Single payer healthcare system discussion

In reply to frenchyd :

Theses a lot of factors that factor into the obesity problem in the US, but by large it affects the less affluent population at a higher rate (generally the demographic who would forgo healthcare due to expense.)

https://www.cdc.gov/mmwr/volumes/66/wr/mm6650a1.htm

The study linked in the previous post was an initial finding after the enactment of the ADA. More study is needed but early data sets suggest there's a correlation between regular access to a primary care doctor and lower obesity rates.

That likely has to do with discussions surrounding nutrition and being able to diagnose and treat issues such as hypothyroidism, and identify risk factors for type II diabetes, which contribute to the issue.

Caloric density, and the availability of cheap highly processed foods when compared to fresh or more balanced choices, is also a contributing factor when it comes to less affluent populations. Not exactly my area of expertise though.

jamscal said:

There are some good points in this thread.

Some disjointed thoughts:

I don't think the wording "Healthcare is a fundamental right" will work in America, nor is it helpful (even if you totally believe it).

A better statement might be: "America is rich enough at this point in history and we will increasingly take care of the health of our citizens."

The path (IMO) would be to say Health care is now a public utility (someone's idea from above^^) and move in that direction.

The justification would be there is  no trade secret or anything special in administering health care, so it should be as standardized as possible. (i.e we know in general what people will need over their lifetimes).

...

On the flip side:

 

I believe NHS works in other countries because they are in general small and/or very homogeneous compared to the US.

We have more people in California than Canada has. 

We have more than three times more drug addicts than Denmark has people.

We have almost 100 million obese people. 100 million diabetics/pre-diabetics.

When you start treating *all* drug addicts and diabetic people (and everything else)...even very efficiently...you see that it will quickly bankrupt us (IMO).

 

 

 

 

 

 

I like much of what you are saying. Especially regarding America is rich enough•••• 

However I think you  over estimate drug addicts and Diabetics. 

The solution to them is to treat addicts as a choice that only they can reverse. Stop putting them in Jail, provide free drugs so they don’t need to steal to get them ( we buy wholesale direct from the producer) 

Still criminalize selling and possession of large quantity. A small percentage of people will be addicts no matter what we do.  Treat those willing to accept treatment as cheaply as possible ( inform them of negative effects so they don’t sue For enablement) signs should do.. a nurse to supervise and crash pads.  

Diabetes, free insulin and required needles etc. in exchange they have to take classes on food suitable for their condition.  

In reply to frenchyd :

My point is that there are common serious medical conditions shared by many millions of people in America.

That go untreated or undertreated.

These numbers often dwarf the populations of whole other countries. (I'm pulling #'s off the web).

600k Americans die of heart disease every year. 121 million currently have heart disease [AHA]

If you start paying for these things that are currently not paid for, no amount of efficiency is going to make it cheaper.

25 million in America have asthma. Population of Sweden is about 10 million.

___

Note I'm not saying we shouldn't start moving in that direction, but I think I know who's going to pay for it...it's not the Rich, corporations, or the poor.

Some of the above solutions require wholesale change to our way of life, will require prison reform, drug policy reform/change, and lifestyle modification (forced?), serious education, etc. Again, all issues almost as large and politically impossible as Single Payer Heath Care.

I would like to expand on the comment below:

"RE: I don't want to pay for others for something I don't use....

Yet they also pay for car insurance, with the 100% hope that they don't ever use it.  Some of that money that goes to car insurance companies will go to pay for other people's accidents.  You can go through life never using your car insurance, pay many thousands for it- and all of it goes to either pay for others, overhead, or profit.  That's exactly how insurance works.  It's socialized coverage of accidents.

Same for home and rental insurance."

I have made the choice where I live.  The consequence of that is the amount I pay in home owner's insurance.  If you can get homeowners insurance living in our community you pay a premium.  You also pay the state an assessment for additional services that I hope will never again be needed in our community.  Most importantly I am required to maintain a defensible space around my house that amounts to clearing all the naturally produced things that end up on the ground.  Then in the fall when the cycle of life for trees produces another round of ground cover, I voluntarily go out and remove them from next to my house and move them to my property line.  

The car insurance premium I pay is again based on what I have chosen to buy , where I live and the additional premium paid reflects how often our family has needed to replace totaled vehicles. Our premium is also adjusted by our driving record.

Medical insurance.  

If you have an accident, that is one discussion.

If you are diagnosed with something, that is next.

Is you ailment is self inflected, again next.

Your turn.

I am willing to be apart of a pool of shared cost, when people take responsibility for their share.

David   

jamscal said:

In reply to frenchyd :

My point is that there are common serious medical conditions shared by many millions of people in America.

That go untreated or undertreated.

These numbers often dwarf the populations of whole other countries. (I'm pulling #'s off the web).

600k Americans die of heart disease every year. 121 million currently have heart disease [AHA]

If you start paying for these things that are currently not paid for, no amount of efficiency is going to make it cheaper.

25 million in America have asthma. Population of Sweden is about 10 million.

___

Note I'm not saying we shouldn't start moving in that direction, but I think I know who's going to pay for it...it's not the Rich, corporations, or the poor.

Some of the above solutions require wholesale change to our way of life, will require prison reform, drug policy reform/change, and lifestyle modification (forced?), serious education, etc. Again, all issues almost as large and politically impossible as Single Payer Heath Care.

Maybe I misunderstand what you're saying but  while many millions do have health problems, many more millions do not, and that's how the system works, and here, everybody pays.

Education is critical. We've had some form of health/diet education fed to us almost constantly since I was a kid and even though I think we need even more, what we have does help. I also think the obesity problem should be treated the same way smoking was (I see it as th same problem), with education and taxation and I see that some states are already part way there.

I said this a number of years ago when this topic came up and I still believe it. As long as the insurance companies are involved you wil always have a second rate health care system. They are the problem.

Suprf1y said:

 

Maybe I misunderstand what you're saying but  while many millions do have health problems, many more millions do not, and that's how the system works, and here, everybody pays.

 

Sorry, my main point is I don't think just because other 1st world countries can do single payer, that we can.  For many reasons. (And I understand this is very complex and I'm not an expert).

But I was trying to highlight that we have a much greater population with more problems in general, spread out over a large land area, than some of the countries with successful single payer systems. Add to that a culture that is "against" it, from a freedoms perspective at least, and a governmental, business and social situation that will prevent it.

I'n no fan of insurance companies, so I think that angle of attack will bring in some people for change.

Also, everybody most certainly does not pay.

In reply to Suprf1y :

Well said!! Insurance companies do not want less sickness/ illness they want more!!  

If you get a percentage of something you want that something to grow.  35% of a billion dollars worth of medical need is less than 35%  of 2 billion or three. 

If pills cost a million dollars and you make 35% won’t you do whatever you can to have pills cost 2 million or three, or 20?  

Same with Hospitals or HMO’s etc. 

Nobody in health care is trying to control growth.  Just the opposite. 

That’s why the government has to do it.  They have an incentive to reduce costs.  There is a finite number of tax dollars.  A politician who causes more sickness and death won’t get Re-elected. 

I'm Canadian and only occasional user of the healthcare system and I would never want to go to the American system. A few points:

-Do you really want people profiting off of denying sick people lifesaving treatment? That's the reality of the American system.

-Do you really think that a private, for profit company has your medical interests closer to heart than your elected officials? I know they're not perfect, but they're accountable to the users of the system (voters), not the shareholders of the company.

-Maybe you have great insurance through work, but what happens if you lose that job? No one's immune to getting laid off.

-Is the right to life, liberty and the pursuit of happiness compatible with people going bankrupt from medical issues or dying because they're too poor to afford treatment?

In reply to RX8driver :

You nailed it.  

Except to point out the incentive for profit makers to increase costs.  

Bumping this, since a new related study was recently released.

I'm not sure there's much that we didn't already know in it, but there are a few interesting numbers that pertain to this topic. Admin costs and materials/labor were the biggest areas of waste in the US medical field. Also interesting that physicians and other medical professionals in the US are compensated much better than those in the other countries used as comparison.

Here's an NYT article that goes over some of the concepts more indepth, without requiring you to pay to read the whole study.

" After administrative costs, prices are the next largest area that the JAMA study identified as waste. The authors’ estimate for this is $231 billion to $241 billion per year, on prices that are higher than what would be expected in more competitive health care markets or if we imposed price controls common in many other countries. The study points to high brand drug prices as the major contributor. "

I'm going to necro this simply to bitch.

In August my wife got into a fight with a rabid cat that jumped out of a bush and tried to attack my youngest son. She and the dog both both got bit and scratched. Dog snapped the cats spine but the cat dragged itself into a wooded area while my wife pulled my son and dog inside. I wasn't able to find the cat carcass when I got home several hours later because some do gooder picked the stupid thing up when it finally made it to the road.

It cost me $180 dollars, without insurance, to take the dog to the vet, have him vaccinated, then go for a follow-up.

My wife's bill just arrived today. Out of pocket for the incident we owe $1099.47 which is highly annoying but won't break me.

The hospital charged:

$21,069.21 for the initial ER visit. We called every urgent care in a 50 mile radius in an attempt to avoid going to the ER, because we know it's expensive, and none of them could administrator the initial exposure vaccine.

• The medication was billed at $19004.95 ($18,424.91 for one and $580.04 for the other)
• $1604 was for the ER visit
• Remainder was some lab work.

There are 3 subsequent required visits required for rabies exposure.

• $630.04 for each

If I had not had insurance that amounts to $22,959.33 for a completely freak exposure.

Anyone know what the side effects of rabies are? You berkeleying die. 100% of the time. If you don't get the vaccination right away the side effects are permanent brain and nervous system damage. This isn't a rhinoplasty or a botox injection. This is something that my 34 year old spouse and mother of 2 needed to continue living. On top of that I had to pick a massive fight with her over it because she gave me this line about how it's going to be expensive and the cat might not be rabid (it was after I finally found the vet who saw a possibly rabid cat with a severed spine in the area.) Well, too bad about the expense. You get it on the off chance that if you don't, you'll die.

I'm lucky in that my company picks up 100% of my insurance premium tab for the entire family to the tune of a bit over $12k. Had it been one of my neighbors who has to pay their own insurance or carries the absolute minium this would have broken them. It's absolutely out of control.

In reply to The0retical :

About 10 years ago, thanks to a bat found in our house at night, we got the rabies shots.  

Just wait until some person dies from rabies who could not afford the shots....  That will wake up some people.  I hope at least.

In reply to The0retical :

Sucks you had to go through this but as someone that was bitten by a possibly rabid dog as a kid I am glad she went ahead and got the shots.

When it happened to me the same thing happened. I was 5 or 6 and I remember it vividly. The dog got away somehow as my mom was more concerned with taking me to the hospital. 

I got 30 shots, yes thirty!! I guess things changed but in the early 80s that how many shots I had to get. I am glad I did now, wasn't happy then. I wonder what the whole ordeal cost back then. 

alfadriver said:

In reply to The0retical :

About 10 years ago, thanks to a bat found in our house at night, we got the rabies shots.  

Just wait until some person dies from rabies who could not afford the shots....  That will wake up some people.  I hope at least.

Doubt it. There are diabetics who have to decide between rent, food, and insulin that are dying right now. 

Contrary to several posts in this thread by folks who apparently don't do math or economics at all, maximum profit is generated by minimum claims over the period time of coverage. 
 

In reply to Slippery :

The vaccines have come a long way. They gave her six or seven shots initially. They don't need to go through the stomach anymore either which makes things easier.

She was feeling pretty cruddy for the 2 weeks afterward and would run a fever for a couple days after each round of shots.

The ER smeared some kind of gel all over my son to see if there was a scratch or puncture. They didn't feel he needed to be vaccinated as well, after inspecting him and not finding any, which would have doubled the cost. So we got lucky there.

I also had a very long conversation with the vet about what would happen, mostly on the potential legal side with the county, if I brought a cat/dog/bat/fox/raccoon/weasel into their office with at least one, non-naturally occurring, hole in it. Apparently it happens more often than I thought.

Berk the insurance companies

Berk the politicians

Berk the folks screwing the masses

I shouldn't be upset because I opt out of employer "provided" coverage anyway. Still, this week is open enrollment and as usual the policies have changed since last year and a couple hundred people just got hosed. Because of a decision made by our HR director, who, according to a little birdie, doesn't have employer coverage anyway and so is unaffected. I heard another employee refer to our HR director as.. essentially a cross between Hitler and Bin Laden.. but in much less forum friendly language.

Pinching pennies during record business months at the expense of the little people.

I'm pretty conservative, make no mistake, but something needs to happen and I'm open to ideas.

tester said:

Contrary to several posts in this thread by folks who apparently don't do math or economics at all, maximum profit is generated by minimum claims over the period time of coverage. 
 

This, and they don't understand how health insurance works very well at all

“Never in the history of the world has any measure been brought here so insidiously designed as to prevent business recovery, to enslave workers and to prevent any possibility of the employers providing work for the people,” said Rep. John Taber (R-NY).

“The lash of the dictator will be felt,” said Rep. Daniel Reed (R-NY), “and 25 million free American citizens will for the first time submit themselves to a fingerprint test.”

Rep. James W. Wadsworth (R-NY) cautioned that passage would open the door to a government power “so vast, so powerful as to threaten the integrity of our institutions and to pull the pillars of the temple down upon the heads of our descendants.”

Statements Made Before Passage of The Social Security Act of 1935

Sound familiar?

In reply to CJ :

It's easy to forget how nasty those battles were back then.  They called FDR a communist a socialist. The president who would end the united states of America's democracy.   It does sound very familiar 

CJ said:

Rep. James W. Wadsworth (R-NY) cautioned that passage would open the door to a government power “so vast, so powerful as to threaten the integrity of our institutions and to pull the pillars of the temple down upon the heads of our descendants.”

Probably not the place to discuss this but this sounds pretty truthful to me. We have a government so vast and so powerful that it intrudes into just about every aspect of our lives and so vast and powerful that we can't even afford to pay for it. 

In reply to The0retical :

The odd thing is, there is typically a big difference between the $23K amount the hospital billed and the actual amount the insurance paid the hospital, which is usually negotiated well in advance. I firmly believe it's just an accounting method by the hospital to insure that no matter what, at the end of the year they show a massive loss. 

In reply to Toyman01 :

The problem is we're paying for it now!  Just inefficiently.  With much higher costs than need be.  

Private insurance wants costs to increase. 35% of a few billion dollars isn't as much as 35% of a lot of billion dollars. 

Hospitals always want increases. Drug companies want increases.  
 

Only the government has any incentive ( They always have someplace else to put tax payers money)  to lower costs or at least keep costs in check. 

alfadriver said:

In reply to The0retical :

About 10 years ago, thanks to a bat found in our house at night, we got the rabies shots.  

Just wait until some person dies from rabies who could not afford the shots....  That will wake up some people.  I hope at least.

There have been a few deaths covered of diabetic people who can't afford the ridiculous prices of insulin and try to ration it, even going as far to make a GoFundMe and failing to meet their needs.  Result? No change to the medical profit machine.

There's going to need to be a massive cultural shift in order for the US to adopt better healthcare policy, just like Gun Control, and it won't happen overnight.

There is a campaign ad right now talking against progressive healthcare reform, talking about how that profit generates innovation in medicine for the entire world.

Yeah... um... they misspelled "profiteering."