I am watching Michael Moore's "Sicko" for the first time....

talaxandra · Mar 26, 2009

I don't know about the health care systems in other countries, only Australia. Our universal health care system, Medicare, was introduced in 1984 to:

provide eligible Australian residents with affordable, accessible and high-quality health care.
Medicare was established based on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income tax and an income-related Medicare levy.
Medicare provides access to:
free treatment as a public (Medicare) patient in a public hospital, and
free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)
Medicare website

Medicare is funded by a 1.5% levy on taxable income (with exemptions for low income earners). In 1999 the government introduced an optional private health insurance carrot/stick - if you earn over $50,000 and take out private health insurance then they'll reimburse you 30% of the insurance cost; if you don't then you have to pay an additional levy (1% of taxable income over $50,000) and if you later join you pay an additional 2% fee for every year over 30 you are. I have chosen not to pay for private insurance because I support universal health care and believe this bill was introduced to erode Medicare; I am happy to pay more money in the form of taxes to support it.

Approximately 43% of Australians also retain private health insurance, even though they are already entitled to free treatment in public hospitals. The major reasons for taking up health insurance despite the free public system are:
Shorter waiting lists in private hospitals (especially for procedures such as joint reconstructions or heart bypass surgery, for which there are often long waiting times in public hospitals).
Choice of hospital/physician in the private system;
Improved accommodation facilities such as private rooms (although medical facilities are usually more extensive in the public system).
Some people choose to have private coverage for ancillary treatment, or "extras", (e.g. chiropractic, dental, optical, ambulance, etc - for which Medicare has limited or no cover) but use the Medicare system for hospital treatment. - Wikipedia

I work in a public hospital, and have been treated both there (hand surgery) and privately (elective oral surgery). I was very happy with my treatment on both occasions. I paid nothing for the ED visit (which involved x-rays and assessment and consultation with a nurse practitioner, resident, registrar and consultant), day surgery, two months of outpatients appointments, distraction splint and k-wire removal, or three months of follow-up hand therapy, though I did pay for my discharge meds (about $20 for 20 oxycodone and 100 paracetamol tablets).

I paid around $5000 for day surgery at a private hospital, and was shocked to learn that I was charged a bed stay, as apparently recovery room costs aren't considered part of theatre expenses (live and learn). I'm still better off than if I'd paid for the last ten years worth of private insurance.

When I go to a GP I can choose either a bulk-billing service (few and far between) or pay up front, around $60 a visit, some 75% of which is refunded. Many places now have an instant refund program - if you bring in your Medicare card and bank details the money's deposited into your account that day; others only charge the difference between the bulk-bill component and their fee. When I have blood work (eg annual cholesterol and lipids) it's bulk billed.

I'm rarely unwell, haven't seen a doctor (except at work, of course!) in over a year, and almost never need scripts. If I did, the cost I pay is capped every year thanks to the Pharmaceutical Benefits Scheme of 1948 - after $1,141.80 I'm only charged $5 for any additional script; concession rates are capped at $290, free thereafter.

talaxandra · Mar 26, 2009

Sorry, I had to post a little early and before I got to edit some of that down! My point is that, though not perfect, the system we have works, and costs a lot less than the US version appears to, with significantly more extensive coverage.

One thing I don't understand, having read a number of permutations of this thread and others like it - why is "socialised medicine" an inherently bad thing? Some of you who oppose universal health care say that as though it's an argument against the idea, and I don't really understand the argument underneath the phrase. Can someone unpack it for me?

Long Term Care Columnist / Guide · Mar 26, 2009

It's a loaded phrase here, talaxandra........in post-G.W. Bush America, "socialized" programs are believed to be a product of liberalism, which is equated with socialism, which is considered to be on par with Communism. (BTW, on most issues I'm conservative!)

Here's the way it works. Commies---evil. Socialists---bad. Liberals---almost as bad as socialists. Spending money on two useless wars=patriotic. Universal healthcare=the end of America as we know it.

Hope this helps clear things up for ya :smokin:

talaxandra · Mar 26, 2009

Hope this helps clear things up for ya

Yeah, no - but as much as I think it's possible too. I think!

Long Term Care Columnist / Guide · Mar 26, 2009

I know.......it's illogical to me too, and I live here!! LOL

talaxandra · Mar 26, 2009

Then I clearly have no hope of getting it.

I really think it's those subtle cultural loadings, rather than the more obvious and bigger things, that separate us - like (small diversion here) an episode of Lie to Me that aired here this week, where an American negotiator reversed the prestige he thought each member of a MIddle Eastern delegation had based on the order they entered a conference room. In America (and many Western countries) the last in is the least important, but in the Middle East the opposite is true.

Not, I grant you, an entirely useful analogy, but hopefully I'm not just burbling on. Or maybe I am. I think I need to take a break :)

WalkieTalkie, RN · Mar 26, 2009

We used to have illegals coming into our ER for dialysis 2-3 times a week! We couldn't refuse to treat them since their lytes were all out of balance, and I pay for them indirectly every time I have blood drawn, see my doctor, need surgery, etc.

I had ankle surgery back in September, and even though I have insurance, I still had to pay about $4K out of pocket... about $2500 for the actual surgery, and the rest for PT, MRI, meds, labs, etc. I had to work a lot of extra shifts to afford this, and I had to deplete part of my savings. The insurance at my hospital sucks, but I am grateful to have that, even if it does.

Of course, when I see my itemized charges, I can't help but be annoyed at what the submitted charges are. You can't tell me that a bag of saline costs like $150. I know damn good and well it doesn't. However, for every bag of saline or other supply/procedure I paid for, I was indirectly paying for everyone who doesn't have insurance or is underinsured.

I put my ankle surgery off for 5 years because I couldn't afford it as a CNA even though I had insurance. I walked around in pain for that long. I don't think that's right, do you?

Jolie, BSN · Mar 26, 2009

I couldn't help but notice the ten so-called "facts" comparing health care of the US, Canada, France, and the UK, seem to be from a group called the Heritage Foundation (The Foundry ) whose mission is 'to promote conservative public policies...' I believe this information differs from other reports like the WHO.

Scott Atlas, the author of the article is a professor at Stanford University (hardly a bastion of conservatism) and a senior fellow at the Hoover Institution, a Stanford University think tank dommitted to domestic policy and international affairs.

http://www.hoover.org/

Yes, this article was published by the conservative Heritage Foundation, but I don't believe they were responsible for its content. I understand that those with a liberal mindset will be somewhat leery of information from a more conservative source, as I am of many liberal sources. My reason for posting this brief list (if you access the full article, there is an explanation of each item) is to highlight the important fact that our system has strengths and positives. Most of what we read utilizes statistics to compare our system of health care and payment very unfavorably with nationalized healthcare systems. While our system does have weaknesses and inequities, it is not all bad, and, in fact, outperforms nationalized systems in some ways.

I don't argue that our system could be improved. But I believe the way to accomplish that is to capture the positives and benefits of both methods of delivery and payment, and not simply ditch our system for nationalized healthcare. The countries that rely on that system will acknowledge that it has faults, too. Some have begun to allow their citizens to purchase private insurance to gain more timely access to elective and urgent care needs. That wouldn't be necessary if nationalized healthcare was perfect in its delivery to all citizens.

I certainly don't want to see my taxes increase for nationalized healthcare and then have to pay private premiums on top of that in order to avoid unacceptable waits for some types of care. I doubt that any of you do, either.

So let's study both delivery and payment methods and find the best way to combine the systems. That will take time, yes. And should involve pilot studies. But if we've learned anything from this bailout mess it is this: The notion that we have to do something now, without thoroughly examining its implications, because the sky is falling, Henny Penny! is unsound. It got us poor results with the financial system, and will get us poor results with the health care system. Instead, let's see some reasonable proposals and field test them to determine what will best serve the American people.

Honnête et Sérieux · Mar 26, 2009

Here's an example of an ounce of prevention...
Colorado is one state where illegal aliens cannot get outpt chronic dialysis paid for. So here's what these pts do- They clog up the ERs in Denver waiting for their K+ levels to become critically high so they can be admitted as inpts and receive "emergency" dialysis. Some of them even eat contraindicated high K+ foods on purpose so that their labs will sufficiently critical to allow them to be admitted and get dialysis.
If they could get outpt dialysis they could get their 3 x week tx, and be done with it. But- because of the way the system "works" they make themselves much sicker on purpose, and end up getting much more expensive inpt tx, and the ERs are filled w/ pts who are really there working the system so that they can get some semblence of their needed chronic tx.
Most of these pts play it so they do end up getting their dialysis twice a week- as inpts. In the meantime, all of their co-morbidies are getting worse due to the constant up and down of their labs, fluid overload, and lack of routine scheduled dialysis.
This is way more expensive and harmful than just giving them outpt dialysis in the first place.
How stupid is this system?

If they are illegal, they deserve ONE dialysis treatment and a bus ride back to Mexico.

It doesn't matter what label you put on a healthcare system, any system is finite, and a socialized system will never be able to afford the flood of illegals jumping on the dole if we are just going to give free care to everyone regardless of their legal status.

I truly don't understand how folks think we can somehow absorb everyone who enters and abuses the system.

Honnête et Sérieux · Mar 26, 2009

We used to have illegals coming into our ER for dialysis 2-3 times a week! We couldn't refuse to treat them since their lytes were all out of balance, and I pay for them indirectly every time I have blood drawn, see my doctor, need surgery, etc.
I had ankle surgery back in September, and even though I have insurance, I still had to pay about $4K out of pocket... about $2500 for the actual surgery, and the rest for PT, MRI, meds, labs, etc. I had to work a lot of extra shifts to afford this, and I had to deplete part of my savings. The insurance at my hospital sucks, but I am grateful to have that, even if it does.
Of course, when I see my itemized charges, I can't help but be annoyed at what the submitted charges are. You can't tell me that a bag of saline costs like $150. I know damn good and well it doesn't. However, for every bag of saline or other supply/procedure I paid for, I was indirectly paying for everyone who doesn't have insurance or is underinsured.
I put my ankle surgery off for 5 years because I couldn't afford it as a CNA even though I had insurance. I walked around in pain for that long. I don't think that's right, do you?

Sorry about your pain.

If you waited five years, it sounds like it was an elective surgery.

Elective surgeries are not priorities in socialized systems. Canada totally stopped doing them several times last year because there were insufficient blood supplies. Some elective surgeries are flat out not covered. Changing to a UHC/Socialized system might not have changed the fact that you had to pay for it, and MRI wait lists in Canada are up to several years for some non-urgent cases.

Honnête et Sérieux · Mar 26, 2009

It's a loaded phrase here, talaxandra........in post-G.W. Bush America, "socialized" programs are believed to be a product of liberalism, which is equated with socialism, which is considered to be on par with Communism. (BTW, on most issues I'm conservative!)
Here's the way it works. Commies---evil. Socialists---bad. Liberals---almost as bad as socialists. Spending money on two useless wars=patriotic. Universal healthcare=the end of America as we know it.
Hope this helps clear things up for ya

Uh, yeah, it doesn't...because you are the only one to introduce these connections. No one but you has made these insulting, irrelevant, and pointless generalizations.

I could just as easily make lame and insulting generalizations about advocates of socialized medicine, but it would be no more productive as your false generalizations about people who are not fans of Canadian/European style healthcare.

It's nice when folks can make their point somewhere other than the extreme end of the spectrum. No one has said that it's the "end of America as we know it." I will submit that a socialized system is not necessarily better for us as a country.

Honnête et Sérieux · Mar 26, 2009

Sorry, I had to post a little early and before I got to edit some of that down! My point is that, though not perfect, the system we have works, and costs a lot less than the US version appears to, with significantly more extensive coverage.
One thing I don't understand, having read a number of permutations of this thread and others like it - why is "socialised medicine" an inherently bad thing? Some of you who oppose universal health care say that as though it's an argument against the idea, and I don't really understand the argument underneath the phrase. Can someone unpack it for me?

Because it doesn't work.

Every experiment in universalizing health care in the US (Massachusetts, Hawaii), either quickly collapsed, or immediately was identified as unsustainable.