I've come to realize that the newer buzzword seems to be "Universal Coverage" instead of "Socialized Medicine". The plans that I read about seem to want to construct a government mandated system that incorporates all the HMOs and insurance companies.
I think this is wrong. One of the problems with our system is that it's got too many fingers in the pie. I'm in favor of a single payer, British style system or else keeping the present free for all we have now. I think the Democrats, who are the most likely to be in favor of a big government program like this, are too afraid to take on the powerful lobbies of HMOs and Insurance companies.
If we come up with a hybrid system like is being proposed, we are in for even more regulatory confusion and mess than we are even seeing now.
I think a single payer, government run socialized system is the best option. I also think that there must be strict tort reform that goes along with it to protect healthcare providers from frivilous lawsuits.
In fact, if you use Medicare as an example, you aren't even close. In 1965, proponents of Medicare predicted that it would NEVER cost more than 1% of income tax and would cost 9 Billion by 1990. In 1990, we spent 67 Billion on Medicare, a cost overrun of 700 PERCENT.
~faith,
Timothy.
We already ration health care. I don't think your medicare comment holds water. If in 1965 the prediction was that medicare would not exceed 1% of ????tax. It really is on track for staying within that ballpark. The medicare tax is on the order of 1.45% now. Any growth in the cost numbers can certainly be attributed to the combination of longer lives, additional technology (MRI anyone???), and increased reliance on prescription drugs.
I think that this debate can be divided along a care vs cure continuum. Care (UHC advocates) believe that money is better spent on prevention through a basic plan of consistent benefits. Cure (private sector/current system) would almost rather let people get sick...and if you can afford to pay for the cure out of pocket so be it. Somewhat of an exaggeration but I think it reflects a reality of belief.
The market theory has failed and is failing.
Won’t this result in rationing like in Canada?
The U.S. Supreme Court recently established that rationing is fundamental to the way managed care conducts business. Rationing in U.S. health care is based on income: if you can afford care you get it, if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. That’s rationing. No other industrialized nation rations health care to the degree that the U.S. does.
...
If there is this much rationing why don’t we hear about it? And if other countries do not ration the way we do, why do we hear about them? The answer is that their systems are publicly accountable and ours is not.Problems with their health care systems are aired in public, ours are not. In U.S. health care no one is ultimately accountable for how it works. No one takes full responsibility.
'care on demand' is there in UHC system , just perhaps not what the USA is used to ...
EMTALA came about to prevent WABC practices (wallet, airway breathing circulation) as well as religious hospitals refusing people who didn't meet their standards of behaviour ...
if there is unviersal access to primary care people won't need to use the ED for primary care , and if they present they can far more safely be 'turfed' to primary care
other aspects of 'care on demand' will remain if peopel are willing to pay over and above ....
however the picture painted by many posting on the board is of a system which doesn't provide 'care on demand' with p[rolonged waits for primary care consultations and prolonged ED ' holds' being the norm ...
there is also the aspect of the amount of specialist time and effort spent on "the worried well' becasue there is no 'gatekeeping' of referrals to secondary care and no incentive for primary care to develop their services
what does 9 billion 1967 dollars equate to in 1990 dollars?
1. Medicaid patients ARE allowed to use preventive care with primary docs. But, because it's FREE, using the ED is more convenient.
2. Medicare was projected to cost 9 billion IN 1900: a forecast that included inflationary adjustment. In any case, there was not a 700 percent inflationary decline in dollars amounts during that time frame.
If you would just agree to the free market for health care, EVERY person could be provided with all the care they need for five dollars a month. THAT is hands down a better deal than the government.
Perhaps you believe I'm being disingenuous about the 5 dollar a month comment in my last post. Either that, or totally unrealistic.
Maybe so, but NOT more so than suggesting that a token increase in taxation would pay for gov't restricted care.
The tax liability would be unlimited. Progressives don't care about that.
The American people will.
Two programs, Medicaid and Social Security, will cost 1 trillion dollars, or, a third of the budget next year. In less than ten years, on top of that, the 'trust' fund markers will be called in, requiring spending on top of those yearly averages. We will have to increase taxation by billions to fund what is already promised.
And yet, we are to believe that tripling these programs will amount to a negligible cost? Let's be realistic or at least, honest.
The reason for a federal funding stream with state control are to assure that resources are able to get where they need to be. Texas and Florida providers benefit under Medicare because of the ability to transfer funds to where the patients are.
Think of snowbirds. A snowbird is a retiree who lives in the upper Midwest during spring, summer, fall and then lives down South during the Winter. How could a state rationally manage that type of funding and expenditure.
Not all federal regulations are bad.
Medicare funding is fixable with some creativity. We can cut substantial amounts from medicare costs simply by discontinuing the Medicare Advantage subsidy. That subsidy to private insurers adds around 15% in additional cost for covering a Medicare Advantage beneficiary vs a traditional Medicare beneficiary.
Medicare for All would also help reduce administrative costs for medical coverage. This could be used to help reduce deficits. Adopting strict evidence based practice guidelines are another way to reduce costs. Reimbursing part D drugs on an evidence based effectiveness protocol would help reduce costs. Allowing Medicare part D patients to use their benefits to buy drugs from Canada would reduce costs. Authorizing bulk purchase discounts for medicare beneficiaries would reduce costs. The simple reality is that the US must contain medical inflation to the levels achieved by OECD countries or our economy will implode.
That presupposes that the CURRENT system is market driven. It is government driven already. The failure is with the government intervention that has destabilized the entire system. So of course, the solution to government intervention is more government intervention.
Before you can claim that market theory has failed, we would have to first TRY market theory.
Everywhere it's currently employed in health care, orthodontics, dentistry, lasik eye surgery, cosmetic surgery, over the counter meds: it's a stunning success.
The reason for a federal funding stream with state control are to assure that resources are able to get where they need to be. Texas and Florida providers benefit under Medicare because of the ability to transfer funds to where the patients are.
Think of snowbirds. A snowbird is a retiree who lives in the upper Midwest during spring, summer, fall and then lives down South during the Winter. How could a state rationally manage that type of funding and expenditure.
Not all federal regulations are bad.
Most are.
I see your point: the States have no idea how to raise taxes. Since they are SO BAD at it, the Feds MUST step up and do this favor for them.
It's just a shame my State isn't capable of taxing as well as the Feds. Right?
It's about control. The Feds are infamous about using funding as their mechanism of control.
Most anti universal health care folks already call any form of government run health care proposals, "Socialized Medicine", whether it be a true single payer system or not. This is an increasingly used buzzword for denegrating the democratic/liberal point of view, but most Americans are too sophisticated to buy that rubbish.
I think they'renot too sophisticated to buy into it, I'm afraid!.
It is not an issue of the states being unable to tax. It is an issue that the states are able to deliver a consistent set of insurance benefits IAW evidence based standards. I think the only way to do that is through federal funding streams.
It is after all "The United States" not a loosely organized confederation of states.
It is not an issue of the states being unable to tax. It is an issue that the states are able to deliver a consistent set of insurance benefits IAW evidence based standards. I think the only way to do that is through federal funding streams.
It is after all "The United States" not a loosely organized confederation of states.
In other words, it's an issue of the FEDS using control of dollars to determine what is 'consistent'. I agree. It's about Federal Administration and control. After all, the States, more local and therefore, more responsive to the people, can't be TRUSTED with the decisions they might make.
I think they'renot too sophisticated to buy into it, I'm afraid!.
Or rather, they ARE too sophisticated to buy into government mandated "free" health care for all at almost no additional taxation and no loss of freedom to choose.
You're right. 1993 and 'hillarycare' proved your theory.
I don't think that anyone is saying that the states cannot be trusted. I do think that setting a minimum standard of health care for all people living in the US is different from telling the states how to achieve that standard. (States IOW would be free to charge copays etc. and administer their programs but not deviate below a certain standard of care.)
I can think of a basic standard of coverage that would be included because they are good practices:
Annual physical
Immunizations covered 100%
Annual Dental Exam and 2 cleanings
Annual eye exam
Cover chronic illness care and medications at 100% with no out of pocket costs.
Medications reimbursed according to evidence based standards.
Contraceptive equity
Mental Health equity
The emphasis of any plan should be towards prevention.
I don't think that anyone is saying that the states cannot be trusted. I do think that setting a minimum standard of health care for all people living in the US is different from telling the states how to achieve that standard.
How is setting a national standard different than denying the States the right to set their own standards?
More to the point, how is this NOT Federal Control? Your plans depend upon Federal funding in order to maintain Federal control. That's fine, but let's not pretend the States would exercise control of the programs. He who pays, decides.
If you don't think the various States will meet 'minimum standards' without Federal control, then what you are saying is that you don't trust the States to do so. It's implicit in the argument.
HM2VikingRN, RN
4,700 Posts
We already ration health care. I don't think your medicare comment holds water. If in 1965 the prediction was that medicare would not exceed 1% of ????tax. It really is on track for staying within that ballpark. The medicare tax is on the order of 1.45% now. Any growth in the cost numbers can certainly be attributed to the combination of longer lives, additional technology (MRI anyone???), and increased reliance on prescription drugs.
I think that this debate can be divided along a care vs cure continuum. Care (UHC advocates) believe that money is better spent on prevention through a basic plan of consistent benefits. Cure (private sector/current system) would almost rather let people get sick...and if you can afford to pay for the cure out of pocket so be it. Somewhat of an exaggeration but I think it reflects a reality of belief.
The market theory has failed and is failing.
http://www.pnhp.org/facts/singlepayer_faq.php#canada_ration