Health Care for Everyone

[Scaff]

So how do you get that information though? Before I knew my options, I had to get impression of my teeth, and a mockup of my jaw was used to figure out how to adjust my bite. After all that work, I finally knew what my options were. I'm guessing the NHS doesn't just shell out hundreds of dollars for this kind of investigative work on a whim. And if it's known ahead of time that the option is not going to be covered (like ortho), do they even talk to you about it? Or you just have to know that ortho might work for you, and go investigate that on your own.

That would be two band-1 charges at £22.70 each, one for the orthodontic assessment and report and one for the impressions to be made (a friend of mine had this done a few years ago), for a total of £51.40.

 

[Danoff]

That would be two band-1 charges at £22.70 each, one for the orthodontic assessment and report and one for the impressions to be made (a friend of mine had this done a few years ago), for a total of £51.40.

So that's cost to that patient? Because this couldn't be done for that price total. The impressions were one thing, the mold was something else. This was the end product:

With an analysis done by removing tooth and adding tooth material from the various molds to adjust the bite until it sit properly. That was what was needed in order to just assess the options. Can't be done for those prices in total. It's hours of work.

So my question is not really what it costs, but whether you'd even see this in a nationalized system for something that could be low-cost at least addressed with an occlusal guard. Or are you just given an occlusal guard and told to go pound sand? My point is that there are always choices in medicine, there is no right answer. And the choices cost different amounts, and those amounts need to be factored in to the ultimate decision - made by the patient. This what I'm concerned about losing under a nationalized system.

 

[Scaff]

So that's cost to that patient? Because this couldn't be done for that price total. The impressions were one thing, the mold was something else. This was the end product:

With an analysis done by removing tooth and adding tooth material from the various molds to adjust the bite until it sit properly. That was what was needed in order to just assess the options. Can't be done for those prices in total. It's hours of work.

So my question is not really what it costs, but whether you'd even see this in a nationalized system for something that could be low-cost at least addressed with an occlusal guard. Or are you just given an occlusal guard and told to go pound sand? My point is that there are always choices in medicine, there is no right answer. And the choices cost different amounts, and those amounts need to be factored in to the ultimate decision - made by the patient. This what I'm concerned about losing under a nationalized system.

The end result my friend got was a set of moulds done, I've not specifically spoken to them about what happened after that, but they have not mentioned any issue with the problem since. I'm happy to ask them the next time I seem them.

I can give another example that I have just finished the diagnosis for personally, I've just received the full report for my ASD diagnosis. The total time in terms of my interactions for the diagnosis was as follows:

• Initial discussion with my GP (15 mins)
• Referal discussion with a specialist (30 mins)
• Assessment session 1: Interview and testing by a psychologist (2 x 1hour)
• Assessment Session 2: Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-r) testing with a psychologist (3 hours)
• Prep of all material by the two psychologists (unknown amount of time - but this would cover the two assessment sessions and the questionnaires my family and I filled out before the face-to-face assessments)
• Case Review (I wasn't required to be present for this) by the two psychologists and a senior psychologist (unknown amount of time)
• Preparation and provision of a 13-page assessment along with a call to discuss (15 minutes)
• A follow-up meeting to cover the impact of my diagnosis (as I now have a confirmed diagnosis of ASD) - 1-hour

That's without the additional support I will get in the future, but the above has cost me a total of £0.00

 

[Danoff]

The end result my friend got was a set of moulds done, I've not specifically spoken to them about what happened after that, but they have not mentioned any issue with the problem since. I'm happy to ask them the next time I seem them.

I can give another example that I have just finished the diagnosis for personally, I've just received the full report for my ASD diagnosis. The total time in terms of my interactions for the diagnosis was as follows:

• Initial discussion with my GP (15 mins)
• Referal discussion with a specialist (30 mins)
• Assessment session 1: Interview and testing by a psychologist (2 x 1hour)
• Assessment Session 2: Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-r) testing with a psychologist (3 hours)
• Prep of all material by the two psychologists (unknown amount of time - but this would cover the two assessment sessions and the questionnaires my family and I filled out before the face-to-face assessments)
• Case Review (I wasn't required to be present for this) by the two psychologists and a senior psychologist (unknown amount of time)
• Preparation and provision of a 13-page assessment along with a call to discuss (15 minutes)
• A follow-up meeting to cover the impact of my diagnosis (as I now have a confirmed diagnosis of ASD) - 1-hour

That's without the additional support I will get in the future, but the above has cost me a total of £0.00

To apply that to the question I'm asking then, what is the result of that? Do you get told what your treatment will be? Or are you presented with options? Are you told how expensive those various options are to the public? And would you have gotten all of that if there was a low-cost bandaid available that you don't like but could be considered good enough. At any point will someone sit you aside and say something like "look, to really solve this problem completely, you're going to have to go outside the NHS and get some work that's not covered". Because in my case, that's what I'd need to hear. I have no illusions that ortho would be covered for my scenario under just about any national health system.

 

[HenrySwanson]

If you're trying to show that it is not the "envy of the world", demonstrating that it was not copied verbatim is not showing that. I'm not sure what else you could be trying to show, but I'd recommend just packing this one in. You're not making any real point here.

The point is the core tenets of the system - that it is free at the point of use and that it's centralised - aren't found together anywhere else in the world apart from....Cuba maybe?

I'm not expecting a full on copy, but I'm not sure that post counters the argument sufficiently since even the closest one on the list IMO (Spain) doesn't fulfil that criteria.

If this was the "envy of the world", surely there must be other countries that do at least the foundations the same..

* For reference, here is the type of article that the Nuffield Trust post was trying to argue against:

If the NHS really is the envy of the world, why don’t countries copy it?

If these assertions are even half-true, they raise a rather awkward question. Why haven’t our European neighbours sought to replicate our cherished system? They have had 68 years to stare in wonder across the English Channel, turning an ever more fluorescent shade of green as their jealousy over the sheer brilliance of the NHS overwhelms them. Yet not one leading European country has taken our blueprint and copied it. Are these foreigners incredibly stupid, amazingly callous or just too bone idle to embrace a great idea when they see one? Alternatively, have they studied the facts and decided that they are much better off with the more market-orientated, less centralised healthcare policies each of them has chosen to adopt?

A glance at the statistics suggests that Johnny Foreigner isn’t as dim as some might think. Presumably, a useful starting point is to judge how good a system actually is at preventing people from dying.

If we could somehow replicate the survival rates from common forms of cancer that they manage to achieve in the Netherlands, nearly 10,000 fewer Brits would die each year. If we could get as good as the Germans, we would save about 13,000 lives annually. If we could somehow aspire to understanding whatever magic health formula the Belgians have stumbled upon, we could get that figure up to 14,000. That’s the equivalent of saving the entire population of Bolton every decade merely from improved cancer treatment. Looking at survival rates overall, the UK is about on a par with the Czech Republic and Slovenia, countries where average income is less than half of ours.

It is true that affluent western European countries tend to spend a little more than the UK on healthcare. But, crucially, they spend it in different ways. They run insurance-based systems and allow for competitive markets and even — horror of horrors — profit-making. The Dutch have no state-owned hospitals, no state hospital planning and no taxpayer subsidies to any hospital. In Germany, less than half of hospitals are run by the public sector. The Belgians even sometimes require a modest payment to see a GP. To different degrees, but across the board, competition in providing the best healthcare is encouraged.

Crucially, all these countries manage to guarantee universal healthcare coverage. The poor are not left without quality treatment. The fear that they might be seems to be behind much of the love for the National Health Service, but such concerns are misplaced. Through a mixture of means-tested subsidies and compensation schemes, the Europeans seem able to ensure that every citizen is properly covered.

** My personal opinion, also taken from experience working in it is that the NHS is pretty close to the top healthcare systems in the world but needs to be de-politicised, funded properly and re-appraised in order to create a world leading service

 

[MatskiMonk]

To apply that to the question I'm asking then, what is the result of that? Do you get told what your treatment will be? Or are you presented with options? Are you told how expensive those various options are to the public? And would you have gotten all of that if there was a low-cost bandaid available that you don't like but could be considered good enough. At any point will someone sit you aside and say something like "look, to really solve this problem completely, you're going to have to go outside the NHS and get some work that's not covered".

Both the NHS and private providers will both tell you about what options they offer, but are less likely to explain options offered by the other, which is reasonable. The choice is always there, but the question of whether you trust the basis of the recommendation in either case works both ways. I think the NHS tried to cheap out on me in 2018 and I ended up in hospital because of it. Conversely had I been in the agonising state I was in last October, I could quite easily have been charged for all sorts of x-rays and scans under a private system, because I was pretty sure I was in deep ****, when actually £10.00 of Ibuprofen did the job. You kind of just have to hope that your faith in the professionals in either case isn't misplaced.

With our healthcare system you don't loose the choice, and that seems to be the crux of the matter for you.

 

[Danoff]

With our healthcare system you don't loose the choice, and that seems to be the crux of the matter for you.

Will the NHS share records with private entities so that you don't have to pay for re-work?

 

[Scaff]

To apply that to the question I'm asking then, what is the result of that? Do you get told what your treatment will be? Or are you presented with options? Are you told how expensive those various options are to the public? And would you have gotten all of that if there was a low-cost bandaid available that you don't like but could be considered good enough. At any point will someone sit you aside and say something like "look, to really solve this problem completely, you're going to have to go outside the NHS and get some work that's not covered". Because in my case, that's what I'd need to hear. I have no illusions that ortho would be covered for my scenario under just about any national health system.

In this case no different treatments exist, Autism isn't something you can fix.

However I do have experience of both NHS case and private (provided by my employer) and in most cases the difference amounts to the speed you are seen, and the niceness of the surroundings rather than the treatments offered.

Will the NHS share records with private entities so that you don't have to pay for re-work?

Yes, as long as you give consent for it to happen.

 

[Danoff]

In this case no different treatments exist, Autism isn't something you can fix.

However I do have experience of both NHS case and private (provided by my employer) and in most cases the difference amounts to the speed you are seen, and the niceness of the surroundings rather than the treatments offered.

Somehow I always end up being presented with all the options.

For my sinuses, I was presented with "you can keep doing what you're doing, or you can take steroids, or you can get surgery". For my teeth I was presented with "you can keep doing what you're doing, or you can get a bite adjustment, or you can get ortho". For eyes it's often a matter of glasses, contacts or lasik. So often with treatment there is a question of "well how bad is your situation now? are you willing to do this much more? how about that much more?" and there is no right answer.

So if the NHS doesn't cover something like lasik, ortho, or sinus surgery (for my particular situation), are you even told about it? It sounds like you'd have to take it upon yourself to go get a second opinion from a private provider. And I guess that works as long as it's legal. It's a bit of hassle, but as long as it's an option and people are diligent about getting outside opinions...

You can see how this reduces cost at the expense of health though right? If you don't tell someone about ortho, lasik, or sinus surgery, then they don't spend the money. And overall less is spent on medical care in the country (improved statistics! yay!). But at the expense of what is a potentially an improved medical situation.

 

[Keef]

I was talking to a pilot friend of mine the other day about my healthcare situation, or complete lack thereof, and his situation, and Bernie's proposal and whatnot. In aviation, we're lucky enough to have some of the broadest and best priced health insurance in the country due to pilot unions and FAA requirements.

He says his current family healthcare costs him $400 a month. Pretty good - my parents paid $800. He's got autistic child expenses. He's got another baby on the way. Healthcare pays for a lot of it but there are still bills in the mail. Yet, he thinks a simple universal system wouldn't benefit him.

He sees it from a tax standpoint I think. He just upgraded to Spirit airlines and will make over $100k this year, good for him. His taxes would certainly go up to help pay for universal healthcare and he argues that it wouldn't benefit him to vote for that because he already has decently priced, excellent healthcare. I mentioned to him that if he makes $100k, he'll be in the top 40% minority of incomes in the US. 60% of American families make less than that. So while Bernie's policies might not benefit him directly, they would benefit most of the country. Within just a few years I plan to be in a position like him, but I don't care if I'm paying more into that system because I know that it's going to benefit most people. My buddy has never needed any social assistance - not even FAFSA - so he doesn't see it from that point of view. I would gladly support such a system because I know what it's like to need it, even 20 years from now when I'm a fat and happy airline pilot bitching about working too much and only making $250k a year. Gotta remember that it helps most people, because most people aren't doing very well at all.

 

[Biggles]

I was talking to a pilot friend of mine the other day about my healthcare situation, or complete lack thereof, and his situation, and Bernie's proposal and whatnot. In aviation, we're lucky enough to have some of the broadest and best priced health insurance in the country due to pilot unions and FAA requirements.

He says his current family healthcare costs him $400 a month. Pretty good - my parents paid $800. He's got autistic child expenses. He's got another baby on the way. Healthcare pays for a lot of it but there are still bills in the mail. Yet, he thinks a simple universal system wouldn't benefit him.

He sees it from a tax standpoint I think. He just upgraded to Spirit airlines and will make over $100k this year, good for him. His taxes would certainly go up to help pay for universal healthcare and he argues that it wouldn't benefit him to vote for that because he already has decently priced, excellent healthcare. I mentioned to him that if he makes $100k, he'll be in the top 40% minority of incomes in the US. 60% of American families make less than that. So while Bernie's policies might not benefit him directly, they would benefit most of the country. Within just a few years I plan to be in a position like him, but I don't care if I'm paying more into that system because I know that it's going to benefit most people. My buddy has never needed any social assistance - not even FAFSA - so he doesn't see it from that point of view. I would gladly support such a system because I know what it's like to need it, even 20 years from now when I'm a fat and happy airline pilot bitching about working too much and only making $250k a year. Gotta remember that it helps most people, because most people aren't doing very well at all.

As I understand it 70% of American households (not individuals) make less than $100,000. It's definitely a "class warfare" situation. The 40% of households who make less than $50,000 would certainly benefit from a universal healthcare system. The 40% above that level, it might depend on particular circumstances, the top 15% (income more than $150,000) would likely be better served by the present system on a general cost/benefit analysis.

Having contributed in Canadian taxes for the last 40 years, without notable sickness in my immediate family, there's no doubt I have paid into the system (so far) way more than I have got out. In Ontario, dental (orthodontics or not) is not covered, nor are various other kinds of healthcare which I have had to pay for out-of-pocket.

On the other hand, my mother-in-law went through four different bouts of cancer (as well as other medical complications). I can't imagine the financial implications of that in the US system. My cousin recently had a liver transplant - would have cost hundreds of thousands of dollars in the US, I assume. The idea of universal healthcare is a given in Canada. The person considered the "founding father" of Canada's health care system, Tommy Douglas, was recently voted "The Greatest Canadian" in a national poll. The vast majority of Canadians do not look at healthcare from a personal cost/benefit point of view - they regard it as human right & something that should be available to all citizens regardless of income level.

Healthcare is an extremely complicated issue (surprising to Trump, apparently). There are definitely issues that arise with a single-payer system & deciding on the details is not easy. However, overall it's clear that the US "for-profit" system is hugely inefficient in its totality, although capable of delivering the highest quality health care to those with the money to pay for it.

 

[TJ13]

Nice copypasta of a meme that's false.

https://www.snopes.com/fact-check/sanders-tax-plan-52-percent/

"Does Sanders’ Medicare for All plan raise taxes to 52% on incomes over $29,000?
In short, no. One proposal offered by Sanders would raise the tax rate to 52% on earnings over $10 million. Sanders also proposed that the first $29,000 of a person’s income would be exempt from taxes, and a 4% income-based premium would be applied to earnings over $29,000.

The meme asserts that Sanders made this claim “at the debate last night.” As this meme started circulating in mid-February 2020, we’ll assume that timing refers to the Democratic presidential debate held in Las Vegas on Feb. 17, 2020. Although Sanders did say that he wanted to raise the minimum wage to $15 during that debate, he did not say that he would pay for his health care plan by raising “taxes to 52% on anybody making over $29,000 a year.”

Didn't know.
Everyone was posting about it after the debate.
I don't watch the debate, let alone I don't watch any president stuff, I just end up seeing it all over news feeds on social media.

 

[Danoff]

As I understand it 70% of American households (not individuals) make less than $100,000. It's definitely a "class warfare" situation. The 40% of households who make less than $50,000 would certainly benefit from a universal healthcare system. The 40% above that level, it might depend on particular circumstances, the top 15% (income more than $150,000) would likely be better served by the present system on a general cost/benefit analysis.

Having contributed in Canadian taxes for the last 40 years, without notable sickness in my immediate family, there's no doubt I have paid into the system (so far) way more than I have got out. In Ontario, dental (orthodontics or not) is not covered, nor are various other kinds of healthcare which I have had to pay for out-of-pocket.

On the other hand, my mother-in-law went through four different bouts of cancer (as well as other medical complications). I can't imagine the financial implications of that in the US system. My cousin recently had a liver transplant - would have cost hundreds of thousands of dollars in the US, I assume. The idea of universal healthcare is a given in Canada. The person considered the "founding father" of Canada's health care system, Tommy Douglas, was recently voted "The Greatest Canadian" in a national poll. The vast majority of Canadians do not look at healthcare from a personal cost/benefit point of view - they regard it as human right & something that should be available to all citizens regardless of income level.

Healthcare is an extremely complicated issue (surprising to Trump, apparently). There are definitely issues that arise with a single-payer system & deciding on the details is not easy. However, overall it's clear that the US "for-profit" system is hugely inefficient in its totality, although capable of delivering the highest quality health care to those with the money to pay for it.

I don't agree with your conclusion, but that was a pretty tightly-written post. 👍 You stop just short of presenting single-payer vs. the US system as the only options. I think most people reading this would walk right through the door on that one.

 

[Dotini]

IMHO, health care systems everywhere are operating within diverse limitations and budgets. If demand for health care increases to a sufficient degree, medical triage might comes into practice. People with lots of money are going to enjoy a great advantage in obtaining health care.

 

[Danoff]

People with lots of money are going to enjoy a great advantage in obtaining health care.

Unless it's (mistakenly) considered a human right... in which case money should not be allowed to buy more of it.

 

[Keef]

Unless it's (mistakenly) considered a human right

Should it be considered a public utility in American law? Is the healthcare argument analogous to the internet argument?

 

[Joey D]

IMHO, health care systems everywhere are operating within diverse limitations and budgets. If demand for health care increases to a sufficient degree, medical triage might comes into practice. People with lots of money are going to enjoy a great advantage in obtaining health care.

Some are, some aren't. Where I work, we're certainly not making huge amounts of money but we're not in danger of going under either. Our budget is absolutely massive too and we are consistently building new facilities across the valley and have a construction plan that goes out to 2025. At previous organizations I've worked for, some were barely hanging on by a shoestring and somewhere just sort of getting by with no huge issue.

Really it comes down to how competent your CFO is, how nurse managers balance their staff, and how many Medicaid/Medicare patients you get.

 

[Danoff]

Should it be considered a public utility in American law? Is the healthcare argument analogous to the internet argument?

It might be analogous - although I don't like public utilities and don't consider the internet to be one. I'd say that healthcare has a better argument for public utility than say, water, electricity or sewer. Sewer can be done on your own with a field. Water can be dug through the ground. And power can come from your roof (or a diesel generator). To give yourself a cat scan... uh....

Edit:

I guess the reason public utilities are considered utilities is because they're assumed to have a monopoly on you based on location. The closest thing I can think of for that in healthcare is an ER.

 

[Biggles]

I don't agree with your conclusion, but that was a pretty tightly-written post. 👍 You stop just short of presenting single-payer vs. the US system as the only options. I think most people reading this would walk right through the door on that one.

No, I really don't think it's necessarily single-payer vs US system, which is why I say it's "a complicated issue".

My only significant personal experience of Canadian healthcare was hernia surgery at the Shouldice Clinic in Toronto.

"While private hospitals are not allowed under Ontario's Private Hospitals Act, Shouldice is one of seven private hospitals in the province grandfathered under the Act. The hospital has been continuously family run from its inception, but is partially publicly funded". (Interestingly, a recent patient at the Shouldice was Rand Paul who selected the Shouldice for his own hernia operation).

The treatment my mother in law received over the years from the Ontario health system seemed caring & attentive. When her cancer doctors discovered she had a brain tumour (after her previous cancers had left her in a very compromised condition), they were still ready to start further treatment even though the prospects for a successful outcome were slim to none (no death panel).

In the UK, my mother had private medical insurance & was treated for cancer at a state-of-the-art private clinic on Harley St. In the end, the treatment probably helped prolong her life by a year or so. Once the prognosis was hopeless, she went on to receive exemplary palliative care from the local NHS care providers.

My youngest daughter has had a mysterious inner ear problem that has proved very challenging to diagnose & treat. Negotiating the Ontario health system for a problem like that has not been easy - I can't imagine anyone in Canada successfully coping with something like that without the intellectual capacity & dogged persistence brought to bear by my wife. We finally received an appointment for an MRI in August. Before that, we considered taking her to a clinic in the US. Fortunately, that date has just been moved up to mid-March, so that won't now be a consideration.

It's possible to have very good people working in both public & private health care, but the bureaucracy involved in the US system actually seems to be worse in many ways than in single payer systems. Overall, the US healthcare system, as determined in a 2017 survey of the healthcare systems of 11 developed countries found the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity. In a 2018 study, the USA ranked 29th in healthcare access and quality. Of course "access" & "equity" are part of that evaluation.

Whatever your personal philosophical views on this, the reality is that access to (more or less) universal healthcare is accepted as a human right in the entire developed world outside the US. I suspect, as time goes by, Americans will increasingly come to recognize the shortcomings of the present US system & move towards a single-payer system, although I would be surprised to see the private option disappear completely.

 

[Joey D]

It's possible to have very good people working in both public & private health care, but the bureaucracy involved in the US system actually seems to be worse in many ways than in single payer systems. Overall, the US healthcare system, as determined in a 2017 survey of the healthcare systems of 11 developed countries found the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity. In a 2018 study, the USA ranked 29th in healthcare access and quality. Of course "access" & "equity" are part of that evaluation.

Whatever your personal philosophical views on this, the reality is that access to (more or less) universal healthcare is accepted as a human right in the entire developed world outside the US. I suspect, as time goes by, Americans will increasingly come to recognize the shortcomings of the present US system & move towards a single-payer system, although I would be surprised to see the private option disappear completely.

Unfortunately, I don't see the red tape that exists in the US government going away anytime soon. This is my biggest issue with universal healthcare in the US. I see first hand how god awful the government is when it comes to attempting to run a healthcare plan. The laws alone the government involves with Medicare and Medicaid require an entire team of people in every organization to decipher what they mean and ensure that doctors are doing what the government requires in order to get reimbursed. These change every single year too and sometimes the changes are massive, which require thousands of work hours to change how the hospital does business.

When Meaningful Use hit the US health system, I was working at a different organization. To get us compliant with it, we had to form a team of 30 people who worked for two years just to meet arbitrary requirements from the government. We could've been doing things to make doctor's lives easier when it comes to documentation and building in better checks and balances for ordering tests and prescriptions, but instead, we were doing pointless work that really had no merit what-so-ever. Some of the changes were really good, such as moving from the ancient ICD-9 diagnosis code system to the much-improved ICD-10, but most of the changes made no sense. We even had to hire on additional people just to figure out what the hell the government was even on about.

I can't even fathom what a universal healthcare system would mean in terms of red tape within the US. Right now the simple act of being readmitted to the hospital for the same condition within a certain amount of time results in a non-payment to the hospital. This becomes a nightmare, especially when you consider how unhealthy many Americans are. Between heart disease, diabetes, and obesity the readmission rates are staggeringly high despite doctor's best efforts to get patients thinking differently about their health. I have no idea how to change this either and I even worked as a medical anthropologist in a previous life trying to figure this out with a whole team of people. I investigated everything from how patients learn best to developing health information for every single language spoken in a 50-mile radius around the hospital. Despite everyone's best efforts and a significant amount of work on my part to customize an in-room learning system for patients, it failed.

People just don't care about their health for whatever reason and, at least in the US, it seems to be a generational thing. Patients over the age of 60 couldn't be bothered to change their habits and just expected the healthcare system to take care of them despite being overweight with heart disease, diabetes, and other life style related illnesses. Also, in the Detroit area at least, patients over the age of 60 loved to smoke like chimneys and always seemed confused when they ended up with cancer. Younger people seemed to get it and I don't know if that has to do with education or the simple fact they weren't relying on a government healthcare system that covered everything.

Universal healthcare could work in the US eventually, but until a bunch of other things are addressed, it's going to fail spectacularly.

 

[Biggles]

Unfortunately, I don't see the red tape that exists in the US government going away anytime soon. This is my biggest issue with universal healthcare in the US. I see first hand how god awful the government is when it comes to attempting to run a healthcare plan. The laws alone the government involves with Medicare and Medicaid require an entire team of people in every organization to decipher what they mean and ensure that doctors are doing what the government requires in order to get reimbursed. These change every single year too and sometimes the changes are massive, which require thousands of work hours to change how the hospital does business.

When Meaningful Use hit the US health system, I was working at a different organization. To get us compliant with it, we had to form a team of 30 people who worked for two years just to meet arbitrary requirements from the government. We could've been doing things to make doctor's lives easier when it comes to documentation and building in better checks and balances for ordering tests and prescriptions, but instead, we were doing pointless work that really had no merit what-so-ever. Some of the changes were really good, such as moving from the ancient ICD-9 diagnosis code system to the much-improved ICD-10, but most of the changes made no sense. We even had to hire on additional people just to figure out what the hell the government was even on about.

I can't even fathom what a universal healthcare system would mean in terms of red tape within the US. Right now the simple act of being readmitted to the hospital for the same condition within a certain amount of time results in a non-payment to the hospital. This becomes a nightmare, especially when you consider how unhealthy many Americans are. Between heart disease, diabetes, and obesity the readmission rates are staggeringly high despite doctor's best efforts to get patients thinking differently about their health. I have no idea how to change this either and I even worked as a medical anthropologist in a previous life trying to figure this out with a whole team of people. I investigated everything from how patients learn best to developing health information for every single language spoken in a 50-mile radius around the hospital. Despite everyone's best efforts and a significant amount of work on my part to customize an in-room learning system for patients, it failed.

People just don't care about their health for whatever reason and, at least in the US, it seems to be a generational thing. Patients over the age of 60 couldn't be bothered to change their habits and just expected the healthcare system to take care of them despite being overweight with heart disease, diabetes, and other life style related illnesses. Also, in the Detroit area at least, patients over the age of 60 loved to smoke like chimneys and always seemed confused when they ended up with cancer. Younger people seemed to get it and I don't know if that has to do with education or the simple fact they weren't relying on a government healthcare system that covered everything.

Universal healthcare could work in the US eventually, but until a bunch of other things are addressed, it's going to fail spectacularly.

It may be that the reason that Medicaid & Medicare involve a lot of red tape currently is because of the way they are cobbled onto a very complicated multi-faceted health care system. I don't hear complaints like that about the way OHIP (the Ontario Health Insurance Plan) works. I don't doubt that there are inefficiencies & bureaucratic bungling within the system - but I suspect that overall it's just a much simpler system to administer because it's more streamlined.

Again with the anti-boomer bias! You're really talking about working class Americans. They grew up in an era when tobacco companies had free rein to market their products to people & addict them when they were young. Same with the junk food companies & obesity & diabetes. And same with the pharmaceutical companies & the opioid crisis. If younger people "get it" it may be because government eventually stepped in & heavily regulated cigarette advertising ... but here we go again with young people & vaping. The tobacco companies haven't been overly concerned about losing a big chunk of the US market, because they've got hundreds of millions of newly affluent Asians to addict to their product. From what I understand, one of the reasons the death toll from Covid-19 is so high in China may be because so many Chinese - especially men - are heavy smokers.

Libertarians like to promote the idea of "individual responsibility", but what's missing in that concept is the inescapable reality that people are only to a limited extent "rational" beings. They are more driven by irrational desires & emotions & are fairly easily persuaded to do things that are clearly not in their best interests.

 

[baldgye]

Unfortunately, I don't see the red tape that exists in the US government going away anytime soon. This is my biggest issue with universal healthcare in the US.

Do you have examples or articles on the comparison between the ‘red tape’ in the US government compared to other European nations with free healthcare?

As someone with limited knowledge of the US ‘system’ it’s hard to imagine you have more red tape than most European nations... such to the extent that it would make free healthcare impossible anyway

 

[Danoff]

My youngest daughter has had a mysterious inner ear problem that has proved very challenging to diagnose & treat. Negotiating the Ontario health system for a problem like that has not been easy - I can't imagine anyone in Canada successfully coping with something like that without the intellectual capacity & dogged persistence brought to bear by my wife. We finally received an appointment for an MRI in August. Before that, we considered taking her to a clinic in the US. Fortunately, that date has just been moved up to mid-March, so that won't now be a consideration.

You're not the only person I've heard talk about wanting to pay their way around the Canadian system. It seems to be a common sentiment... and yet...

Whatever your personal philosophical views on this, the reality is that access to (more or less) universal healthcare is accepted as a human right in the entire developed world outside the US.

If it's a human right, you shouldn't be allowed to do that. The problem is that you're misusing the word "right" in this case, and leads to unwelcome conclusions, like the conclusion that you'd not be allowed to throw money at your medical problems to get "more" of what is considered a right.

Healthcare can't be a human right. It requires making criminals out of people that don't provide it.

You should frame the conversation differently. You could say that universal healthcare is a basic social safety net. Or a cornerstone of prosperity. Or a great idea that will help everyone. Or you could call it humane. But a right? That's different, and it's leading to some really unappetizing but necessary conclusions like criminalizing private versions.

Also, if healthcare were a right, there is absolutely no basis for refusing to take care of someone's expired breast implants. Even in the "it's a good idea" version of universal healthcare, these pesky personal decisions really come back to bite. Because ultimately peoples' health, and the care they receive, has to be a personal choice.

It may be that the reason that Medicaid & Medicare involve a lot of red tape currently is because of the way they are cobbled onto a very complicated multi-faceted health care system. I don't hear complaints like that about the way OHIP (the Ontario Health Insurance Plan) works. I don't doubt that there are inefficiencies & bureaucratic bungling within the system - but I suspect that overall it's just a much simpler system to administer because it's more streamlined.

America is pretty bad at government. Partly because we don't like it. So when we do get big government, it's often an absolute nightmarish mess.

Libertarians like to promote the idea of "individual responsibility", but what's missing in that concept is the inescapable reality that people are only to a limited extent "rational" beings. They are more driven by irrational desires & emotions & are fairly easily persuaded to do things that are clearly not in their best interests.

On behalf of Libertarians everywhere I'll just say "we know" and "we're fine with that".

As someone with limited knowledge of the US ‘system’ it’s hard to imagine you have more red tape than most European nations... such to the extent that it would make free healthcare impossible anyway

I would believe it. We're quite bad at government. Having experienced the US government in-depth during the process of adopting a child, and then experiencing the Chinese government, I'll tell you with certainty that the Chinese experience was more streamlined and had significantly less red tape. I also saw the way the Chinese government "runs" and orphanage, and I have to say that it's very straightforward compared to what the equivalent would be here in the US. There is something about embracing government as a society that leads to more efficient programs.

 

[Joey D]

It may be that the reason that Medicaid & Medicare involve a lot of red tape currently is because of the way they are cobbled onto a very complicated multi-faceted health care system. I don't hear complaints like that about the way OHIP (the Ontario Health Insurance Plan) works. I don't doubt that there are inefficiencies & bureaucratic bungling within the system - but I suspect that overall it's just a much simpler system to administer because it's more streamlined.

I'm sure there are many reasons why the current Medicaid and Medicare systems are extremely bloated. I don't know much about the Canadian system outside the few Canadians I know and they offer mixed opinions on it. It probably is simpler though since nearly everything the US government gets involved in is an administrative mess, which goes back to my initial point. I'm so adamantly against a universal healthcare system in the US because it will end up bloated, broken, costly, and probably not help anyone that actually needs the help. When Obama introduced the ACA, it seemed like it could be an OK idea, but it turned into a dumpster fire and continues to be a dumpster fire today. Hell, they couldn't even build the website correctly.

Again with the anti-boomer bias! You're really talking about working class Americans. They grew up in an era when tobacco companies had free rein to market their products to people & addict them when they were young. Same with the junk food companies & obesity & diabetes. And same with the pharmaceutical companies & the opioid crisis. If younger people "get it" it may be because government eventually stepped in & heavily regulated cigarette advertising ... but here we go again with young people & vaping. The tobacco companies haven't been overly concerned about losing a big chunk of the US market, because they've got hundreds of millions of newly affluent Asians to addict to their product. From what I understand, one of the reasons the death toll from Covid-19 is so high in China may be because so many Chinese - especially men - are heavy smokers.

I can't help my anti-boomer bias. I know we've talked about this before, but given the boomers that I come into contact with, I can't help but think they are the most entitled generation ever. Not to mention they broke the housing market, ruined social security, bleed Medicare dry, vote in asshats like Trump, and think anyone younger than them is a millennial that needs a safe and some sort of participation award. I can't stand it because they're clueless. Is it all boomers? No, of course not, but if you were around entitled people all of a certain age who all had roughly the same ideas, you'd probably have a similar outlook.

Whoever it is though and whatever reason they have for abusing their bodies, people who don't care about their health are going to be a huge problem in a universal system. I can pretty much guarantee you that any universal system in the US will come with a readmission stipulation simply because it saves the government a ton of money. Basically, if you're readmitted to the hospital for the same condition in, I think it's 30 days, the hospital is still going to treat you but they're not going to get paid for it. This causes problems now and will cause even more problems if it's a stipulation for everyone. Many private insurances do reimburse for readmission, albeit at a lower rate.

I don't know what the rest of the world is like, I've only ever visited places and the longest I've spent anywhere outside the US is four months in the UK while taking classes. I can't really give an honest answer if things like this are a problem outside the US or not and I'm not sure how the rest of the world deals with them. But if say the UK system continuously pays for people going in and out of the hospital due to lifestyle illnesses, I see that as a problem. Paying for people who have a condition beyond their control is one thing, paying for people who just don't care is another, at least in my mind.

Do you have examples or articles on the comparison between the ‘red tape’ in the US government compared to other European nations with free healthcare?

As someone with limited knowledge of the US ‘system’ it’s hard to imagine you have more red tape than most European nations... such to the extent that it would make free healthcare impossible anyway

Nope, I don't honestly research other systems enough to have any meaningful sources to say anything about them.

 

[Danoff]

I can't help my anti-boomer bias.

You're profiling. It's what the human brain does, and you wouldn't want to stop it. I'm sure you're aware that you're doing it and maintain an open mind about the possibilities of people that don't fit the profile.

 

[baldgye]

Nope, I don't honestly research other systems enough to have any meaningful sources to say anything about them.

Oh, so do you think the US government (even with its bureaucratic problems), couldn't run and manage a perfectly working free health system when nearly all of Europe and most of the world, manages?

 

[Danoff]

perfectly working free health system when nearly all of Europe and most of the world, manages?

Perfectly?

 

[Joey D]

Oh, so do you think the US government (even with its bureaucratic problems), couldn't run and manage a perfectly working free health system when nearly all of Europe and most of the world, manages?

Nope. I'm not sure why it works in other countries, or at the very least, appears to work. As I said, I don't research them and don't know nearly enough about them to make a factual statement. I just know that our current socialized healthcare systems are awful, poorly ran, bloated, expensive, and badly abused. Expanding that will only make all of that worse unless several other problems are addressed. And if I had to guess if you were to address those other problems, you wouldn't need a universal plan because our system would start to actually work.

 

[HenrySwanson]

It's possible to have very good people working in both public & private health care, but the bureaucracy involved in the US system actually seems to be worse in many ways than in single payer systems. Overall, the US healthcare system, as determined in a 2017 survey of the healthcare systems of 11 developed countries found the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity.

It was also last in healthcare outcomes, arguably the most important metric for a healthcare system.

Which makes me wonder why the US system is defended so fervently by some Americans. I understand their distrust in government, but there's really only one direction you can go from being last....

 

[Danoff]

It was also last in healthcare outcomes, arguably the most important metric for a healthcare system.

Which makes me wonder why the US system is defended so fervently by some Americans. I understand their distrust in government, but there's really only one direction you can go from being last....

Who is defending the US system? I haven't seen anyone do it for some time now.