Universal Health Care... what would this mean...

jjjoy, LPN · Feb 8, 2008

When you reduce the cost of healtcare to the end user you must reduce the cost of delivery & ways to do that include:
1) rationing - every socialized system uses rationing of healthcare, where on the wait list will you land?

Our current health insurance companies also dictate what procedures are and are not covered. Yes, someone could pay out-of-pocket, but many national health programs also allow that option.

One might argue that at least with health insurance, you have some choice between companies, but unless you have unlimited resources, the choices available to you won't protect you from a health problem driving you to deplete your resources and end up on government assistance anyway.

2) reduced pay and benefits to HC workers - Canadian Nurses do not have the same standard of living as their US counterparts and when the government decides - they can't strike either - there is also no competition between employers - it's all the goverment as employer

In the US, we may be able to get treatment immediately if needed (eg a CABG done immediately). So, the procedure is done but if the patient doesn't have the resources to pay either the hospital has to eat the cost or the person may qualify for Medicare (so we end up paying with our tax dollars anyway). And health insurance companies aren't far behind Medicare in attempting to negotiate the lowest reimbursement fees possible. What choice do hospitals have than to accept what's offered? They have to get their patients from somewhere and something is better than nothing.

So then the hospital reduces staffing to try to keep costs down, making nurses miserable and leading to high turnover despite the relatively good wages nurses currently enjoy.

I don't know the answer either. Health care costs so much & there are so many wonderful treatments out there to improve quality of life and treat health problems... we run into cost issues no matter what approach we take.

Simplepleasures · Feb 9, 2008

i was politely suggesting that your arguments would be better enhanced by facts supporting them then by name-calling of those who disagree with you.
btw-not a consevative, try libertarian.
conservative may be a dirty word to some, but i used it to draw a distinction. as i said we have the right to express our opinions, i certainly do not think that by saying your opinion being a typically conservative one, is "name calling". maybe as a libertarian you would consider it name calling, maybe the conservatives might feel the same way about being called libertarian, as for me i am a died in the wool liberal and you can call me a "liberal" anytime.
i do not believe that you supported your generalized statements about americans by facts. this side argument about name calling is a bit foolish dont'cha think? how about we get back to uhc and what it would mean to americans.

catshowlady · Feb 9, 2008

. And seriously if I was in Canada and I could just go to the doctor when I was sick, why in the world would I cross the border so i could pay tons of $$$$ for the same care I would receive for free back home???
Actually, I know someone who did just that - came to the US from Canada for care. A person I know through my hobby (showing cats) was diagnosed with breast cancer. From what I understood, because she was over 50, she was told she was going to have to wait several months for diagnostic work to stage her breast cancer. The cat-show community here in the States raised money for her to come here to have her diagnostic workup, so that she could start treatment.
Granted, this may be only one case, but I will tell you it does happen.

StudentOzGirl · Feb 9, 2008

I just wanted to clarify with my previous post about Australia's system of healthcare - that those requiring surgery usually go on waiting lists according to severity of cases. The majority of cases are dealt with upon presentation and/or followed up on a case by case basis according to the principles of triage (in hospital situations) or by gp's. Of course those who don't want to wait can elect to skip the waiting and pay for the costs themselves or through their insurance.

fronkey bean · Feb 9, 2008

not at all, and perhaps not having lived in the us you completely miss the point being directed primarily at my fellow countrymen.

unfortunately, the u.s. populace tends to be extremely lititagous. burglers sue and win for damages from an injury during a home invasion, parents sue physicans and hospitals for newborns with congential defects..i'm sure this trend is common knowledge internationally.

many americans have abdicated personal responsibility, and would be horrified to learn that there are parts of the world where one's own actions or lack thereof have impact on outcomes. lack of or wait for availabilty of our current high-tech interventions would not be widely acceptable to american health care consumers, who are apt to sue a hospital if their breakfast is cold (yes, exageration for point.)

and, to bring it all back to topic, the discussion is how universal health care would impact the usa, and whether or not european models are appropriate for comparison. the point is and remains that european models are not appropriate for comparison due to the points already listed.

ps-we americans have an aversion to both taxes and lack of freedom to choose our own destinies, in case the 1700's have slipped your mind.:usarm: vet, wife, and mom

that actually might be the only good thing about uhc. since you can't sue the gov't lawsuits might go down.

people from the uk and canada have both posted information to the contrary. their tax rates are not that much different from ours.

i was going to reply to this but then fizz said it so much better than i could that i thought i would just repost that reply.

but they are not comparing fairly and equally. canadian tax rates start at a much lower dollar figure. for example canadians move into a higher tax bracket at around 25000/year income, then again over 38000/year. american don't start to pay the higher rate until they are over 72500 for agi.
plus when i hear the "same" tax arguement. i just laugh. canadians do not have nearly the same tax deductions. mortgage interest - nope, travel for business - in usa it's a deduction in canada it's a taxable benefit.
when people here post arguments of lower administrative cost they must me dreaming. goverment run is not cheaper administration, do you really think running the pentagon or homeland security is cheap overhead?
these administrative cost surveys are bogus since they continue to cite the american business overhead costs and continue to ignore the government entities in other countries.
inject some reason here. you can't get something for nothing or it's worth exactly what you paid.
when you reduce the cost of healtcare to the end user you must reduce the cost of delivery & ways to do that include:
1) rationing - every socialized system uses rationing of healthcare, where on the wait list will you land?
2) reduced pay and benefits to hc workers - canadian nurses do not have the same standard of living as their us counterparts and when the government decides - they can't strike either - there is also no competition between employers - it's all the goverment as employer
as for md's - yeah i want to invest years of my life to be an md only to have some bureaucrat tell me how much i can make - may as well choose a different profession. ask canadians how hard it is to find a primary care doc and get an appt and then months or years later actually get any treatment.
3) reduced innovation and access to the latest treatment for patients - face it. innovation is driven by opportunity for profit and competitive edge, often paid for by americans and adopted by other countries later.
only the swiss & usa allow the drug companies to pander all their new meds and make real payback profit - later, sometimes 10 years later do countries like canada allow a drug to the market after the free enterprise countries have paid for the cost of development.
are you going to risk all your money just to have someone else decide if you can make a profit? that would be like going to work today and after you've invested your expertise, your cost to commute, your efforts and expenses to go to work and at the end of the day i come along and say "well it wasn't worth that much to me" here i'll reimburse you your expenses and give you $10.
why do people continue this foolishness about how much they're going to get for free or next to nothing? it's not expected anywhere else. remember the cost has to be borne by someone.
further, study the numbers of "uninsured". the survey is a snapshot of an instant in time. if you quit a job and didn't use cobra and went without for a month (say january) in the ininsured that month - you were counted.
two, look how many household over $50k or $75k don't have insurance. ae you saying they can't afford it? because it's going to be really fair taking taxes out of some guy's check who makes $35000 to pay for losers that make $75k and drive a lexus and don't want to pay.
and the comparisons of european hc to us never account for a difference so different it should be obvious. geography!
delivery of hc to a huge mass of population in a country the size of montana (germany) is different than in a country the size of usa.
further - usa i the melting pot, most european countries are very carefully regulated on immigration. it's easier to determine particular expectations in one cultures vs the vast differences across a nation like the usa.
no the hc here is not the end all and be all and it needs fixing. but wholesale adoption of these socialized systems is a recipie for failure and mediocrity.

excellent points despite the objections. as catshowlady below and others (even some from uhc countries) have pointed out not every one in uhc countries is happy w/ their system. just as it is a mistake to generalize americans it is a mistake to generalize that a few people being happy w/ the system means it works well overall.

. and seriously if i was in canada and i could just go to the doctor when i was sick, why in the world would i cross the border so i could pay tons of $$$$ for the same care i would receive for free back home???
actually, i know someone who did just that - came to the us from canada for care. a person i know through my hobby (showing cats) was diagnosed with breast cancer. from what i understood, because she was over 50, she was told she was going to have to wait several months for diagnostic work to stage her breast cancer. the cat-show community here in the states raised money for her to come here to have her diagnostic workup, so that she could start treatment.
granted, this may be only one case, but i will tell you it does happen.
this is not an isolated occurance (witness the post earlier about the canadian man who had to get tx for his brain tumor in the u.s. the point is that no system is going to serve everyone equally. there are always some who slip through the cracks. rather than trying to completly redo our system for one that is also flawed, why don't we try to fix some of the cracks?
for some reason, americans tend to try to fix problems by throwing more and more money at them. this hasn't worked for out schools, or our justice system, or the war, etc. etc., and it won't work for health care. lets not spend who knows how many billions to completely overhaul a system that works about 80% of the time for another system that works mabey 80% of the time. lets spend fewer resources and try to fix our system and let the canadians fix what doesn't work about theirs.

dragonheart, MSN · Feb 9, 2008

the u.s has traditionally seen patients who present themselves to the system. we have referred to them on the fiscal side of the house as indigent. this term does not follow them through the system but rather alerts the financial side of the operation that the patient does not have the funds to pay for care. this has long been the basis for higher costs for those who could pay for care. the bills are higher for brick and mortar costs to absorb indigent fees.

we might look historically at poor house hospital care and how patients in the 18th and early 19th century viewed hospitals as a place to go and die and work that historical perspective to current day hospital care

we could look at how much care is actually gratis from a comptroller mapping of fees , services, nursing care and explore how the gaps in reporting what we do contribute to blanket statements about rising healthcare cost and lack of care for all

we could consider that the current approach to care of all has not been widely publicized because the er serves as the entry point for a large portion of the demand for care without ability to pay. the care is based on signs/symptoms and not a sign accompanying patient dictating financial ability to pay.

healthcare providers and specifically nurses have traditionally been a cost that is included in the brick and mortar fees vice line item charge for specific physician fees, supplies and equipment

i would suspect that the workload would increase, the brick and mortar staff salary remain the same.

what would change under unversal healthcare as presented would be:

patient satisfaction with quality and timeliness of care

volume of patients entering the current as is system

there has been no detail presented re: staffing, education of patients re self-triage to free standing clinics or a plan that physicians use to increase doctor office visits or increase in physicians assistants, nurse clinical specialists ( the process of accommodating this universal health care plan)

this article was in the los angeles times feb 2008

universal healthcare's dirty little secrets

[color=#333333 ! important]patients in countries that provide government insurance often experience hurdles to care such as extremely long waitlists.

[color=#999999 ! important]by michael tanner and michael cannon, michael tanner is director of health and welfare studies and michael cannon is director of health policy studies at the cato institute.

april 5, 2007

as they tack left and right state by state, the democratic presidential contenders can't agree on much. but one cause they all support-along with republicans such as former massachusetts gov. mitt romney and california's own gov. arnold schwarzenegger-is universal health coverage. and all of them are wrong.

what these politicians and many other americans fail to understand is that there's a big difference between universal coverage and actual access to medical care.

simply saying that people have health insurance is meaningless. many countries provide universal insurance but deny critical procedures to patients who need them. britain's department of health reported in 2006 that at any given time, nearly 900,000 britons are waiting for admission to national health service hospitals, and shortages force the cancellation of more than 50,000 operations each year. in sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. in a 2005 ruling of the canadian supreme court, chief justice beverly mclachlin wrote that "access to a waiting list is not access to healthcare."

supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. of course, all americans already have access to at least emergency care. hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.

you may think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care. and yet, in reviewing all the academic literature on the subject, helen levy of the university of michigan's economic research initiative on the uninsured, and david meltzer of the university of chicago, were unable to establish a "causal relationship" between health insurance and better health. believe it or not, there is "no evidence," levy and meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health. similarly, a study published in the new england journal of medicine last year found that, although far too many americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."

another common concern is that the young and healthy will go without insurance, leaving a risk pool of older and sicker people. this results in higher insurance premiums for those who are insured. but that's only true if the law forbids insurers from charging their customers according to the cost of covering them. if companies can charge more to cover people who are likely to need more care-smokers, the elderly, etc.-then it won't make any difference who does or doesn't buy insurance.

finally, some suggest that when people without health insurance receive treatment, the cost of their care is passed along to the rest of us. this is undeniably true. yet, it is a manageable problem. according to jack hadley and john holahan of the left-leaning urban institute, uncompensated care for the uninsured amounts to less than 3% of total healthcare spending-a real cost, no doubt, but hardly a crisis.

everyone agrees that far too many americans lack health insurance. but covering the uninsured comes about as a byproduct of getting other things right. the real danger is that our national obsession with universal coverage will lead us to neglect reforms-such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets-that could truly expand coverage, improve quality and make care more affordable

as h. l. mencken said: "for every problem, there is a solution that is simple, elegant, and wrong." universal healthcare is a textbook case.

BlueRidgeHomeRN · Feb 9, 2008

the conservative cookie dough..... conservative mantra s.
no, i believe that the above are indeed intended to be perjorative, and that attacking one's opponent personally is a sign of a weak argument, without facts or logic behind it.
now that you've added "silly" to the list, hit me some facts or reasoned opinions, or admit that this is the best you can do when your self--admitted liberal arguments produce smoke and mirrors.
words-and facts-have actual meaning. small children have strong opinions, adults can produce facts or at least a rationale behind them. now, back to uhc as examined by health care professionals..

Home Health Columnist / Guide · Feb 9, 2008

:typing

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Simplepleasures · Feb 9, 2008

http://www.prospect.org/cs/articles?article=why_2009_is_the_year_for_universal_health_carehttp://www.prospect.org/cs/articles?article=why_2009_is_the_year_for_universal_health_care

it's not 1994 all over again. the next president can get the reforms that harry truman and bill clinton couldn't.

uncharitable observers might sneer that this is all it deserves. they would be wrong.

this time, the process has already started within the halls of congress. wyden's healthy americans act, a universal-coverage bill that opens up menus of regulated insurance choices to everyone in the country, subsidizes coverage up to 350 percent of the poverty line, and slows spending growth is co-sponsored by six republicans: judd gregg, mike crapo, chuck grassley, robert bennett, lamar alexander, and norm coleman. none are names you customarily see attached to democratic bills. "i think we're building the sort of coalition that can break 60 years of paralysis," says wyden.

for the first time in decades, congressional power players are talking seriously about concrete health-reform legislation. "to grow a healthy crop, you have to prepare the soil," says sen. max baucus, now chairman of the senate finance committee. "the finance committee will hold an aggressive series of hearings next year [2008] on comprehensive health-care reform. … next year can be a prime time for ideas, a time to lay the groundwork for immediate action when a new president and a fresh congress take the field in 2009." whatever the legislation that may emerge from this process, the momentum for change is certainly building.

you can also see the increased savvy in the coalition building, in the early organizing. the unions are onboard early. "our forces are stronger, smarter, have learned lessons, and understand the need to address [the public's concerns] from the start," says heather booth, who is coordinating the afl-cio campaign. "and i think the right wing is fracturing, less confident, and the public is more aware of their false solutions."

even the national federation of independent business (nfib), which was militantly anti-reform in 1994, has joined a prominent health-care coalition organized by the services employees international union. indeed, nfib president todd stottlemyer writes, "we must find a way to fundamentally alter the forces driving costs. … we will do nothing less than commit every resource to fight for a health-care system that makes affordable, quality health care available to everyone." an offhand comment by sen. wyden suggests stottlemyer may mean business. "the businesses, in 1993, that said they couldn't survive health-care reform are now saying they can't survive without it. i talk to todd stottlemyer, the president of the nfib, once a week!"

with elections in 2008 and the strong possibilty of a democratic government , i do believe as this article states that the time is right and we as americans have the "right stuff". the government is us, its up to us to select those who would bring about the changes that are so badly needed. as obama says, we can do it, we need to stop looking at others mistakes and think we will follow in their footsteps, we can learn from those mistakes and do it in a uniquely american style, we don't have to become a second class nation unless we the people let it happen by our negativity and cant do attitude. mo. you are free to agree or disagree, my feelings wont be hurt.

in 1994, 37 million americans were uninsured. in 2007, 47 million are. between 1996 and 2005, an employee's spending on health premiums for his or her family has shot up 85 percent -- and incomes, of course, have not followed.
"my [personal] index," says len nichols, director of the new america foundation's health-policy program, "is the ratio of family premiums to median family income. in 1987, it was 7 percent. today it's 17 percent. that fundamental dynamic, that health-care costs are growing so much faster than economic productivity, means that even though unemployment is so low and the macroeconomic indicators are good, there's still intense, acute anxiety." in economics, there's a famous dictum known as stein's law, which states that when something cannot go on forever, it will stop. our health-care system, as currently composed, cannot go on forever. it will wreck our economy, collapse our businesses, render both private and public insurance unaffordable. and so, it will stop. reform is not a question of if, but when and how. and just think what a library exhibit it will make.

as i said before , we will find a way, i think the health care reform train has left the station.all aboard!

jjjoy, LPN · Feb 9, 2008

For some reason, Americans tend to try to fix problems by throwing more and more money at them.

I don't think anyone who seriously cares about our society suggest 'let's just throw money at the problem.' You may disagree with the potential effectiveness of the idea, and that's where the critique should lie.

I think we'd all get much farther in such discussions by emphasizing where we agree - that we want what's best for the most - and then respectfully pointing out the strengths of our own plans over another - as opposed to just pointing out how *wrong* , *stupid*, *foolish* , *naive*, etc the other person's plan is. And I'm saying this in regard to discussion both individual and social levels (eg in politics), not specifically in regard to any particular poster here.

Lets not spend who knows how many billions to completely overhaul a system that works about 80% of the time for another system that works mabey 80% of the time. Lets spend fewer resources and try to fix our system and let the Canadians fix what doesn't work about theirs.

To me, this argument makes much more sense than most I've heard (as opposed to warnings of dire consequences of UHC). I'd love to the see some suggestions about other approaches that could help reduce the threat of illness of leading to astronomical personal & societal costs. Anyone want to start another thread?

HM2VikingRN, RN · Feb 9, 2008

Zippy,

Thanks for your eloquent researched response..

Simplepleasures · Feb 9, 2008

http://www.commonwealthfund.org/aboutus/aboutus_show.htm?doc_id=649326

The limitations of the predominant fee-for-service payment system—especially in promoting effective, coordinated, and efficient care—is becoming readily apparent. A major contributor to high costs in the United States is the way our system rewards hospitals and physicians for providing more care, not for more efficiently getting the results patients want.

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One of the keys to better health system performance is ensuring that all patients are linked to a regular source of medical care—one that is accountable for coordinating all services and provides convenient access to appointments. This style of practice, sometimes called a "patient-centered medical home," allows patients to contact their provider by telephone, get same-day medical appointments as well as care or medical advice in the evening and on the weekend, and experience well-organized office visits—with their complete medical history readily available.

One major barrier to the spread of medical homes is that public programs, such as Medicare and Medicaid, and private insurers pay disproportionately higher rates for specialized procedures than for preventive and primary care. Fund-supported research is helping to develop and evaluate new payment methods that encourage more physicians to practice primary care, employ a team approach to care, and meet the standards of the patient-centered medical home.

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Accountable Leadership
Achieving the goal of a high performance health system requires new leadership from the federal government in conjunction with public–private collaboration. What our country could use is a single entity that:
Sets national targets for health system performance and specific priorities for improvement.
Ensures a uniform health information technology system.
Generates information on the comparative effectiveness of drugs, medical devices, procedures, and health care services and disseminates that information to payers, clinicians, and patients.
Develops the databases and compiles the information needed for assessing effective practices and for identifying and rewarding high performance of those who deliver health care.
Reports regularly on health system performance and makes recommendations on how to meet desired targets.
At the same time, stronger partnerships between the federal government and the states—which together account for almost half of all U.S. health care spending—are needed to link payment to guidelines and performance standards. Federal and state governments should also lead by example through the establishment of financial incentives for Medicare and Medicaid providers that meet high levels of quality—something that has already begun.

The Commonwealth fund is one of those think tanks that has been working on health care reforms. Incredibly intelligent , principled people who with support of the American public can design a health care system that will work for all Americans alike.