In reply to oldtin:
No one is forcing them into a profession but a few posts up you see
any Dr that drops Medicaid/Medicare patients personally and professionally can take no non-direct care related compensation from insurance companies for 10 years.
Which sounds to me you are trying to tell them who the can and can not treat.
MDJeepGuy, I must have missed the post where you brought some solutions to the table. So far, all I have seen is you selecting other's comments and suggesting that the poster's opinion is invalid or trying to put them on the defensive with your inflammatory remarks. If you cannot bring something constructive to the discussion than I ask that you step away from the thread.
In reply to EastCoastMojo:
The solution has been posted here, take the government out of it. Making it a rich vs poor issue is not bringing a solution to the table either, but that seems to get a pass from you.
MDJeepGuy wrote: In reply to FlightService: So who gets to decide what business is and is not for profit? You want to force arbitrary rules on Doctors, are you ok if they decide your profession is next?
I figured someone would get that twisted. There are certain restrictions, let's call them non-competes, in all businesses that are binding. The point isn't the restriction, it's the 10 years. Make it long enough it's not profitable to buy them out.
I was an engineer and now a patent examiner. All of my jobs have had strict and sometimes personal liability from governament regulations, so no I don't mind.
As this is the norm for all professionally licensed careers
Back to the topic. Many if not all the first world countries with the exception of the US seem to make single payer systems work and at a cost per person significantly less than us. So can it work - yes. Is the US ready for it? Probably not. We'll probably have to screw it up a little more to go over the edge. On the other hand we can always go third world and everyone is on their own.
MDJeepGuy wrote: In reply to EastCoastMojo: The solution has been posted here, take the government out of it. Making it a rich vs poor issue is not bringing a solution to the table either, but that seems to get a pass from you.
Taking government out doesn't work. If it did, this thread would not exist.
History time and time again proves that companies are in it for themselves and shareholders and nobody else.
This is a good discussion, I'd hate to see it get locked.
I think who gets healthcare is kind of a moot point. We've already established that pre and post ACA, no one was denied medical treatment, and everyone else was paying for that treatment already, through taxes, increased costs for care, etc. The main idea of the ACA was to shift those costs back to the insurance pool. Ideally, everyone would have insurance, reducing taxpayer burden, and costs in average would go down because you are not paying indirectly for the care of others through higher charges from the health care providers. The goal was to give everyone equal access to health care.
In my personal experience, my costs have gone up and my access to care has been restricted. I now get two bad options for my health plan, and I choose the least worst, which is a high deductible plan. My premiums are high, but I still have to pay 100% until I hit my deductible. So when my toddler has an asthma attack (always after business hours it seems,) I have to make a decision. Is bad enough take him to the emergency room for a shot? I know it will be at least $1000 bill. It really sucks to be put in that situation. I see others who have no such reservation in the same situation, because they are not paying for it. I have seen no reduction in the cost of the services themselves since the ACA. My insurance costs have gone up, and my pre deductible care costs have gone up.
One thing that I find interesting is the use, or lack thereof, of urgent care instead of the emergency room for minor emergencies. I always go to the urgent care center when it's open. Not only is it much less expensive, but it's usually empty with no wait and better care. Many of the emergency room patients that I've witnessed could most certainly have gone to urgent care, freeing up the burden on the emergency room. But in my area, the urgent care facilities are not at the same location. Wouldn't it make sense to put them at the same place, so that patients could get the most appropriate level of treatment? And why not leave it open? I've never know anyone to schedule a medical emergency, minor or major, during business hours.
I did have a good experience recently. My son's asthma started acting up, right before closing time at urgent care. It closes early on the weekend. But it's in the next town over. My wife spoke to the doctor, agreed that he needed to be seen, and he was sympathetic about the large emergency room bill that we would get. He waited for my wife and saw my son in the parking lot.
Thanks to everyone who's posted their ideas & opinions on this sensitive, but important topic, in pretty adult & civilized way. It's good to be able to learn about this issue from a variety of viewpoints!
In reply to oldtin:
Back to the topic. Many if not all the first world countries with the exception of the US seem to make single payer systems work and at a cost per person significantly less than us. So can it work - yes. Is the US ready for it? Probably not. We'll probably have to screw it up a little more to go over the edge. On the other hand we can always go third world and everyone is on their own.
Do they get the same level of care? Is it really less expensive? Just because they do it, it doesn't make it better. It might just be easier. And the history of the world shows that personal freedom is not the easiest solution. Our system of government was set up specifically to prevent this kind of intervention. It is about personal freedom, not majority rule or the greater good. For better or worse, we do not do things like the rest of the world. Overall, I'd say it is for the better. Are there room for improvements? Of course. But there is a huge list of restrictions on why we can't do things like the rest of the world, and that's a good thing.
In reply to MDJeepGuy:
You have mail. Everyone else, please carry on. Thank you for your polite and civil discussion on this sensitive topic.
One idea that has been floated many times is making the patient more responsible for health care cost decisions. This can be done by publishing prices, increasing competition, and most people I've seen advocating for it tend to lump it in with HSAs and higher deductibles.
That hasn't been tried in other countries as far as I can tell.
The field where this has been tried is actually Veterinary Medicine. All decisions have to have a cost discussion, and most vets know their prices pretty well. You can call around and find the cheapest place to have a surgery or medicine, and choose that.
The new problems with that system are that patients are pretty poor judges of what procedures and costs are extraneous, so the physician ends up practicing medicine blind with one hand tied behind their back. Also, making care decisions based on short term cost tends not to lead to long term savings, due to increased mismanagement of disease, whether that's due to declined tests and treatment or seeking out the lowest-cost (and often lowest-skilled) providers.
One of the biggest drivers of the increase in healthcare costs is the exponential increase in drug prices. I've yet to see someone seriously address that. When all the newest cancer drugs are $10,000-50,000 a month, good luck with an HSA.
Boost_Crazy wrote: Do they get the same level of care? Is it really less expensive? Just because they do it, it doesn't make it better. It might just be easier. And the history of the world shows that personal freedom is not the easiest solution.
I believe it does cost less per capita, and they get better care since they live longer in many countries.
bastomatic wrote:
Best argument ever for changing our entire system.
I just read this whole thread and am glad it has remained civil.
I have a question to ask about other countries' systems, because I really don't know the answer. Maybe I can get a real and civil answer here.
In the United States, it is perfectly legal (and may be a Constitutional right {free speech}) for representatives of organizations in healthcare/insurance/pharmaceutical industries to lobby lawmakers with unlimited amounts of monetary and non-monetary compensation in order to get specific laws (often written by the industry itself) enacted, or in some cases, denied.
Is that likewise the case in nations that offer universal health care? I suspect that it is not.
If I'm correct, it is this one difference, and none other, that will continue to keep the US on it's current system, and prevent any major systemic changes to the health care and insurance industries.
Boost_Crazy wrote: Do they get the same level of care? Is it really less expensive?
I can only speak from my limited experience in Germany with relatively minor illness. I had an ear infection.
I looked up private doctors near the school. I walked into an office without an appointment one afternoon after class and was seen after about an hour wait. I was admonished that next time to at least call ahead in the morning to set up an appointment for the afternoon.
The student insurance I had was a bit weird. I had to pay out of pocket ahead of time, and submit the bill to them for reimbursement. It didn't matter. The bill from the doctor was less than what my standard copay with insurance seeing a doctor here in the U.S. Same deal with the antibiotics. They were about the same price I would pay even with insurance.
Other students who got sick or injured reported pretty similar experiences. Basically, quality of care was about the same as in the U.S. If there was a difference, they didn't bother checking all the ancillary things (weight, temp, blood pressure, etc.) if you were just coming in with an acute condition.
Boost_Crazy wrote: In reply to oldtin:Back to the topic. Many if not all the first world countries with the exception of the US seem to make single payer systems work and at a cost per person significantly less than us. So can it work - yes. Is the US ready for it? Probably not. We'll probably have to screw it up a little more to go over the edge. On the other hand we can always go third world and everyone is on their own.Do they get the same level of care? Is it really less expensive? Just because they do it, it doesn't make it better. It might just be easier. And the history of the world shows that personal freedom is not the easiest solution. Our system of government was set up specifically to prevent this kind of intervention. It is about personal freedom, not majority rule or the greater good. For better or worse, we do not do things like the rest of the world. Overall, I'd say it is for the better. Are there room for improvements? Of course. But there is a huge list of restrictions on why we can't do things like the rest of the world, and that's a good thing.
I'd really like to know if (other developed nation's HC system) level of care is comparable. I've seen some anecdotal evidence in this conversation that indicates it is. The "life expectancy" metric is powerful and simple.
The fact that our government is so easily bought, and the reality that we are so used to shenanigans, skews our willingness to even consider such a system - because we are conditioned to believe it'll never work. That's shameful.
I think single payer works in those countries because they are, in general, very homogeneous, and have much lower populations than the US. They also have much greater population density.
The social safety net in some of the countries is great for them, but even with good insurance in the US you'd also need disability insurance to avoid bankruptcy, because you'll be losing your job if you're out for a year+ successfully fighting cancer.
Finally, we have a lot of people who don't pay income taxes and the burden will fall heavier on those who do...should we go single payer.
Cheaper overall won't mean necessarily mean cheaper for you. 
Unfortunatly I think we'll do a lot of talking about it and work around the edges of the problem for many years to come. 
In reply to EvanR:
In Germany it's kind of a similar process. There are regional/state governments and representatives for federal government (we kinda helped in writing their grundgesetz for them with a constitution that's sort of based on the Weimar Republic constitution). Interesting that given a do-over for constitution writing we promoted a different style of democracy than in the US. Anyway, introduction of laws is similar to us and there is plenty of lobbying going on in the U.K. And Western Europe. Boxhead Tim could explain it better.
In reply to Boost_Crazy:
Re: personal freedom.
Yes, that is how our system is set up, but I'd call it more personal rights. So they the rights of the individual trumps the will of the masses.
But... in the Constitution, there's also notes for "general welfare". Both time it's mentioned, it's after "common defense". So while we spend a lot of taxes on defense, we can do the same for welfare of some kind.
In reply to jamscal:
Re: who pays.
Right now, the burden of defense spending is on those who pay and not on the ones who don't, and they get equal defense.
And I'd bet that after all is said and done, we spend more on defense than healthcare. Which is interesting considering what each of them do to keep us safe.
In reply to FlightService:
I looked up what they included in the data for that graph...
"Total health expenditure is the sum of public and private health expenditures as a ratio of total population. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation. Data are in current U.S. dollars."
That appears to be everything health related other than water and sanitation. If health related education and public assitance programs are included, I would not be a surprise that we spend so much, but it's not directly related to the topic of our discussion. They also mentioned that different countries used different reporting criteria when calculating their numbers.
Health care (medical care) is one factor in life expectancy. Genetics, environment, culture, wealth, etc. are also very important factors. It's a giant leap to conclude that the country with the longest life expectancy has the best medical care.
When I talk about overall cost, I don't mean just the dollar cost. I mean the cost of shifting the overall budget towards medical care. That means that you need to devote less to something else- defense, infrastructutre, education, etc.. Doing so has a cost. Not that we can't do better in those areas too, but that's another topic.
One thing to remember and is a pretty common misconception is that many of the "other" healthcare systems are not truly single payer. Sadly I think most people have these discussions with far too little information (some of which is obscured on purpose of course). I am no expert, but this is a very good explanation of some of the other systems:
In reply to Boost_Crazy:
Re: shifting money.
One thing to remember, there is a large part of the population that has healthcare paid for. Realistically, all of those funds can be moved to single payer healthcare. Again, taking a black box look at it, money that is already paid out so nobody will miss it much.
The problem is that it would be a new tax, which people hate a lot. People would rather pay more out to pay less taxes, which is illogical.
jamscal wrote: I think single payer works in those countries because they are, in general, very homogeneous, and have much lower populations than the US. They also have much greater population density. The social safety net in some of the countries is great for them, but even with good insurance in the US you'd also need disability insurance to avoid bankruptcy, because you'll be losing your job if you're out for a year+ successfully fighting cancer. Finally, we have a lot of people who don't pay income taxes and the burden will fall heavier on those who do...should we go single payer. Cheaper overall won't mean necessarily mean cheaper for you.
Just going to point out that the population density of Canada is a little lower than that of the US 
Really, Canada and the US are not all that different in terms of demographics so it's a good comparison. Canada has their poor areas and their powerhouses. Some provinces subsidize the others - directly by cash transfer, actually. Individual wealth is pretty similar. Sure, the per-capita military spending is lower (I don't think anyone first world country beats the US on that metric) but if you cut health care costs in half (see per-capita costs on graph above) that frees a lot of money up to spend on bombs and bullets.
In reply to Keith Tanner:
Or bridges and boulevards. That's two more "B" words that we really need to focus on.
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