people in the US, the middle class or median income user is less satisfied with the European system in all likelihood.
I agree though, the European system is far cheaper than our half privatised, half public one.

As it happens the source for patient satisfaction figures is available online here...

http://www.moh.govt.nz/notebook/nbbooks.nsf/acab810454217625cc2570ca00808a6a/7de6ba56ff9550f9cc256e37007c510d?OpenDocument

where they summarise their examination of the data thus...

"comparing the responses of insured Americans only to responses of
patients in the other four countries had little effect on the U.S. rankings for
patient-reported quality measures."

This is a partial quote at the end of the executive summary, I can't claim to have examined the paper in detail.

Edited to add... In response to your first point, of course we have minor problems too. One member of my family requires major medication daily, which was limited by insurance in the States and isn't limited here. But another needed to see a consultant and be referred to a radioisotope lab for treatment which was delivered in a timely manner similar to that expected in the US. And there's the usual run of minor infections and so on which require GP appointments, which are all timely. The only thing we pay for is a standard prescription charge.

We have family members who work for the US health service. They were all convinced the UK's "socialised" healthcare system would let us down. They are all eating their words. I think the biggest problem the US has is the perception it has of healthcare in other countries. Similarly, I think people who haven't lived in the USA idealise the US system. When we go back to the USA, it's noticeable how worried a lot of people are about the financial consequences of a family member getting sick.

[Xavier]

It is hemorrhaging [...]

In case you are curious, that is the correct spelling.

[Ryokan]

As it happens the source for patient satisfaction figures is available online here...

http://www.moh.govt.nz/notebook/nbbooks.nsf/acab810454217625cc2570ca00808a6a/7de6ba56ff9550f9cc256e37007c510d?OpenDocument

where they summarise their examination of the data thus...

"comparing the responses of insured Americans only to responses of
patients in the other four countries had little effect on the U.S. rankings for
patient-reported quality measures."

This is a partial quote at the end of the executive summary, I can't claim to have examined the paper in detail.

Edited to add... In response to your first point, of course we have minor problems too. One member of my family requires major medication daily, which was limited by insurance in the States and isn't limited here. But another needed to see a consultant and be referred to a radioisotope lab for treatment which was delivered in a timely manner similar to that expected in the US. And there's the usual run of minor infections and so on which require GP appointments, which are all timely. The only thing we pay for is a standard prescription charge.

We have family members who work for the US health service. They were all convinced the UK's "socialised" healthcare system would let us down. They are all eating their words. I think the biggest problem the US has is the perception it has of healthcare in other countries. Similarly, I think people who haven't lived in the USA idealise the US system. When we go back to the USA, it's noticeable how worried a lot of people are about the financial consequences of a family member getting sick.That's not what I here from alot of people, including relatives, who've lived in the Uk and the study seems to bear out exactly what I am saying. Except that it seems if we want National Health, we should look to Australia or New Zealand, rather than Britain, as a model.

[Darth Executor]

Clinics are ok in Toronto, but the ER is worthless. I had to wait a couple of hours after I was allowed in before I got treatment while my lungs were being filled up with crap and I could barely breathe. A while ago I heard a story on the radio about a wounded person being brought to the hospital and dying on the hallways because they were taking so long to admit him/her.

[Teallaura]

I've had experience of treatment for chronic and acute illnesses in the US and in the UK. I didn't see a lot of differences in treatment or results. My family is a fairly major consumer of healthcare in the UK and I think the NHS is pretty good, on the whole.

That's anecdotal, but wider statistical studies bear out my experience.

http://www.medicalnewstoday.com/medicalnews.php?newsid=27348

"THE FINDING THAT LITIGATION AND WAITING LISTS do not explain most of the higher U.S. health spending is perhaps not surprising considering previous research showing that the prices of care, not the amount of care delivered, are the primary difference between the United States and other countries.32 These higher prices are increasingly making health care unaffordable for many Americans.33 Equally troubling, the more-costly U.S. health care has not resulted in demonstrably better technical quality of care or better patient satisfaction with care.34 Future U.S. policies should focus on the prices paid for health services and on improving the quality of those services."

-From the Anderson et al study.

Socialised medicine is just more cost effective than the US system

Note: I'm taking no position on the OP issue at this time.

I dunno, Geo, the study doesn't seem to compare wait times, outcomes or any other patient specific criteria. Now, to be honest, I ain't paying $12.95 to see the study proper so it could contain more than the article includes. However, I would think the patient specific stuff would show up in a good report, so I'm dubious. It seems to me to be a straight C/B analysis - not that that is invalid, but as such it's far from an adequate study for an overall comparison.

At least one item struck me as silly - um, if you have more machines (MRI) per capita, wouldn't you expect to have them in use fewer hours? Isn't availability kinda the point of having more of them? If they're having to work more hours then they aren't as available for use. :hrm:

[Alien]

I think the biggest problem the US has is the perception it has of healthcare in other countries. Similarly, I think people who haven't lived in the USA idealise the US system. When we go back to the USA, it's noticeable how worried a lot of people are about the financial consequences of a family member getting sick.

I agree.

I can certainly support the point about people being worried. We had a talk at church from a lady who is employed in victim support. She mentioned that often people who have been injured as a result of crime refuse to be taken to hospital because they fear the huge bills that may result.

And then there are the "cracks" that people can fall through. I retired last year and took the COBRA option, which covered my wife also. When I became 65, I moved on to Medicare and she continued with COBRA, which runs out in September. Unfortunately, she has had a couple of conditions arise that are "red flags" to medical insurance companies, and all her enquiries for insurance to replace the COBRA coverage have been rejected (not accepted with an increased premium, but outright rejected). We're still working on it, but if we can't find something she may be uninsured until she qualifies for Medicare in 2 years. This is worrying, because a big medical claim could wipe out everything we have worked all our lives for. And we have been responsible! We have always worked, paid taxes and are quite prepared to pay reasonable premiums for medical insurance. We're not poor, we can't just walk away from medical bills. We own enough and have saved enough that they can and would come after us for these bills.

Then there's what happens if you are uninsured. She was in hospital earlier this year for three days. The bill (which included several tests) was around $16000. The insurance paid $6000 and the rest was "written off". (This is what happens every time an insured person uses a medical facility, little or much). The hospital probably gets most of it's income from insured people, so I guess they somehow manage to get by with the $6000 in all these cases. But what would the bill have been if she had not been insured? Right, $16000. My dentist, who used to accept $81 dollars for a cleaning when I was insured, now proposes to charge me $120. I could go on.

Is anyone surprised that people are worried?

Quite frankly, this is only what we should expect in a private system driven by market forces. Insurance companies seek to maximise profit and don't care about what happens to individuals. This is not some diatribe about the evils of the capitalist system, it's just how it works. If they don't make a profit they go out of business, so of course they try to eliminate high risk applicants. It's not the way to get everyone insured though!

I lived in England most of my life and I always found the NHS comforting. I knew that, whether I was employed or not, or if I fell on hard times or not, I would always be eligible for medical treatment. I guess it's a choice; which system do we prefer? I know which I would pick, warts notwithstanding.

[Alien]

At least one item struck me as silly - um, if you have more machines (MRI) per capita, wouldn't you expect to have them in use fewer hours? Isn't availability kinda the point of having more of them? If they're having to work more hours then they aren't as available for use. :hrm:

Oh, I don't know. They're not less available until they are in use 24/7 (allowing for maintenance, etc[1]). I think the point is that the measure should be available equipment hours, not number of machines.

[1] OK, I know there are more factors, including location/availability, cost of staffing and so on. The point is that 10 machines working 10 hours are providing the same number of MRI scans as 20 machines working 5 hours and the cost is less.

[Teallaura]

Oh, I don't know. They're not less available until they are in use 24/7 (allowing for maintenance, etc[1]). I think the point is that the measure should be available equipment hours, not number of machines.

[1] OK, I know there are more factors, including location/availability, cost of staffing and so on. The point is that 10 machines working 10 hours are providing the same number of MRI scans as 20 machines working 5 hours and the cost is less.

Um, their issue was that we had machines working an average of 10 hours compared to 18 because we have more machines. Like I said, kinda silly.

[geochron]

That's not what I here from alot of people, including relatives, who've lived in the Uk and the study seems to bear out exactly what I am saying. Except that it seems if we want National Health, we should look to Australia or New Zealand, rather than Britain, as a model.

I think if you want National Health you should aim to get the best bits of all the current examples. As another study (or is it this one?) I read yesterday says, each system has something it does badly and something it does so well the other systems ought to learn from it.

[geochron]

Note: I'm taking no position on the OP issue at this time.

I dunno, Geo, the study doesn't seem to compare wait times, outcomes or any other patient specific criteria. Now, to be honest, I ain't paying $12.95 to see the study proper so it could contain more than the article includes.



The study's main aim is to figure out why American healthcare is so expensive. It concludes that it is not because of short wait times (because procedures you wait for in other countries are a very small fraction of total expenditure) and that it is not the presence of more litigation either.

Data on patient outcomes is available and I've posted it before on this site somewhere. The US doesn't do that well, as I recall. For instance, infant mortality rates in the US are 7.2/1000 vs 5.9/1000 in the UK. Life expectancy is 70 in the US vs 71.7 in the UK.



At least one item struck me as silly - um, if you have more machines (MRI) per capita, wouldn't you expect to have them in use fewer hours? Isn't availability kinda the point of having more of them? If they're having to work more hours then they aren't as available for use. :hrm:



I think you misunderstand. The say that the US having more MRI machines is a point in its favour, but this is reduced because they are used less so the US probably does not have more availablility of MRI machines to patients.

My own belief is that it is down to geography - being more spread out the US needs more facilities and each one serves a smaller population (on average).

[Ryokan]

The study's main aim is to figure out why American healthcare is so expensive. It concludes that it is not because of short wait times (because procedures you wait for in other countries are a very small fraction of total expenditure) and that it is not the presence of more litigation either.

Data on patient outcomes is available and I've posted it before on this site somewhere. The US doesn't do that well, as I recall. For instance, infant mortality rates in the US are 7.2/1000 vs 5.9/1000 in the UK. Life expectancy is 70 in the US vs 71.7 in the UK.



I think you misunderstand. The say that the US having more MRI machines is a point in its favour, but this is reduced because they are used less so the US probably does not have more availablility of MRI machines to patients.

My own belief is that it is down to geography - being more spread out the US needs more facilities and each one serves a smaller population (on average).
As I understand it, the reasons for higher medical cost here are a. We do give 50/50 surgeries to 75 year old men, which isn't cost efficient but is easier to afford with insuranse than National Healthcare, and we have a private system but cannot allow hospitals to refuse emergency medical care, so this risk increases costs.

[BillyBob]

And the liberals just want to keep throwing more money at it.



That's what liberals do best. [As long as it isn't their own money]

[geochron]

As I understand it, the reasons for higher medical cost here are a. We do give 50/50 surgeries to 75 year old men, which isn't cost efficient but is easier to afford with insuranse than National Healthcare, and we have a private system but cannot allow hospitals to refuse emergency medical care, so this risk increases costs.

Both of these seem to be to do with what staff and beds are doing rather than with the cost of the staff and the beds. It's the cost that is higher in the US. As a country the US pays 140 per cent above the OECD median(30 developed countries) per capita on health care, which bought the US lower than median supplies of physicians and hospital beds. You can see that the cost per doctor (whatever they do, whoever they treat) is a lot higher in the USA.

Given your explanation, it's hard to see why it would cost more to pay a doctor to give 50/50 surgery to a 75 year-old or to treat somebody who is uninsured in the USA than it does in the rest of the developed world (where they same things are done). The paper does not talk about the cost to the individual insured person (which goes up if the uninsured are treated "for free"), the paper is about spending per person in the country (total cost divided by total population). On this score the US is much more expensive than elsewhere.

[Teallaura]

The study's main aim is to figure out why American healthcare is so expensive. It concludes that it is not because of short wait times (because procedures you wait for in other countries are a very small fraction of total expenditure) and that it is not the presence of more litigation either.

Data on patient outcomes is available and I've posted it before on this site somewhere. The US doesn't do that well, as I recall. For instance, infant mortality rates in the US are 7.2/1000 vs 5.9/1000 in the UK. Life expectancy is 70 in the US vs 71.7 in the UK. Fine - my point wasn't that it wasn't a good study (what I saw looked fairly decent) but that it might not be best for the comparison at hand.

Vital stats aren't what I had in mind, by the way - too many other factors affect them. I want to see actual care outcomes. I suspect that would tell a great deal more than a straight C/B analysis. (Again, I'm not taking a position here, merely noting what I would look for in my own research.)



I think you misunderstand. The say that the US having more MRI machines is a point in its favour, but this is reduced because they are used less so the US probably does not have more availablility of MRI machines to patients. That's not at all what it implied to my mind. Given that it's a C/B analysis, it seemed to me to be implying that having more machines but using them less (as a direct result) was somehow less efficient. That is not necessarily true.

My own belief is that it is down to geography - being more spread out the US needs more facilities and each one serves a smaller population (on average).That I concur with. Our county has an MRI (I know this from personal and painful experience - those dyes do too hurt! :egad:) which serves a four county area - approximately 80,000 (maybe less) people. It's not going to be anywhere near as busy as one in NYC - but sending people a hundred miles away to get an MRI would be less efficient both in terms of service and cost (some patients needing to be transported by ambulance - not cheap).

[Ryokan]

Both of these seem to be to do with what staff and beds are doing rather than with the cost of the staff and the beds. It's the cost that is higher in the US. As a country the US pays 140 per cent above the OECD median(30 developed countries) per capita on health care, which bought the US lower than median supplies of physicians and hospital beds. You can see that the cost per doctor (whatever they do, whoever they treat) is a lot higher in the USA.

Given your explanation, it's hard to see why it would cost more to pay a doctor to give 50/50 surgery to a 75 year-old or to treat somebody who is uninsured in the USA than it does in the rest of the developed world (where they same things are done). The paper does not talk about the cost to the individual insured person (which goes up if the uninsured are treated "for free"), the paper is about spending per person in the country (total cost divided by total population). On this score the US is much more expensive than elsewhere.
Its easy. The cost of a hospital eating the uninsured persons costs in care leads to a greater increase in cost for the hospital than just the cost itself, and the hospital has to raise prices on every other type of care accordingly, and based not on the actual amount of free care they have to provide, but rather the risk of such care. This uncertainty raises prices. Also, doig surgery on high risk people is very expensive, more expensive than doing it on someone younger and healthier.

[Jeannot]

The NHS is failing. It's leaking money, falling into insurmountable debt, and hospitals are closing, and the government seems to think the solution is to pump more money into it. Of course no politician in the UK with his head screwed on would ever mention privatizing the NHS, because the public are addicted to it. Although it is inevitable that in the next decade or so the NHS will have to be privatized, for most people the inevitable hasn't dawned yet and they're happy to flutter away their money down the NHS blackhole.
The US "system" costs far more. It's just that the costs are borne by people who get sick.

[Teallaura]

The US "system" costs far more. It's just that the costs are borne by people who get sick.Not really - the lion's share is borne by business and the government. Most people are insured, one way or another, and insurance bears the majority of the burden, with businesses paying the bulk of the premiums. M'caid and M'care are governmental insurance programs.

[geochron]

Its easy. The cost of a hospital eating the uninsured persons costs in care leads to a greater increase in cost for the hospital than just the cost itself, and the hospital has to raise prices on every other type of care accordingly, and based not on the actual amount of free care they have to provide, but rather the risk of such care. This uncertainty raises prices.



Even if true, it seems to me that this is just another way of saying the current US system is very cost inefficient. All these people get treated in the other systems too, and treated more effectively at less cost.



Also, doig surgery on high risk people is very expensive, more expensive than doing it on someone younger and healthier.



It's not clear to me that the US actually does perform more high risk surgeries than the other OECD countries. But even if it does the greater expense reflects the need for more doctors, more anaesthetists, more nurses, more bedspace, more surgeries and so on- in other words you would be buying a greater quantity of tangible medical assets to perform these higher risk surgeries. So if this was a contributory factor there would be evidence of the US having more doctors, anaesthetists etc - the extra spend would get extra assets who would be visible. They aren't, as far as I can see.

[geochron]

Fine - my point wasn't that it wasn't a good study (what I saw looked fairly decent) but that it might not be best for the comparison at hand.

Vital stats aren't what I had in mind, by the way - too many other factors affect them. I want to see actual care outcomes. I suspect that would tell a great deal more than a straight C/B analysis. (Again, I'm not taking a position here, merely noting what I would look for in my own research.)



The paper I scanned yesterday said that the USA did better in some areas and worse in others. If I recall correctly, breast cancer survival rates were good in the USA while transplant survival rates were poor, but the spread wasn't huge. They were comparing USA, Canada, Australia, New Zealand and UK, I believe. If I get a chance I'll try to find it again.

[Jeannot]

Not really - the lion's share is borne by business and the government. Most people are insured, one way or another, and insurance bears the majority of the burden, with businesses paying the bulk of the premiums. M'caid and M'care are governmental insurance programs.
You' re right. But it remains true that the US system is costly and ineffcient.

The mantra of some conservatives is that the free market is always more efficient. True in many cases, but not health care.

[Ryokan]

Even if true, it seems to me that this is just another way of saying the current US system is very cost inefficient. All these people get treated in the other systems too, and treated more effectively at less cost.
I agree. But its an explaination why. If America had a true market system, it would be more efficient. Cold hard fact. But it would be more efficient because we denied people service. Since that is not acceptable to us, our half way system works less well than a fully socialized one.


It's not clear to me that the US actually does perform more high risk surgeries than the other OECD countries. But even if it does the greater expense reflects the need for more doctors, more anaesthetists, more nurses, more bedspace, more surgeries and so on- in other words you would be buying a greater quantity of tangible medical assets to perform these higher risk surgeries. So if this was a contributory factor there would be evidence of the US having more doctors, anaesthetists etc - the extra spend would get extra assets who would be visible. They aren't, as far as I can see.I may be wrong. :shrug:

[Ryokan]

You' re right. But it remains true that the US system is costly and ineffcient.

The mantra of some conservatives is that the free market is always more efficient. True in many cases, but not health care.
We don't have a real free market, that's why. And I don't think we want one.

[Alien]

I agree. But its an explaination why. If America had a true market system, it would be more efficient. Cold hard fact. But it would be more efficient because we denied people service. Since that is not acceptable to us, our half way system works less well than a fully socialized one.


And that is the most succinct description of the situation so far.

What seems to have happened in the US is an attempt to reconcile two different philosophies, and the result is a patched up system that works well in some areas and not at all well in others. I would love to see the bullet firmly bitten here, the whole mess swept aside and a new system introduced which incorporates the best of all the other systems, without reference to either conservative or liberal entrenched philosophies. We would first decide what we wanted to achieve; hopefully that would be some form of universal availability of healthcare. Then we would decide what is the best way to provide it. The result, I think, would be a healthcare system that would be the envy of the world.

<Bump! Oh sorry, I just woke up ... I had the strangest dream ....>

[Ryokan]

And that is the most succinct description of the situation so far.

What seems to have happened in the US is an attempt to reconcile two different philosophies, and the result is a patched up system that works well in some areas and not at all well in others. I would love to see the bullet firmly bitten here, the whole mess swept aside and a new system introduced which incorporates the best of all the other systems, without reference to either conservative or liberal entrenched philosophies. We would first decide what we wanted to achieve; hopefully that would be some form of universal availability of healthcare. Then we would decide what is the best way to provide it. The result, I think, would be a healthcare system that would be the envy of the world.

<Bump! Oh sorry, I just woke up ... I had the strangest dream ....>
I like that dream, but...

Seriously, though, I think their is a way to make a system that acknowledges our American character and individualist tendacies while still providing coverage and efficiency. Really, alot of different systems could work better than the one we have now.

[Jeannot]

We don't have a real free market, that's why. And I don't think we want one.
It's not free as far as Medicaid, etc, go, but it's free for the HMOs.

[Teallaura]

The paper I scanned yesterday said that the USA did better in some areas and worse in others. If I recall correctly, breast cancer survival rates were good in the USA while transplant survival rates were poor, but the spread wasn't huge. They were comparing USA, Canada, Australia, New Zealand and UK, I believe. If I get a chance I'll try to find it again.Thanks! :smile:

[dizzle]

accoridng to forum member Glenn Morton the studies show that cancer survival rates are highly in favour of the US

Someone might want to alert him to this thread. He is a cancer survivor himself.

[Zeluvia]

But, you have to remember that the capitalistic ideal is based on Freedom of the CONSUMER since Demand is the driving force.

In the current healthcare paradigm, the end consumer is not free.
We are not free to choose our healthcare plan in many cases, because of the way they are bundled and sold to employers as part of a benefit package. This means that healthcare corporations do compete, but at the corporate level of service, not at the individual level, which in effect penalizes smaller companies and employees of smaller companies because of smaller risk pools.

Then you have provider competition. Doctors are not really into advertising rates, nor are hospitals. If you look at my favorite example of profit healthcare advertising, plastic surgery, or even lasix eye surgery, or dentistry, or veternarian medicine, you can see market consumer driven forces in action.

Then to top it all off, we have an elite education system that actually hinders some career paths, and the AMA balking some things, and our own privacy rights holding up some possible technological advantages.

I wouldn't mind going to a lab, ordering my own blood test, or a biopsy of a suspicious growth, and getting the results sent to me, where I then access a database for possible diagnosis, treatment options, ect, complete with menu pricing.

Same with x-rays, MRI's ect.

95% of what people need medical treatment for is pretty cut and dried, and the other 5% the doctor is just as likely to get it wrong.

Give me full control and full consumer rights and free market competition !!
Or give me a totally socialized system.

I don't care, one or the other !!

[Ryokan]

accoridng to forum member Glenn Morton the studies show that cancer survival rates are highly in favour of the US

Someone might want to alert him to this thread. He is a cancer survivor himself.
Yeah, I remember him mentioning this. Clearly, adopting the British model part and parcel is not a good idea. We need something new that keeps as much of the advantages we have where solving as many of the problems.

[dizzle]

unfortunately socialism doesn't work, in any area

[Gideon Brown]

and the AMA balking some things

Ack! Don't get me started on the Canadian medical authorities... :rant: Suffice it say that there is a looming (possibly acute) doctor shortage in this country while there are thousands of foreign-trained doctors driving cabs because the licensing requirements are too strict... :shoot:

[Ryokan]

unfortunately socialism doesn't work, in any area
Really, Dee Dee? What do you think the armed forces, police department, fire department, department of transportation, etc. are? Free market loving fools. Truth is, "socialism" as you are defining it does work in certain cases, and you have to define work. Would a free market health care system be more efficient than our current one or a nationalized "socialist" one? Without a doubt. WOuld it provide anywhere near full coverage, or even as much coverage as our current system provides? No. Not at all. Is our current system, a type of hybrid, in general, not in particulars, less efficient than a full blown "socialist" one? Yes. So, clearly, if socialism doesn't work, what we are doing works less and the free market approach is morally unacceptable to most. So we need a change in the system.

[bandecoot]

accoridng to forum member Glenn Morton the studies show that cancer survival rates are highly in favour of the US

Someone might want to alert him to this thread. He is a cancer survivor himself.


Funny you should say this ...I happen to have links to just this topic.

The NCI's Surveillance, Epidemiology, and End Results (SEER) Program
Public-Use Data Web Page: The SEER program tracks cancer incidence and
survival using geographically defined, population-based, central cancer
registries in the United States. The SEER Public-Use Data Web page
includes links to SEER incidence and population data associated by age,
sex, race, year of diagnosis, and geographic areas. This resource is
available at

http://seer.cancer.gov/publicdata/

on the Internet.


NCI's SEER Program Statistical (SEER*Stat 6.2) software: SEER*Stat is
a powerful tool that can be used to view individual cancer records and
produce statistics about trends over time, survival, frequency and rate,
and limited-duration prevalence of different types of cancer. The
SEER*Stat software is distributed with the SEER 1973-2002 public-use
data, and a signed SEER Public-Use Data Agreement is required to access
the information. This resource is available at
http://seer.cancer.gov/seerstat/ on the Internet.


You may wish to perform a search of the medical literature for
published articles about remission and mortality rates. The PubMed(R)
database, a service of the National Library of Medicine (NLM), provides
a free search tool to help people find journal articles of interest in
the health and medical sciences. PubMed can be found at
http://www.pubmed.gov on the Internet.


sorry about the cut n paste..... some days ya just gotta do it.

[Teallaura]

Really, Dee Dee? What do you think the armed forces, police department, fire department, department of transportation, etc. are? Free market loving fools. Truth is, "socialism" as you are defining it does work in certain cases, and you have to define work. Would a free market health care system be more efficient than our current one or a nationalized "socialist" one? Without a doubt. WOuld it provide anywhere near full coverage, or even as much coverage as our current system provides? No. Not at all. Is our current system, a type of hybrid, in general, not in particulars, less efficient than a full blown "socialist" one? Yes. So, clearly, if socialism doesn't work, what we are doing works less and the free market approach is morally unacceptable to most. So we need a change in the system.Ry, you just defined governmental functions as a specific system - that's not true. Most of those functions are provided by any government in any system because they are functions of government: i.e. things that are duties of and/or best accomplished by government. Such functions are common throughout the spectrum and don't define any system.

The hybrid system you mention does exist, but you're using the wrong functions to demonstrate it. Welfare and related systems - i.e. non-traditional functions - are the ones you want.

Looks to me as if you are both straying from traditional definitions of socialism - and making the conversation murky in the process.

[Darth Executor]

"Socialism" works only when combined with a competent social authoritarian. For example, you can have an efficient welfare system that is designed to be borderline torture for lazy bums and encourages them to find work. But, to apply the torture part, you need to severely restrict people's personal liberties. For example, if you don't have a job, the government provides you with food (only vegetables and meat substitutes like tofu). If you're fat, the government puts you on a diet by limiting the ammount of food you get. No welfare money whatsoever. The government should not be giving the poor one cent. The government gives you access to a room that contains a bed and a telephone, no bigger than a prison cell, in a building with common showers and toilets. Make the bed on the matress harder than it has to be (if you replace the matress with blankets altogether it would be perfect). A common room with internet and printer access to help with job searches would be nice. Anyone able to work who is not in school and does not have enough money to live without a job should be forced into this system. TV, videogames and the like are not allowed. I guarantee that people will be so bored and hate their life so much that they will beg for jobs instead of leeching off the government.

[dizzle]

What Teal said - those are not socialistic systems IMHO.

[Ryokan]

Ry, you just defined governmental functions as a specific system - that's not true. Most of those functions are provided by any government in any system because they are functions of government: i.e. things that are duties of and/or best accomplished by government. Such functions are common throughout the spectrum and don't define any system.
But it is simply a artificial barrier, teal. When DDW says "socialism doesn't work" what she is saying is the government doesn't work. It does, at certain things.
The hybrid system you mention does exist, but you're using the wrong functions to demonstrate it. Welfare and related systems - i.e. non-traditional functions - are the ones you want. Fire fighting is just as good. It was once a private service, now its not. health care could be seen in a similiar light.

Looks to me as if you are both straying from traditional definitions of socialism - and making the conversation murky in the process.
She brought it up, and I kept "socialism" in quotes. I agree, real socialism is not being talked about by anyone here.

[Teallaura]

But it is simply a artificial barrier, teal. When DDW says "socialism doesn't work" what she is saying is the government doesn't work. It does, at certain things.Maybe, as far as your interpretation of DD's meaning - but it's still a false definition, which was my issue.

If you pursue the government can work theme, try rural electrification and WIC as examples of governmental successes. Neither is arguably socialist but both were/are tremendous programs.


Fire fighting is just as good. It was once a private service, now its not. health care could be seen in a similiar light.Which is precisely why I said most.

I disagree that fire fighting makes your point, though - government took over the function because the private sector was ill suited for it (rival companies were known to brawl in the street as fires raged). Government does have a vested interest in not letting its cities burn to the ground - which is why that the few private (ie volunteer) units remaining are extremely strictly regulated. There's nothing distinct of socialism there.

She brought it up, and I kept "socialism" in quotes. I agree, real socialism is not being talked about by anyone here.Okay.

[Ryokan]

Maybe, as far as your interpretation of DD's meaning - but it's still a false definition, which was my issue.

If you pursue the government can work theme, try rural electrification and WIC as examples of governmental successes. Neither is arguably socialist but both were/are tremendous programs. That would work too.


Which is precisely why I said most.

I disagree that fire fighting makes your point, though - government took over the function because the private sector was ill suited for it (rival companies were known to brawl in the street as fires raged). Government does have a vested interest in not letting its cities burn to the ground - which is why that the few private (ie volunteer) units remaining are extremely strictly regulated. There's nothing distinct of socialism there. See, but I would say the market is ill suited to meet the goals we have for health care, too.
[/QUOTE]

[Ryokan]

What Teal said - those are not socialistic systems IMHO.
You need to define what you mean, Dee Dee. What is inherently different about them vs. healthcare? I can, actually, think of a couple difference between them and emergency or terminal care, at least, but I want to know what is the difference in your mind and what would make some sort of guaranteed health plan "socialistic".

[Teallaura]

That would work too.

See, but I would say the market is ill suited to meet the goals we have for health care, too.
I'm still not taking a position on that - I was just pointing out that it wasn't a good example of a socialistic program.

[Ryokan]

I'm still not taking a position on that - I was just pointing out that it wasn't a good example of a socialistic program.
I didn't ask you too, just for you to see the possibility of a parallel. Especially as far as preventative medicine goes.

[Teallaura]

I didn't ask you too, just for you to see the possibility of a parallel. Especially as far as preventative medicine goes.Okay - but DD's the one you're having that discussion with! :teeth:

[dizzle]

I mean socialism in the exact way Teal means socialism as in the title of this thread. It is simply obvious to me, and not something that I am finding easy to explain - I knows it when I sees it, and I think Teal addressed well the distincitions in the areas you brought up.

[Ryokan]

I mean socialism in the exact way Teal means socialism as in the title of this thread. It is simply obvious to me, and not something that I am finding easy to explain - I knows it when I sees it, and I think Teal addressed well the distincitions in the areas you brought up.
Yeah, but that is very unuseful, because then socialism simply becomes "A certain kind of thing I don't think will work somehow related to government activity". How can I discuss that? What is different about healthcare compared to other government functions that makes it not work? Forget "socialism".

[Alien]

"Socialism" works only when combined with a competent social authoritarian. For example, you can have an efficient welfare system that is designed to be borderline torture for lazy bums and encourages them to find work. But, to apply the torture part, you need to severely restrict people's personal liberties. For example, if you don't have a job, the government provides you with food (only vegetables and meat substitutes like tofu). If you're fat, the government puts you on a diet by limiting the ammount of food you get. No welfare money whatsoever. The government should not be giving the poor one cent. The government gives you access to a room that contains a bed and a telephone, no bigger than a prison cell, in a building with common showers and toilets. Make the bed on the matress harder than it has to be (if you replace the matress with blankets altogether it would be perfect). A common room with internet and printer access to help with job searches would be nice. Anyone able to work who is not in school and does not have enough money to live without a job should be forced into this system. TV, videogames and the like are not allowed. I guarantee that people will be so bored and hate their life so much that they will beg for jobs instead of leeching off the government.

Hmmmm. Is the "crime" that the poor commit being idle, or being poor? If it's being idle, then the idle rich should be subjected to the same regimen, should they not?

(I really hope that was intended to be a subtle joke. If not, it's one of the most hateful things I have read in some time. Don't be surprised if you get visited by three ghosts next Christmas!)

[anthrogirl]

This is a question for those in countries that have socialized health care: How well does it work?

I'm asking because it just occurred to me that I hadn't seen any favorable discussion of it from those in nations with such programs. I'm wondering if I'm noticing an actual trend here or just missed something along the way (yeah, yeah, I know :rasberry:). But seriously, I'm curious as to what those with such systems have to say.

Thanks!


/nitpick/ The UK is the only state in the world that has socialized medicine. Socialized health care only exists when every employee in the health care system is an agent of the state, and all aspects of the health care system are controlled by the government. This is contrasted with universal health care systems (such as Canada, Australia, New Zealand, and all EU countries--except the UK, of course!). /nitpick/

ag

[Teallaura]

/nitpick/ The UK is the only state in the world that has socialized medicine. Socialized health care only exists when every employee in the health care system is an agent of the state, and all aspects of the health care system are controlled by the government. This is contrasted with universal health care systems (such as Canada, Australia, New Zealand, and all EU countries--except the UK, of course!). /nitpick/

ag


:rasberry:


Actually, 'socialized' isn't the same thing as 'socialism' with the UK being of the latter, so the term can correctly apply....


Picky! :brood:

[anthrogirl]

:rasberry:


Actually, 'socialized' isn't the same thing as 'socialism' with the UK being of the latter, so the term can correctly apply....


Picky! :brood:
sorry--i am afraid you are incorrect.

World Health Org hreleased the results of a study that compared overall patient satisfaction in five or six industrialized nations based on quality, access and cost--it is a fascinating report. i am out of the country at the moment, or else i would provide the results here.

regards,
ag

[Teallaura]

sorry--i am afraid you are incorrect.

World Health Org hreleased the results of a study that compared overall patient satisfaction in five or six industrialized nations based on quality, access and cost--it is a fascinating report. i am out of the country at the moment, or else i would provide the results here.

regards,
ag

Strictly speaking, you were right about the definition at least of socialism - but the term 'socialized' has a looser meaning that would be correct. It indicates that the system mimics socialism - not that it actually is a socialism.

[anthrogirl]

okay.

best,
ag

[Alien]

/nitpick/ The UK is the only state in the world that has socialized medicine. Socialized health care only exists when every employee in the health care system is an agent of the state, and all aspects of the health care system are controlled by the government. This is contrasted with universal health care systems (such as Canada, Australia, New Zealand, and all EU countries--except the UK, of course!). /nitpick/

ag

By that definition, even the UK NHS is not "socialized", as there is private practice in the UK (ie not all employees of the system are "agents of the state"), and you can buy medical insurance separate from the National plan (though you can't opt out of the NHS).

The Government regulates the whole thing of course, but that is true even in the US. (Second thoughts, that may not be strictly true anywhere, I just thought of herbal remedies).

[Rahab]

By that definition, even the UK NHS is not "socialized", as there is private practice in the UK (ie not all employees of the system are "agents of the state"), and you can buy medical insurance separate from the National plan (though you can't opt out of the NHS).

The Government regulates the whole thing of course, but that is true even in the US. (Second thoughts, that may not be strictly true anywhere, I just thought of herbal remedies). Bonjour Alien,

I think a mixed system allowing for private practice while insuring that lower economical classes can access health care would be ideal. The thought of a person being struck by a catastrophic illness such as cancer without any financial means to sustain the cost of long term or repeated treatments ought to motivate the presence of socialized health care. The only reason why I can benefit of such long term and repeated care myself is because we can "shell out" almost 1/3 of my husband's income into health care insurance. And that does not include co payments.

The other issue IRW cancer treatments is how detection will be delayed because of the financial inability to sustain the cost of the tests. Imagine... a PET scan costs over 8000 dollars! Even as one may benefit of a state or county funded program to detect colon cancer for example, an uninsured individual may not be able to access the necessary treatments to deal with it.

The cost of long term or repeated treatments would be less if the illness is detected at early stages. Which necessitates the financial means to assume a complete physical. In my case, I was for three years without any health care coverage until I was diagnosed. I had reached a stage borderlining IV. I avoided visits to a physician for lack of insurance. Had I benefited of socialized health care, my type of cancer would have been detected at a stage requiring only radiation therapy being contained then to one group of lymph nodes. Having had to delay physicals and tests resulted in an advanced stage of my illness and required high cost treatments and that for a long term.

We can safely assume that out of the 45 millions of uninsured Americans, some have delayed physicals, preventative medical care and certainly could not afford tests for early cancer detection. Those folks are susceptible to join the catastrophic illness statistics, be limited in their capacity to work and go from a relatively stable economical situation to poverty level income.

IMO many do not realize the multiple negative impacts a catastrophic illness may have on anyone. It is not just the emotional, physical and psychological effects. But also the drastic economical changes that may occur.

If we claim to be a society which wills to eliminate poverty, we need to prevent situations which can unbalance the economical status of its citizens. Medical situations are definitly a cause of loss of income and unexpected major expenses. Regular physicals ought to be at no cost. Early cancer detection ought to be at no cost. It is in the best economical interest of a nation to maintain a healthy working force.

There is also the alternative to motivate and stimulate the existence of private charitable foundations (such as the excellent system of the Shriners) to support medical care and cost of economicaly disadvantaged individuals. It gives folks ,who have the motivation to contribute part of their wealth to the medicaly needy, an opportunity to choose which organizations they want to support and invest their generous state of mind.

[Alien]

I think a mixed system allowing for private practice while insuring that lower economical classes can access health care would be ideal.

It seems to offer the best of both worlds, certainly.


The thought of a person being struck by a catastrophic illness such as cancer without any financial means to sustain the cost of long term or repeated treatments ought to motivate the presence of socialized health care.

You mean we should actually have compassion for people in trouble rather than conclude it's probably their fault in some way? That's a novel idea.


The other issue IRW cancer treatments is how detection will be delayed because of the financial inability to sustain the cost of the tests. Imagine... a PET scan costs over 8000 dollars! Even as one may benefit of a state or county funded program to detect colon cancer for example, an uninsured individual may not be able to access the necessary treatments to deal with it.

Did you know that Medicare doesn't cover the kind of yearly checkups that are standard with most private insurance? Seems shortsighted to me!


IMO many do not realize the multiple negative impacts a catastrophic illness may have on anyone. It is not just the emotional, physical and psychological effects. But also the drastic economical changes that may occur.

Right.


There is also the alternative to motivate and stimulate the existence of private charitable foundations (such as the excellent system of the Shriners) to support medical care and cost of economicaly disadvantaged individuals. It gives folks ,who have the motivation to contribute part of their wealth to the medicaly needy, an opportunity to choose which organizations they want to support and invest their generous state of mind.

And on the other hand, those who want to keep their money all to themselves don't have to contribute a thing. My view is different. I think that if we, as a society through the democratic process, decide to do something then we should all contribute whether we want to or not. It's no different from supporting the armed forces through taxation. I hate many of the ways that my money is spent in that area, but no one gives me a choice. That is the way to make those in need secure. Not to make them dependant on the whims of those who may or may not have the goodwill or resources to contribute at any given time. That's not to denigrate those who work in charities or contribute to them financially, they are good people. I simply prefer the security of a system funded through taxation. (Waits for the abuse to start.)

[Ryokan]

My idea is simple, alien, maybe you'd like it. Basically, the state sets out a minimum standard of care, say vaccinnations, yearly check up, serious illness or terminal illnesses and medication. It requires everyone in the country to purchase a plan like that at least. You get get more if you like. If you are under a certain income level, or fall below it, the state pays for your insurance. That way, no one is not insured, no one goes bankrupt from a illness, and the state does not spend to much money on healthcare than it does now. Its a right wing fix, too be sure, and insurance companies would throw a party at the prospects of millions of more insurees, but I think it would work. They are gonna try a smaller plan like this is Mass.

[Abigail]

My idea is simple, alien, maybe you'd like it. Basically, the state sets out a minimum standard of care, say vaccinnations, yearly check up, serious illness or terminal illnesses and medication. It requires everyone in the country to purchase a plan like that at least. You get get more if you like. If you are under a certain income level, or fall below it, the state pays for your insurance. That way, no one is not insured, no one goes bankrupt from a illness, and the state does not spend to much money on healthcare than it does now. Its a right wing fix, too be sure, and insurance companies would throw a party at the prospects of millions of more insurees, but I think it would work. They are gonna try a smaller plan like this is Mass.

I agree with you. There has to be a minimum standard available to all irrespective of their ability to pay. Here in UK we dont pay to see the doctor but unless you are exempt you pay for your medication £6.65 per item on the perscription (if you are chronically ill and get lots of items regularly they do have schemes whereby you dont pay so heavily). Those who are exempt dont pay for medicine prescribed by a doctor ie children under 16 (up to 18 if in full time education), pensioners, pregnant women and those who are on benefits (incapacity, income support, job seekers allowance etc)

Oral contaceptives are free

[Keith Johnson]

This is a question for those in countries that have socialized health care: How well does it work?

I'm asking because it just occurred to me that I hadn't seen any favorable discussion of it from those in nations with such programs. I'm wondering if I'm noticing an actual trend here or just missed something along the way (yeah, yeah, I know :rasberry:). But seriously, I'm curious as to what those with such systems have to say.

Thanks!

If it were unpopular then people could gain politically from proposing to end it. That doesn't happen. Several years ago in Great Britian, the Labour Party accused Tory PM John Major of advocating the end of their socialized medicine. His reaction? He called the charge a damned lie (I paraphrase) because he knew that the people [i]wanted[/i[ socialized medicine, compared to the alternative of the kind of privatized system we have in the US. There are some serious market failures in health care, the free market isn't really the most efficient way to provide health care. Some kind of socialized medicine is the only way to efficiently to provide health care for everyone.

your friend
keith

[Alien]

My idea is simple, alien, maybe you'd like it. Basically, the state sets out a minimum standard of care, say vaccinnations, yearly check up, serious illness or terminal illnesses and medication. It requires everyone in the country to purchase a plan like that at least. You get get more if you like. If you are under a certain income level, or fall below it, the state pays for your insurance. That way, no one is not insured, no one goes bankrupt from a illness, and the state does not spend to much money on healthcare than it does now. Its a right wing fix, too be sure, and insurance companies would throw a party at the prospects of millions of more insurees, but I think it would work. They are gonna try a smaller plan like this is Mass.

OK. That looks good at first blush. I don't care if it's right or left wing, so long as it works. Let's flesh it out and see if it still looks good. :smile:

You want everything to be administered by the Insurance companies? OK.

When you cease to be covered by your parents' policy(s), you have to (can you opt out?) take a policy with one of the Insurance companies that participate in the plan. They are all bound to offer the same benefits and underwriting under the "basic" plan (how "basic" will it be?) and can't refuse to cover you or rate you differently from anyone else no matter what is the state of your health. They can compete on price, but must offer the same premium to all. If you are not paying taxes (employed, basically, but not necessarily) then your premium is paid by the Government. Otherwise, you pay by deduction from your income. This is "phased in" at lower levels of income. You have the option of paying extra for higher levels of coverage, with that company or another one. This policy is not tied to employment in any way and employers are not bound to contribute (which should enable them to raise wages for those previously covered by employers' plans) but may do so as a "benefit" if they wish. Employers may also pay for extra levels of coverage if they wish to offer this as a benefit.

The basic policy cannot be cancelled by the Insurance company so long as premiums continue to be paid (which they must be as I see it), nor can the premium be raised because of bad underwriting experience. Premiums can be adjusted for inflation and general claims experience as can the coverage and underwriting rules, but this is done through Government regulation, after consultation with the companies.

Health care providers are obliged to accept the basic coverage as a condition of their licensing.

Medicare is abolished in its current form. The basic policy simply continues into old age, under the same rules (what about early retirement?). Medicaid is no longer necessary, as the basic policy covers everyone.

This is a national thing (administered by the Federal Government), or universally applied by the States. If the latter, it should be easy to move from state to state without losing coverage or having it dramatically altered. Ideally all states should offer the same benefits and premiums.

Discussion on the italicized points:

1.How "basic" will it be? This is make or break, imo. It will be a balance between cost and what is a reasonable minimum coverage. Too low coverage will still be a "them and us" situation, and too high will not be affordable.

2. Can you opt out? I would say, no. It's tempting to say yes on the basis of personal freedom, but what will happen is that a lot of young people in good health on low incomes will try to "go it alone" to get a higher immediate income, and then squeal when they get sick later on. Also if everyone is covered and everyone contributes, the underwriting will be much better. You don't want just sick people in it. In the early days you pay for the increased risk later on.

3. What about early retirement? This is a subset of the question "What about people that just don't want to work and simply take free healthcare?". The current situation is that if you retire early (or just quit work) you are responsible for providing your own coverage until you reach the age of 65. This could continue in principle. If you decide not to work when you can, then you would be expected to pay the basic premium yourself. There would be the advantage that the premium would not be affected by your state of health. Otherwise the same sort of rules could be applied as we currently have for unemployment benefits.

I'm actually not too happy with this last one. I'd really prefer that the coverage was provided regardless of any rules like this, and I have all kinds of social arguments to support it. I suspect it would be a minor factor anyway.

What do you think? have I misrepresented the original idea?

[Ryokan]

OK. That looks good at first blush. I don't care if it's right or left wing, so long as it works. Let's flesh it out and see if it still looks good. :smile: Works for me.

You want everything to be administered by the Insurance companies? OK.
They ARE in it to make a profit, but this also inspires them to reduce waste and not be incompetant. In the end, if I think the market can do it, I'd rather deal with their problems than a bueracracy.
When you cease to be covered by your parents' policy(s), you have to (can you opt out?) take a policy with one of the Insurance companies that participate in the plan. They are all bound to offer the same benefits and underwriting under the "basic" plan (how "basic" will it be?) and can't refuse to cover you or rate you differently from anyone else no matter what is the state of your health. They can compete on price, but must offer the same premium to all. If you are not paying taxes (employed, basically, but not necessarily) then your premium is paid by the Government. Otherwise, you pay by deduction from your income. This is "phased in" at lower levels of income. You have the option of paying extra for higher levels of coverage, with that company or another one. This policy is not tied to employment in any way and employers are not bound to contribute (which should enable them to raise wages for those previously covered by employers' plans) but may do so as a "benefit" if they wish. Employers may also pay for extra levels of coverage if they wish to offer this as a benefit. Basically, yeah. It retains alot of the flexibility of the current system, without the risk of noncoverage or catastophic illness leading to bankruptcy.

The basic policy cannot be cancelled by the Insurance company so long as premiums continue to be paid (which they must be as I see it), nor can the premium be raised because of bad underwriting experience. Premiums can be adjusted for inflation and general claims experience as can the coverage and underwriting rules, but this is done through Government regulation, after consultation with the companies.

Health care providers are obliged to accept the basic coverage as a condition of their licensing.
Yep.
Medicare is abolished in its current form. The basic policy simply continues into old age, under the same rules (what about early retirement?). Medicaid is no longer necessary, as the basic policy covers everyone. Yes.

This is a national thing (administered by the Federal Government), or universally applied by the States. If the latter, it should be easy to move from state to state without losing coverage or having it dramatically altered. Ideally all states should offer the same benefits and premiums. State to state portable is probably the only way it would pass. The feds set a minimum, and states are free to have further requirements, but not lower the minimum. Ideally, it be a fed thing, but it'd probably not pass.

Discussion on the italicized points:

1.How "basic" will it be? This is make or break, imo. It will be a balance between cost and what is a reasonable minimum coverage. Too low coverage will still be a "them and us" situation, and too high will not be affordable.
IMO, it'd have to cover preventative care, like vaccinations, yearly checkups, etc. in order to keep the prices down int the long run. it also should provide some sort of safety net for terminal or life threatening illnesses, as well as a drug plan. For children, a higher level of standard care. For adults, if you have to go for bronchitis or some standard illness to the doctor and want no coverage, I think that's permissible. So, its a little on the expensive side, but less so than a fully nationalized plan, I think. I am no expert, so I really shouldn't make this call.
2. Can you opt out? I would say, no. It's tempting to say yes on the basis of personal freedom, but what will happen is that a lot of young people in good health on low incomes will try to "go it alone" to get a higher immediate income, and then squeal when they get sick later on. Also if everyone is covered and everyone contributes, the underwriting will be much better. You don't want just sick people in it. In the early days you pay for the increased risk later on. No opt out. i agree.

3. What about early retirement? This is a subset of the question "What about people that just don't want to work and simply take free healthcare?". The current situation is that if you retire early (or just quit work) you are responsible for providing your own coverage until you reach the age of 65. This could continue in principle. If you decide not to work when you can, then you would be expected to pay the basic premium yourself. There would be the advantage that the premium would not be affected by your state of health. Otherwise the same sort of rules could be applied as we currently have for unemployment benefits.[/QUOTE} We would have to set a minimum retirement age, basically. Probably 67-68, to help alleive the baby boom bubble a bit.
[QUOTE]
I'm actually not too happy with this last one. I'd really prefer that the coverage was provided regardless of any rules like this, and I have all kinds of social arguments to support it. I suspect it would be a minor factor anyway.

What do you think? have I misrepresented the original idea?
You have it about right. The appeal of it, I think, is it provides more or less universal coverage without the inefficiencies of a massive buercratic regime. Is the coverage as perfect as a socialized system? No, not really. But it is better than our current one, and reflects America's more self reliant and government suspect character. I don't think their is a one size fit all system for each country. Different things matter to different peoples.

[geochron]

In the end, if I think the market can do it, I'd rather deal with their problems than a bueracracy.



This amused me, since we're in the middle of dealing with the bureaucratic fallout from my other half's last stay in a private US hospital. Does the insurance pay, how much do they pay, why haven't they paid...? I think the phone bill will soon be more than the medical bill.

There surely is bureaucracy in the state run system, but I don't have to deal with it. We just show up and get treated, and that's the end of it.

[Teallaura]

No, Geo, but you do pay for it. Ry's right that bureaucracies tend toward inefficiency - which leads to increased cost. Even if not comparable - who wants to pay for waste?


Ry, one other note - doctors need the right of refusal or your plan will die hideously. Some patients are simply too contentious and/or non-compliant. Docs aren't going to go for any plan where they are going to have to deal with any and all comers. Frankly, I side with them on that - doctors shouldn't have to deal with dangerous patients (and yes, it happens) just to get paid.

Being required to accept any given plan is problematic - plans vary widely in how they bill. A small practice may not have the resources to hire specialized billers to deal with a myriad of billing practices (this has been a historic problem with M'caid which often bills differently from M'care and BC/BS) and hospitals don't want the hassle.

Here's a spot where right of refusal has gained providers in M'caid. The current M'caid rules are good - pt's can be refused at the door, but not once in the exam room. That protects both the provider and the patient. Once in the exam room, the patient is assured his insurance will be billed. Once out, the doctor is assured he never has to deal with that patient in clinic again.

[Alien]

We would have to set a minimum retirement age, basically. Probably 67-68, to help alleive the baby boom bubble a bit.

That's what's happening with Social Security. The retirement age goes up every year. For some reason, Medicare doesn't follow that.


You have it about right. The appeal of it, I think, is it provides more or less universal coverage without the inefficiencies of a massive buercratic regime. Is the coverage as perfect as a socialized system? No, not really. But it is better than our current one, and reflects America's more self reliant and government suspect character. I don't think their is a one size fit all system for each country. Different things matter to different peoples.

True. Nothing will work (well, maybe "nothing will be started" would be more accurate) if people are not on board with it.

[Alien]

This amused me, since we're in the middle of dealing with the bureaucratic fallout from my other half's last stay in a private US hospital. Does the insurance pay, how much do they pay, why haven't they paid...? I think the phone bill will soon be more than the medical bill.

There surely is bureaucracy in the state run system, but I don't have to deal with it. We just show up and get treated, and that's the end of it.

You should see the mess that providers have to deal with too. There's a huge overhead just processing claims.

We had a similar experience with a surgery my wife had a few months ago. She was covered under COBRA and paid premiums to one organization, who passed them on to the insurer. They always did this late, and every month the coverage was suspended, then reinstated. She was just about to go into hospital, the preparatory tests were done, and then the hospital threatened to cancel the whole thing because she "wasn't covered". This was due to the late payment (not by her). It took endless phone calls to sort it all out. Ill people shouldn't have to be subjected to this stuff.

[Alien]

No, Geo, but you do pay for it. Ry's right that bureaucracies tend toward inefficiency - which leads to increased cost. Even if not comparable - who wants to pay for waste?

I wonder (I have no idea what is the correct answer) which is really more wasteful when everything is considered. The cost of a Government program can be clearly seen, as all the numbers are readily available. In the private situation, it's not so straightforward. Is anyone adding up the cost of all the staff in all the Doctors' offices processing all the claims to all the Insurance companies? The current system (and I've had personal experience of it recently as my wife is a provider and has also had two hospital stays this year, and, quite frankly, it's a mess.

In theory, a Government plan, with one payer and one set of rules should be more efficient. So is it really less efficient, or is that just conventional wisdom? Again, I don't know.


Ry, one other note - doctors need the right of refusal or your plan will die hideously. Some patients are simply too contentious and/or non-compliant. Docs aren't going to go for any plan where they are going to have to deal with any and all comers. Frankly, I side with them on that - doctors shouldn't have to deal with dangerous patients (and yes, it happens) just to get paid.

I think I introduced that one. I was trying to make sure that there was general available of treatment. I think economics play a bigger part in whether a given provider will accept a given plan than fear of difficult patients. Medicare pays less than other plans and if a Doctor doesn't need the business he may decide not to accept it. Also, there's no reason why providers could not be allowed to refuse certain patients for cause, while still accepting the plan in general.

That said, providers don't have to accept Medicare now and the system seems to work reasonably well. So, if this plan were to be implemented, I'd be happy leave that decision in the hands of those more qualified to decide.


Being required to accept any given plan is problematic - plans vary widely in how they bill. A small practice may not have the resources to hire specialized billers to deal with a myriad of billing practices (this has been a historic problem with M'caid which often bills differently from M'care and BC/BS) and hospitals don't want the hassle.

But this would be only one more plan. There is already a movement towards standardized forms and so on, and it would make sense for the new plan to adopt existing practices.

In any case, the point is that the whole thing will fail if providers are allowed to opt out and do so in large enough numbers that availability is impaired. No doubt this is something that could be dealt with if it arises.

[geochron]

No, Geo, but you do pay for it. Ry's right that bureaucracies tend toward inefficiency - which leads to increased cost. Even if not comparable - who wants to pay for waste?



And yet somehow it ends up cheaper than the US system.

The myth here is that bureaucracy is magically restricted to the public sector.

[Teallaura]

...


But this would be only one more plan. There is already a movement towards standardized forms and so on, and it would make sense for the new plan to adopt existing practices.

In any case, the point is that the whole thing will fail if providers are allowed to opt out and do so in large enough numbers that availability is impaired. No doubt this is something that could be dealt with if it arises.

:huh: Did I miss something? The plan you and Ry seemed to be discussing was akin to the new M'care Part D. Private insurers would still (in theory) controll their billing practices.

Most insurance bills on a HCFA 1500 (physician, anyway) now - but the allowed codes and (more annoyingly) the way information is put on the form varies. For instance, used to (been a long time since I worked for M'caid so it could have changed) M'caid required that the M'care EOP (explanation of payment) be attached to the M'caid claim (M'caid is always payer of last resort). Now, BC required that the payment amount be entered on the HCFA, but M'caid required that it not appear on the HCFA. The result was M'caid frequently not paying claims (called a zero pay) because, to M'caid's perception, the biller had already received more than the M'caid allowable - this because to M'caid it looked like the biller had received twice the amount from M'care that they actually had. The claim had to be corrected and refiled in order to receive payment from M'caid.

[Teallaura]

And yet somehow it ends up cheaper than the US system.

The myth here is that bureaucracy is magically restricted to the public sector.Actually, that isn't an established point. If the quality of service/care is lower than in the US (not saying it is since we haven't any data to work from) then the C/B is wrong. Paying less money but getting a lower quality of care or service is not necessarily a bargain - and may actually be a deteriment.

That said, I was making a straight observation - governmental bureaucracy may end up costing more in waste than it's worth. There are some things government does better than the private sector - and some it does not. Without patient/outcome data in the mix I don't think you can establish which is actually doing the better job.

No, I'm well aware that the private sector has bureaucratic issues as well - but the private sector can resolve those much (and I do mean much) faster than the public sector when need be.

At this stage, I'm still positionally neutral. From this thread I merely wanted to see the trend within the Tweb community. To make up my mind for real I'd have to do more homework.

[Alien]

:huh: Did I miss something? The plan you and Ry seemed to be discussing was akin to the new M'care Part D. Private insurers would still (in theory) controll their billing practices.

I was thinking about the Medicare "top-up policies" (I forget the correct name) where the benefits are standard and all insurers have to offer the same thing. Part D is similar, certainly. How did I confuse you?


Most insurance bills on a HCFA 1500 (physician, anyway) now - but the allowed codes and (more annoyingly) the way information is put on the form varies. For instance, used to (been a long time since I worked for M'caid so it could have changed) M'caid required that the M'care EOP (explanation of payment) be attached to the M'caid claim (M'caid is always payer of last resort). Now, BC required that the payment amount be entered on the HCFA, but M'caid required that it not appear on the HCFA. The result was M'caid frequently not paying claims (called a zero pay) because, to M'caid's perception, the biller had already received more than the M'caid allowable - this because to M'caid it looked like the biller had received twice the amount from M'care that they actually had. The claim had to be corrected and refiled in order to receive payment from M'caid.

Yah, that sounds par for the course. This would replace Medicaid, though, so it wouldn't be an extra plan. An opportunity for more standardisation, perhaps?

[Alien]

From this thread I merely wanted to see the trend within the Tweb community.

It's been interesting. I was expecting a much more strident defense of the current system.

[Ryokan]

And yet somehow it ends up cheaper than the US system.

The myth here is that bureaucracy is magically restricted to the public sector.
You missed the early part of the discussion, where we acknowledged the US system isn't actually free market.

[Teallaura]

I was thinking about the Medicare "top-up policies" (I forget the correct name) where the benefits are standard and all insurers have to offer the same thing. Part D is similar, certainly. How did I confuse you? :twitch: Huh? M'care doesn't use private insurers except for part D unless you're talking about the billing contracts themselves (not even sure they do that). M'care is its own payer, to the best of my knowledge, except for Part D where it pays to private insurers who pay to pharmacies.

Regardless, as payer, M'care calls the coverage shots. But it is a single 'plan' (different parts but essencially one plan). It sounds more like you're talking about regulation of insurers here. I don't think this was what Ry was talking about. His proposal was that universal coverage be required and the government cover the cost (at least - not sure if he said universally or not) for those unable to pay, but private insurers would be the payers. The premiums, not the direct cost, would be paid by government. Government would require a basic standard of care/coverage but the insurers would still be allowed to offer more to those who could afford it.



Yah, that sounds par for the course. This would replace Medicaid, though, so it wouldn't be an extra plan. An opportunity for more standardisation, perhaps?I don't think it's a good replacement for M'caid. You'd likely be talking a reduction in services and I flat out oppose anything that wouldn't offer EPSDT protections to children. It would be a good filler for the gap between the M'caid eligible and the insured (those who cannot afford insurance).

[Dr. Jack Bauer]

That's not what I here from alot of people, including relatives, who've lived in the Uk and the study seems to bear out exactly what I am saying. Except that it seems if we want National Health, we should look to Australia or New Zealand, rather than Britain, as a model.It aint pretty here in New Zealand. Socialised healthcare here really fails those most at risk. I'm not saying a private scheme couldn't do that. But waiting lists for really genuine need here are just unacceptable, and it's getting worse, yet none of those problems - or the huge union/employer problems - seem to plague our private health providers. The difference is truly massive. It's a money pit. The services could be worse, for sure, but the situation is far from acceptable.

[Alien]

:twitch: Huh? M'care doesn't use private insurers except for part D unless you're talking about the billing contracts themselves (not even sure they do that). M'care is its own payer, to the best of my knowledge, except for Part D where it pays to private insurers who pay to pharmacies.

OK, I've remembered the correct name. Medigap policies are offered by insurance companies, but regulated in the sense that they all have to offer the same benefits. This allows us old folks to choose a coverage and then shop around for the best deal without having to factor in differences in the product. It was that aspect of these policies that I was referring to, and suggested that might be the way the suggested "new" plan could be set up.


Regardless, as payer, M'care calls the coverage shots. But it is a single 'plan' (different parts but essencially one plan). It sounds more like you're talking about regulation of insurers here. I don't think this was what Ry was talking about. His proposal was that universal coverage be required and the government cover the cost (at least - not sure if he said universally or not) for those unable to pay, but private insurers would be the payers. The premiums, not the direct cost, would be paid by government. Government would require a basic standard of care/coverage but the insurers would still be allowed to offer more to those who could afford it.

Yes, that's about it I think.


I don't think it's a good replacement for M'caid. You'd likely be talking a reduction in services and I flat out oppose anything that wouldn't offer EPSDT protections to children. It would be a good filler for the gap between the M'caid eligible and the insured (those who cannot afford insurance).

Ah, but I would want a basic coverage that was considered "sufficient" for all. What that would be would be subject to debate, and hopefully your objection would be taken into account. I would only support a reasonably robust coverage. I don't want some kind of half-assed sop to the consciences of those better covered. I want a "real" benefit to those in need.

[Teallaura]

OK, I've remembered the correct name. Medigap policies are offered by insurance companies, but regulated in the sense that they all have to offer the same benefits. This allows us old folks to choose a coverage and then shop around for the best deal without having to factor in differences in the product. It was that aspect of these policies that I was referring to, and suggested that might be the way the suggested "new" plan could be set up. Okay, gotcha. But that actually wouldn't work as a revamp - Medigap fills in the gaps (obviously) - it doesn't create a comprehensive coverage standard.

Doesn't matter, I think I get the gist now.


Ah, but I would want a basic coverage that was considered "sufficient" for all. What that would be would be subject to debate, and hopefully your objection would be taken into account. I would only support a reasonably robust coverage. I don't want some kind of half-assed sop to the consciences of those better covered. I want a "real" benefit to those in need. As a gap filler, no prob. It's the 'comprehensive' thing that really worries me. M'caid is actually 31 (32? I think 32 in Alabama) different programs and it has taken literally years to formulate them all. A massive 'rewrite' (in effect) to create coverage standards could prove a nightmare. I think that it would be far more likely to fall short, as Part D M'care has, than to do the job properly. That's gonna create a huge mess that will take years to completely fix (regulation is a pain).

It could be done, obviously (you can do virtually anything if the political will is there) but I'm not sure it would be actually worth it.

I dunno - the 'Medigap' type thing is doable - but doing away with M'caid/M'care strikes me as foolish in the extreme.

[Alien]

Doesn't matter, I think I get the gist now.

Good. To repeat .. the only thing I was taking from Medigap was the idea of having a standard coverage that all insurers would have to conform to, while remaining free to compete on price. Forget all other aspects of Medigap! :smile:


As a gap filler, no prob. It's the 'comprehensive' thing that really worries me. M'caid is actually 31 (32? I think 32 in Alabama) different programs and it has taken literally years to formulate them all. A massive 'rewrite' (in effect) to create coverage standards could prove a nightmare. I think that it would be far more likely to fall short, as Part D M'care has, than to do the job properly. That's gonna create a huge mess that will take years to completely fix (regulation is a pain).

It could be done, obviously (you can do virtually anything if the political will is there) but I'm not sure it would be actually worth it.

I dunno - the 'Medigap' type thing is doable - but doing away with M'caid/M'care strikes me as foolish in the extreme.

OK. I agree with much of what you say, but I'm not sure you still fully understand what I'm suggesting. I'll try again.

The complexity of Medicare, I suspect, flows largely from the attempt to decide who is entitled to it, and to what extent, and the attempt to stop people "getting away with something". Correct me if I am wrong. What I'm suggesting is a basic coverage, exactly what to be decided, but certainly sufficient to get by on for everyone. That coverage would be provided to all, with those able to afford it paying their own premiums and everyone else having all or part of the premiums paid out of taxation. We accept that there will be some fraud (by people misrepresenting their income) but we take reasonable steps to prevent this (the IRS already has a mechanism in place for this anyway) and then don't obsess over it.

If everyone now has a coverage that supplies their basic medical needs regardless of their situation (income or age), why are Medicare and Medicaid still required?

It seems to me that this would make everything simpler. There would be one basic plan, with one set of rules. Underwriting would a lot easier as the "group" is everyone, with no opportunity to opt in and out. There would be one set of regulations, instead of the mess we have now. Additional coverage would be between individuals, insurers and insurance companies, and might be equally messy if current practices are not reformed, but the Government doesn't have to worry about it overmuch as the basic needs of the population are already met.

You think that wouldn't work?

[Jeannot]

Good. To repeat .. the only thing I was taking from Medigap was the idea of having a standard coverage that all insurers would have to conform to, while remaining free to compete on price. Forget all other aspects of Medigap! :smile:



OK. I agree with much of what you say, but I'm not sure you still fully understand what I'm suggesting. I'll try again.

The complexity of Medicare, I suspect, flows largely from the attempt to decide who is entitled to it, and to what extent, and the attempt to stop people "getting away with something". Correct me if I am wrong. What I'm suggesting is a basic coverage, exactly what to be decided, but certainly sufficient to get by on for everyone. That coverage would be provided to all, with those able to afford it paying their own premiums and everyone else having all or part of the premiums paid out of taxation. We accept that there will be some fraud (by people misrepresenting their income) but we take reasonable steps to prevent this (the IRS already has a mechanism in place for this anyway) and then don't obsess over it.

If everyone now has a coverage that supplies their basic medical needs regardless of their situation (income or age), why are Medicare and Medicaid still required?

It seems to me that this would make everything simpler. There would be one basic plan, with one set of rules. Underwriting would a lot easier as the "group" is everyone, with no opportunity to opt in and out. There would be one set of regulations, instead of the mess we have now. Additional coverage would be between individuals, insurers and insurance companies, and might be equally messy if current practices are not reformed, but the Government doesn't have to worry about it overmuch as the basic needs of the population are already met.

You think that wouldn't work?
With okay to buy drugs in bulk, unlike now?

[Teallaura]

Good. To repeat .. the only thing I was taking from Medigap was the idea of having a standard coverage that all insurers would have to conform to, while remaining free to compete on price. Forget all other aspects of Medigap! :smile:



OK. I agree with much of what you say, but I'm not sure you still fully understand what I'm suggesting. I'll try again.

The complexity of Medicare, I suspect, flows largely from the attempt to decide who is entitled to it, and to what extent, and the attempt to stop people "getting away with something". Correct me if I am wrong. What I'm suggesting is a basic coverage, exactly what to be decided, but certainly sufficient to get by on for everyone. That coverage would be provided to all, with those able to afford it paying their own premiums and everyone else having all or part of the premiums paid out of taxation. We accept that there will be some fraud (by people misrepresenting their income) but we take reasonable steps to prevent this (the IRS already has a mechanism in place for this anyway) and then don't obsess over it.

If everyone now has a coverage that supplies their basic medical needs regardless of their situation (income or age), why are Medicare and Medicaid still required?

It seems to me that this would make everything simpler. There would be one basic plan, with one set of rules. Underwriting would a lot easier as the "group" is everyone, with no opportunity to opt in and out. There would be one set of regulations, instead of the mess we have now. Additional coverage would be between individuals, insurers and insurance companies, and might be equally messy if current practices are not reformed, but the Government doesn't have to worry about it overmuch as the basic needs of the population are already met.

You think that wouldn't work?

It's not so much that it won't (read couldn't be made to) work as the devil being in the details. Even just laying out coverage requirements will be a nightmare - and is where a lot of the M'caid/M'care billing problems actually originate.

Now, the billing would not be a headache for the same reasons (Ack, code x conflicts with code y and no one realized until it went live! <- M'care/M'caid problem) but it will end up a headache unless you require standardized billing as well - which creates another headache - ya gotta coordinate that originally. However, it's the coverage decisions that will actually be nightmarish - there is a tremendous amount of stuff to be decided in that.

Which procedure codes will be mandatory (procedure codes represent actual procedures in billing and are a much better way of specifying what is or is not allowable)? Which diagnosis codes (same idea for diagnosis)? There are thousands - literally!

Use M'caid/M'care as the basis? Problem - they don't cover the same things and even when they do it isn't necessarily under the same circumstances.

That's why I think it's a better idea to use it as a gap filler and let M'caid/M'care remain the workhorses even if you change the nature of their payments (i.e. premiums rather than direct pay - that's doable via contracts). Over time, the gap filler might very well replace M'caid/M'care but scraping the existing system just sounds foolish to me - it would end up like Part D.

Part D has caused a huge amount of trouble in billing (pharmacies having trouble getting paid literally for months after the system went live - and some still having trouble) and in people getting coverage (I can read that junk because I have a lot of experience in insurance billing - but the average elderly person finds it confusing in the extreme). Imagine that spread out over the entire continuum of medical care!

[Teallaura]

With okay to buy drugs in bulk, unlike now?Different law - and probably not. For some, they're simply too dangerous and would never be allowed in large quantities.

For others, people change, as does the effectiveness. Drugs outside a pharmacists control cannot be returned to market (this to prevent tampering) so prescripitions would need to be tamper proof (offsetting the bulk savings). It's not cost effective for the insurance company that way.

[Alien]

With okay to buy drugs in bulk, unlike now?

I don't see the relevance of this. Please explain.

Edit to add: I see Teal has already addressed this.

[Alien]

It's not so much that it won't (read couldn't be made to) work as the devil being in the details. Even just laying out coverage requirements will be a nightmare - and is where a lot of the M'caid/M'care billing problems actually originate.

Now, the billing would not be a headache for the same reasons (Ack, code x conflicts with code y and no one realized until it went live! <- M'care/M'caid problem) but it will end up a headache unless you require standardized billing as well - which creates another headache - ya gotta coordinate that originally. However, it's the coverage decisions that will actually be nightmarish - there is a tremendous amount of stuff to be decided in that.

Which procedure codes will be mandatory (procedure codes represent actual procedures in billing and are a much better way of specifying what is or is not allowable)? Which diagnosis codes (same idea for diagnosis)? There are thousands - literally!

Use M'caid/M'care as the basis? Problem - they don't cover the same things and even when they do it isn't necessarily under the same circumstances.

That's why I think it's a better idea to use it as a gap filler and let M'caid/M'care remain the workhorses even if you change the nature of their payments (i.e. premiums rather than direct pay - that's doable via contracts). Over time, the gap filler might very well replace M'caid/M'care but scraping the existing system just sounds foolish to me - it would end up like Part D.

Part D has caused a huge amount of trouble in billing (pharmacies having trouble getting paid literally for months after the system went live - and some still having trouble) and in people getting coverage (I can read that junk because I have a lot of experience in insurance billing - but the average elderly person finds it confusing in the extreme). Imagine that spread out over the entire continuum of medical care!

OK, I see where you are coming from.

Other than to hope that this might be used as an opportunity to reduce the confusion, rather than make it worse, I can't add anything! :smile:

I get my Part D through Humana, and they seem to be doing OK. I only see part of the process, of course.

[Keith Johnson]

I wonder (I have no idea what is the correct answer) which is really more wasteful when everything is considered. The cost of a Government program can be clearly seen, as all the numbers are readily available. In the private situation, it's not so straightforward. Is anyone adding up the cost of all the staff in all the Doctors' offices processing all the claims to all the Insurance companies? The current system (and I've had personal experience of it recently as my wife is a provider and has also had two hospital stays this year, and, quite frankly, it's a mess.

In theory, a Government plan, with one payer and one set of rules should be more efficient. So is it really less efficient, or is that just conventional wisdom? Again, I don't know

There are people counting those costs and the private system is much less efficent. You should try to find what economist Paul Krugram has written on the subject (his writing is very clear, especially for an economist). And the extra costs are not just due to processing insurance claims. There is huge incentive for private companies to limit their coverage to people who are healthy (and who consequently don't make so many claims) so private companies spend a significant amount of money screening out patients who pose a higher than "acceptable" risk. This drastically increases the percentage of revenue that goes to places other than actual care.

Free markets are often a useful tool for efficiently allocating resources, but not always. Health care is one of those times the market fails. Socialized medicine is far more efficient.

your friend
keith

[geochron]

There are people counting those costs and the private system is much less efficent. You should try to find what economist Paul Krugram has written on the subject (his writing is very clear, especially for an economist). And the extra costs are not just due to processing insurance claims. There is huge incentive for private companies to limit their coverage to people who are healthy (and who consequently don't make so many claims) so private companies spend a significant amount of money screening out patients who pose a higher than "acceptable" risk. This drastically increases the percentage of revenue that goes to places other than actual care.

Free markets are often a useful tool for efficiently allocating resources, but not always. Health care is one of those times the market fails. Socialized medicine is far more efficient.

your friend
keith

In general, universal benefits are much more efficient than means tested benefits. I forget the exact figures, but >90% of the money spent on (universal) child benefit in the UK ends up with the people receiving it - administrative costs are very small. For means tested benefits it's nearer 30%. Which means it costs twice as much to decide who ought to get the benefit as the amount given per person. This is one thing insurance-based schemes suffer from - figuring out who is entitled to how much of the costs of what treatment costs a fortune.

[Dr. Jack Bauer]

In general, universal benefits are much more efficient than means tested benefits. I forget the exact figures, but >90% of the money spent on (universal) child benefit in the UK ends up with the people receiving it - administrative costs are very small. For means tested benefits it's nearer 30%. Which means it costs twice as much to decide who ought to get the benefit as the amount given per person. This is one thing insurance-based schemes suffer from - figuring out who is entitled to how much of the costs of what treatment costs a fortune.I don't deny this, however I would like to see at least some evidence for it.

Secondly, It's not clear that this is a bad thing for the person recieving care. Does it make a difference to the cost to the end user, or to the quality of care received?

[Keith Johnson]

I don't deny this, however I would like to see at least some evidence for it.

Secondly, It's not clear that this is a bad thing for the person recieving care. Does it make a difference to the cost to the end user, or to the quality of care received?

The fact that our privatized health insurance system spends such high percentage of its overall revenue on eligibility tests and paperwork has to make a difference to the end user, or to whoever is paying for the care the end user recieves. It may not mean the doctoring you finally receive is inferior care, but since our premiums have to pay for the care plus the overhead, anything that reduces the overhead would reduce what we pay.

your friend
Keith

[Dr. Jack Bauer]

OK, so there's no corroborating data here, it's just a case of "well it has to"? This is not reassuring, especailly given your last post along the lines of "I don't really know what the figures are, but here I go..."

Right or wrong, this isn't credible without data - in either post.

[geochron]

OK, so there's no corroborating data here, it's just a case of "well it has to"? This is not reassuring, especailly given your last post along the lines of "I don't really know what the figures are, but here I go..."

Right or wrong, this isn't credible without data - in either post.
Are you thinking that last post was from me?

Anyway, you prompted me to look it up. I suppose it's no surprise that things aren't as bad as my recollection of means testing social security payments. But something interesting showed up. Here's the figures for HMOs...

http://www.kff.org/insurance/7031/ti2004-6-10.cfm

who spend about 10-15% of their revenue on administration and profit.

Meanwhile, the federal government manages to run the state benefits while spending about 2% of their revenue on administration.

http://www.ssa.gov/OACT/TRSUM/trsummary.html

(the figures are about 1/3 of the way down the page.)

[geochron]

I found this site with details of the US system, some comparable to the poll above...

http://www.kff.org/insurance/7031/print-sec7.cfm

[Ryokan]

There are people counting those costs and the private system is much less efficent. You should try to find what economist Paul Krugram has written on the subject (his writing is very clear, especially for an economist). And the extra costs are not just due to processing insurance claims. There is huge incentive for private companies to limit their coverage to people who are healthy (and who consequently don't make so many claims) so private companies spend a significant amount of money screening out patients who pose a higher than "acceptable" risk. This drastically increases the percentage of revenue that goes to places other than actual care.

Free markets are often a useful tool for efficiently allocating resources, but not always. Health care is one of those times the market fails. Socialized medicine is far more efficient.

your friend
keithActually, you seem to making the arguement that it is less efficient based on a measure that requires everyone to be covered, or by the msot money being psent on actual care. Both of these are not the kind of efficiency markets create. Teh problem sin't with free markets, but rather we have a different goal than market efficiency.

[geochron]

Sorry for the post barrage, here's a survey of satisfaction with healthcare compared between the USA and Canada (if I recall correctly the US spends twice as much per capita on health care as Canada).

http://www.statcan.ca/Daily/English/040602/d040602a.htm

And I just came across this report of a study in the New England Journal of Medicine...

"USA wastes more on health care bureaucracy than it would cost to provide health care to all of the uninsured"

http://www.medicalnewstoday.com/medicalnews.php?newsid=8800

"The administrative structure of the U.S. health care system consumes a large share of health spending. In 1999, administrative spending consumed at least 31.0 percent of health spending, according to a report in today’s New England Journal of Medicine. In contrast, administrative costs in Canada, which has had a national health program since 1971, are about 16.7% of health spending. "

I guess the figures I quoted earlier left out costs incurred elsewhere in the system.

[geochron]

I found this pdf report with a huge mass of statistics, including survival rates for various diseases.

http://www.sourceoecd.org/upload/8105171e.pdf

I don't think there's much evidence that the US system is treating people more effectively than other systems.

I came across a paper by Gil and Garcia analysing causes of health care costs. They found a correlation among developed countries - the higher public sector involvement in health care provision, the cheaper private healthcare was. Their conclusion was that "the state" is pretty good at keeping costs under control, and that individual decisions between waiting for "free" treatment or paying for immediate private treatment act as a brake on the costs of private health care.

[Dr. Jack Bauer]

Are you thinking that last post was from me?

Anyway, you prompted me to look it up. I suppose it's no surprise that things aren't as bad as my recollection of means testing social security payments. But something interesting showed up. Here's the figures for HMOs...

http://www.kff.org/insurance/7031/ti2004-6-10.cfm

who spend about 10-15% of their revenue on administration and profit.

Meanwhile, the federal government manages to run the state benefits while spending about 2% of their revenue on administration.

http://www.ssa.gov/OACT/TRSUM/trsummary.html

(the figures are about 1/3 of the way down the page.)OK, well that's a relief, compared to your astronomical estimates of private healthcare that you referred to earlier. 10-15% is easily acceptable.

[geochron]

OK, well that's a relief, compared to your astronomical estimates of private healthcare that you referred to earlier. 10-15% is easily acceptable.

If you read further (post 99) you will find that it is 31% vs 17%. And that's 31% of expenditure per patient that is already twice as high as elsewhere. In other words, the US system pays ~4 times as much administrative costs per patient as the Canadian.

Look at it this way...

Canada spends $1000 of which admin is $170
The USA spends $2000 for the same thing, of which admin is $620
The admin ineffiiciency in the US is already around half (450/1000) the difference in expenditure between the US system and the Canadian.

[Dr. Jack Bauer]

OK, so the proportion is 16% vs 30%. It's the percentages that matter here. Still, that is absolutely nothing like the initial proportion you stated. And it's still a relief, and no reaqson at all to favour one over the other. And given my own observations about state provided vs insurance provided (posted earlier in this thread), it could never be enough of a reason to favour a cheap dodge as opposed to a fairly cheap ferrari.

[geochron]

OK, so the proportion is 16% vs 30%. It's the percentages that matter here. Still, that is absolutely nothing like the initial proportion you stated. And it's still a relief, and no reaqson at all to favour one over the other. And given my own observations about state provided vs insurance provided (posted earlier in this thread), it could never be enough of a reason to favour a cheap dodge as opposed to a fairly cheap ferrari.

Actually, I think it's the cost of treatment that matters here - and the US private system (not moderated by competition with a state system) is twice as expensive, with half the difference down to paying for bureaucracy.

As for your observations, are you talking about this post?

It aint pretty here in New Zealand. Socialised healthcare here really fails those most at risk. I'm not saying a private scheme couldn't do that. But waiting lists for really genuine need here are just unacceptable, and it's getting worse, yet none of those problems - or the huge union/employer problems - seem to plague our private health providers. The difference is truly massive. It's a money pit. The services could be worse, for sure, but the situation is far from acceptable.

That's barely even anecdotal. Let's take a look at some stats...

Male life expectancy at birth: USA 69.9, NZ 71.3
Female life expectancy at age 65: USA 19.6, NZ 20.3

Either NZ has a cheap Ferrari, or the US has an expensive Dodge.

The links to data are above, some things the US does better at, some NZ does better at. And the Gil and Garcia study underlines the importance of a state run system in keeping costs down in the private sector.

In New Zealand, the public share of total health expenditure is 79%, (5,8 insurance, 16% out-of-pocket). And the USA spends 3 times as much per capita on health care as New Zealand.

[Dr. Jack Bauer]

Actually, I think it's the cost of treatment that matters here - and the US private system (not moderated by competition with a state system) is twice as expensive, with half the difference down to paying for bureaucracy.What matters is which system is better.
As for your observations, are you talking about this post?

That's barely even anecdotal. Let's take a look at some stats...

Male life expectancy at birth: USA 69.9, NZ 71.3
Female life expectancy at age 65: USA 19.6, NZ 20.3

Either NZ has a cheap Ferrari, or the US has an expensive Dodge.What? You discount observations as "barely anecdotal" because of age expectancy? What is this oddness??? How on earth is that supposed to suggest a problem with my comments? That was truly - and I'm not just trying to score rhetorical points - it was truly weird. I don't think life expectancy is a useful point of comparison at all. But if it were, you should compare life expectancy of insured vs uninsured in the U.S., or if you like, the life expectancy of the insured vs the uninsured in New Zealand.


Thus far, the whole "it's all swallowed up in bereaucracy" line is a combination of exageration (which has now been somewhat corrected with data) and distractions from the issue of which system is better.

[geochron]

What? You discount observations as "barely anecdotal" because of age expectancy? What is this oddness??? How on earth is that supposed to suggest a problem with my comments? That was truly - and I'm not just trying to score rhetorical points - it was truly weird. ]



I discount your observations because they aren't even observations. Your post is simply a statement of your opinion. I gave you two examples from the data site I gave a link to above. Data for survival of various illnesses is in the same place - as I said sometimes the USA does better, sometimes NZ does better, so the threefold extra the US is spending does not show up in outcomes as far as I can see. In general the US does not stand out as doing better than countries with socialised systems. You haven't presented any data at all. You requested I back up something I said with numbers - now take your own advice.

Was what I said exaggerated, I'm not so sure. For every $1000 NZ spends on healthcare, the USA spends $3000. Assuming the administrative cost in NZ is similar to Canada's, NZ spend $170 on admin while the USA spends $930 on admin - ample demonstration that private insurance is much less efficient.



I don't think life expectancy is a useful point of comparison at all. But if it were, you should compare life expectancy of insured vs uninsured in the U.S., or if you like, the life expectancy of the insured vs the uninsured in New Zealand.



So choose your points of comparison and present the data.

I don't have the data for New Zealand (by all means go and find it). But up above there is a link to a study between the USA and Canada where, if I recall correctly, insured people in the USA have similar stats to Canadians, and the uninsured US population do worse.

In New Zealand, only 6% of the healthcare budget comes from insurance. If it's anything like the UK, major life threatening illnesses will be treated by the socialised system even when people have insurance, so I'm not sure the comparison will be valid.



Thus far, the whole "it's all swallowed up in bereaucracy" line is a combination of exageration (which has now been somewhat corrected with data) and distractions from the issue of which system is better.



I've shown that the extra US spend is half swallowed up by bureaucracy. I didn't say "it's all swallowed up by bureaucracy". My original point was the the privatised bureaucracy cost a fortune. I think that this point is established - bureaucracy swallows up half the extra money the US spends.

As far as I can see, the data show that healthcare outcomes are broadly similar across most developed countries, but the system which isn't socialised (meaning has no universal healthcare system organised and regulated by the state) spends 2-3x as much getting it. That's why I think the US system is worse than the others.

[Dr. Jack Bauer]

Was what I said exaggerated, I'm not so sure. For every $1000 NZ spends on healthcare, the USA spends $3000. Assuming the administrative cost in NZ is similar to Canada's, NZ spend $170 on admin while the USA spends $930 on admin - ample demonstration that private insurance is much less efficient.Here is the exaggeration i was referring to, which you later majorly corrected with data:
In general, universal benefits are much more efficient than means tested benefits. I forget the exact figures, but >90% of the money spent on (universal) child benefit in the UK ends up with the people receiving it - administrative costs are very small. For means tested benefits it's nearer 30%.There it is, in one system 90% gets tot he patients, in the other system it's more like 30%. When you later actually checked, it was 16% spent on admin in one system, and %30 spent on admin in the other. It was an enormous difference, which is why I called the first an exaggeration, which was a very fair comment I daresay.
I don't have the data for New Zealand (by all means go and find it). But up above there is a link to a study between the USA and Canada where, if I recall correctly, insured people in the USA have similar stats to Canadians, and the uninsured US population do worse.OK, so the uninsured do worse. That is the kind of fact that is relevant.
I've shown that the extra US spend is half swallowed up by bureaucracy. I didn't say "it's all swallowed up by bureaucracy". My original point was the the privatised bureaucracy cost a fortune. I think that this point is established - bureaucracy swallows up half the extra money the US spends.Half? Smuggling that word in is misleading. Thirty percent is consumed by admin costs. That is acceptable, and it is not the important outcome to test. What we should test is the outcome to the end user. Maybe that's the only kind of analysis that socialized healthcare promoters think is important, and if that's so, it's an interesting fact in and of itself.

[Teallaura]

LE is more of a QoL measure - it has way too many variables to be a solid HC measure.

Theo's right, you need end user outcome data.

[geochron]

There it is, in one system 90% gets tot he patients, in the other system it's more like 30%. When you later actually checked, it was 16% spent on admin in one system, and %30 spent on admin in the other. It was an enormous difference, which is why I called the first an exaggeration, which was a very fair comment I daresay.



Child benefit isn't a health care - it was an example from a different field explaining why I believed means testing was inefficient. After the research I've done I think my belief has been substantiated. If you interpreted it as a commitment from me that the actual figures for healthcare were those I quoted, then you misinterpreted.



Half? Smuggling that word in is misleading. Thirty percent is consumed by admin costs. That is acceptable, and it is not the important outcome to test. What we should test is the outcome to the end user.



The context in which I used "half" is entirely correct. The extra admin costs of the US system consume half of the extra money spent in the US system.



Maybe that's the only kind of analysis that socialized healthcare promoters think is important, and if that's so, it's an interesting fact in and of itself.



I've linked to other data above as I've found it. By all means go look through it, or even find some data of your own. I don't think the OECD is a "socialized healthcare promoter".

[Dr. Jack Bauer]

Child benefit isn't a health care - it was an example from a different field explaining why I believed means testing was inefficient. After the research I've done I think my belief has been substantiated. If you interpreted it as a commitment from me that the actual figures for healthcare were those I quoted, then you misinterpreted.So you're happy to say that you used data from one field to draw conclusions about another field altogether? Is that really a fair way to use data at all? Geochron, are you sure this isn't a foregone conclusion for you?
The context in which I used "half" is entirely correct. The extra admin costs of the US system consume half of the extra money spent in the US system.It's misleading. "half" of th emoney is not consumed by admin costs, so let's stay on track. The proportions are acceptable, and the outcome is not impugned by any figures cited. if you want to just insist that those with privatre insurance are no better off than those provided for by state healthcare (without, incidentally, providing any data that even attempts to answer that question), go right ahead. Free speech and all that.

[geochron]

LE is more of a QoL measure - it has way too many variables to be a solid HC measure.

Theo's right, you need end user outcome data.

The USA spends 2-3x as much per head of population on healthcare as other countries with comparable economic development.

They do this without increasing any measures of the health of the population. The USA does not do particularly well on...

1. life expectancy.
2. potential years of life lost (all causes except suicide).
3. disability free life expectancy at birth.
4. infant mortality rates.
5. life expectancy at age 65.

This seems to me to be solid evidence that the US system is not better than other systems.

Now it may be possible that this is because other factors compensate for a US system that is very good at treating life threatening illnesses. But I submit that the prima facie case has been made that the US system is not cost effective. Rather than asserting the need for outcome data, perhaps you could offer a model of how outcomes might be significantly better in the US without making population healthcare measures higher than those in other countries? Then we could look for data to test your model.

For instance, I suspect that the major causes of death among the over 65s are medical conditions. So if outcomes are so much better in the US, why isn't life expectancy at age 65 higher in the US? And it's not that the US has kept more ill people alive to 65, since life expectancy over all is not as high in the US.

It's also not clear to me that health systems should be measured just on outcomes anyway. If the US is better at treating someone who presents with TB than some other country, but the other country is better at immunizing its population against TB, which is the better system? If the US system is better at treating heart disease linked to obesity, but another country is better at preventing people becoming obese (due to health campaigns funded through the medical budget), which is the better system? I think the standard measures take this sort of thing into account.

[geochron]

So you're happy to say that you used data from one field to draw conclusions about another field altogether? Is that really a fair way to use data at all?



What I said was... "In general, universal benefits are much more efficient than means tested benefits. I forget the exact figures, but >90% of the money spent on (universal) child benefit in the UK ends up with the people receiving it - administrative costs are very small. For means tested benefits it's nearer 30%."

Do you not understand what "In general" means.



Geochron, are you sure this isn't a foregone conclusion for you?



Yes. It's a conclusion based on evidence (and I've not seen any evidence from you at all).



It's misleading. "half" of th emoney is not consumed by admin costs, so let's stay on track. The proportions are acceptable, and the outcome is not impugned by any figures cited. if you want to just insist that those with privatre insurance are no better off than those provided for by state healthcare (without, incidentally, providing any data that even attempts to answer that question), go right ahead. Free speech and all that.



"Acceptable" to whom?

Where does the extra money spent in the US go? At least half of it goes on admin. Do you deny that? If not, can we move on?

(Also, rereading the source, 31% is the calculated minimum US spend on admin, so make that "at least half".)

It's not my position that those with private healthcare are not better off than those with state healthcare. My position is that the US system is not as cost effective for the public as those systems with a state funded universal element, which is a different thing altogether. In particular, the cost of private treatment is lower in countries with a "socialized" system (Gil and Garcia, Hacienda Pública Española / Revista de Economía Pública, 161-(2/2002): 31-48).

And "socialized" is a misnomer anyway, In the UK, at least, it is not illegal to provide or purchase health care privately.

[Dr. Jack Bauer]

So you admit that you are happy to compare a system in which, according to you, 70% of the money is spent on admin, to private healthcare where 30% is spent on admin, and you used the former figure to offer an indication of how, efficient "in general" (the magic words) private schemes are, knowing full well that this is outrageous in comparison to the actual schemes in question here? That's less than honest.

"Move on" to what? I have been asking you to move on to something relevant, like end user results, but you seem to think the only analysis that matters is the percentage spent on administration. When did I dispute the 30% figure? it just seems acceptable - to me. Are you saying it's unacceptable to you? If so all we have here is a standoff based on your brain and mine!

Thankfully most of us know that 31% is not the same as "half." Can we agree to that, and move on?

If all you have to say is what you have said about the monetary efficiency of the US private health sector then fine, you've said your piece. Personally, I'm more interested in what's better. I have viewed all the data you presented, and it isn't on that topic. That's not to say it isn't important in it's own right, don't get me wrong. What I do know is that waiting times in the socialised health sector here in NZ is nothing at all next to the public sektor. And the current industrial action standoff is terrible here, it has never happened like that in the private sector. If it's more efficient, it certainly aint better.

I'm just describing the results, not the efficiency.

[geochron]

So you admit that you are happy to compare a system in which, according to you, 70% of the money is spent on admin, to private healthcare where 30% is spent on admin, and you used the former figure to offer an indication of how, efficient "in general" (the magic words) private schemes are, knowing full well that this is outrageous in comparison to the actual schemes in question here? That's less than honest.



Do you suffer from misunderstanding what people write a lot. But, then, how would you know?

Once again, here's the text of my post. I'm adding amplifications...



In general [ie not specifically restricted to health care], universal benefits are much more efficient than means tested benefits [note I did not say private vs public]. I forget the exact figures, but >90% of the money spent on (universal) child benefit in the UK ends up with the people receiving it - administrative costs are very small. For means tested benefits it's nearer 30% [note that in the examples I'm actually comparing two different ways of distributing government money, no private vs public here]. Which means it costs twice as much to decide who ought to get the benefit as the amount given per person. This is one thing insurance-based schemes suffer from - figuring out who is entitled to how much of the costs of what treatment costs a fortune [once again, I don't distinguish private from public but means tested from not-means-tested, nor did I associate the percentages I remembered with any particular health care scheme - that happened entirely within your head. I merely used them to illustrate a principle I believed to be true. And I think I've shown it is true after the research I did subsequently at your request].





"Move on" to what? I have been asking you to move on to something relevant, like end user results, but you seem to think the only analysis that matters is the percentage spent on administration. When did I dispute the 30% figure? it just seems acceptable - to me. Are you saying it's unacceptable to you? If so all we have here is a standoff based on your brain and mine!



I've done enough research to satisfy myself. If you have any numbers on end user results then by all means post them for us to discuss.

And, no, I don't think it is acceptable to spend enough extra on admin to buy health cover for everybody who is uninsured.

"USA wastes more on health care bureaucracy than it would cost to provide health care to all of the uninsured"

http://www.medicalnewstoday.com/medicalnews.php?newsid=8800



Thankfully most of us know that 31% is not the same as "half." Can we agree to that, and move on?



Can you point out where I've said 31% is the same as half? Thought not. What I actually said is that half the extra cost in the US goes on extra administration. I think this is useful in understanding why US healthcare is expensive. Take it or leave it.



If all you have to say is what you have said about the monetary efficiency of the US private health sector then fine, you've said your piece. Personally, I'm more interested in what's better. I have viewed all the data you presented, and it isn't on that topic. That's not to say it isn't important in it's own right, don't get me wrong.



Then find and produce something that is on topic. You haven't supported anything you've said as far as I can see.



What I do know is that waiting times in the socialised health sector here in NZ is nothing at all next to the public sektor. And the current industrial action standoff is terrible here, it has never happened like that in the private sector. If it's more efficient, it certainly aint better.



Once again I note that you don't produce anything at all to back up your statements. And do you mean "next to the private sector"?

The problem is that the comparison I offer is between a system like the US (means tested, limited, state coverage + private insurance + out-of-pocket) and one like the UK (free at the point of delivery state coverage for all + private insurance + out-of-pocket).

You seem to be comparing waiting times and industrial relations in the private sector and the public sector. I don't see the relevance. In a state run scheme the public decide how much tax money to invest through their government - perhaps the NZ scheme is set with too little, I don't know. Then the individual decides whether to spend extra money on health insurance to avoid waiting times and whether to buy private treatment to avoid waiting times. The latter two features seem to be what keeps private costs low in such countries - if private care gets too expensive people will opt to wait.

WARNING FOR THEONOMY - I HAVEN'T LOOKED THIS UP MAYBE YOU WOULD LIKE TO PROVE ME WRONG!?

I suspect you would find that most private treatment in NZ is substantially cheaper than the same treatment in the USA, because in NZ the private agency has to compete with the state-run agency and this keeps costs down.

[Keith Johnson]

OK, so there's no corroborating data here, it's just a case of "well it has to"? This is not reassuring, especailly given your last post along the lines of "I don't really know what the figures are, but here I go..."

Right or wrong, this isn't credible without data - in either post.

I want to make sure we are talking about the same thing here. There does exist plenry of data that shows the overhead cost of universal, government run health insurance plans is much smaller than private health insurance, but since I didn't present any such data (and I am not interested in digging it out right now) I understand if you want to withhold judgment. But...

You also said you didn't know if that (alleged) fact would make heath care more expensive for the consumer. I didn't present any evidence for that either. But Iwouldn't present any evidence that a person who weighs 300 pounds would be more difficult to lift than a person who weighs 100 pounds because I don't need to--it is obviously true. I'd say the same is true about health care; a system that devotes 30% or so of its revenue to non-health care is very likely going to cause a given level of medical care to cost more than it would in a system where 90-95% of the revenue goes to health care. The 30% overhead is a cost of the bureacracy; private health insurance has much more bureacracy than government single-payer, universal coverage systems do because government systems don't have to deal with marketing, with a zillion sets of insurance coverages, or with screening out the unhealthy.

your friend
Keith

[Teallaura]

Keith,

I think Theo, like myself, is interested now in end user data. Being cheaper is all well and good - as long as you don't substantially sacrifice service and/or care. Service can be shown in wait data (though not in its entirety - that data wouldn't tell you anything about in-house service). Care can be shown in outcome data. Geo (I think) provided a smattering of the former*, but no one has shown any of the latter. That includes me - I'm still largely sitting this one out as I haven't the time for that kind of data hunt right now.

Without service/care included in the mix, I don't think a C/B is compelling enough to be definitive.










_________________________________________
* Not referring to his life expectancy data. I find LE to be a useless measure by itself for this purpose - it has too many other variables.