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

HM2VikingRN, RN · Feb 4, 2008

some research links to show how and why uhc is better:

- administrative costs consume 31 percent of us health spending, most of it unnecessary .
  (woolhandler, et al “costs of health administration in the u.s. and canada,” nejm 349(8) sept. 21, 2003)
- half of all bankruptcies are caused by medical bills. three-fourths of those bankrupted had health insurance at the time they got sick or injured.
  (“illness and injury as contributors to bankruptcy,” himmelstein et al, health affairs web exclusive, february 2, 2005.)
- taxes already pay for more than 60 percent of us health spending
  
  americans pay the highest health care taxes in the world. we pay for national health insurance, but don’t get it .
  (woolhandler, et al. “paying for national health insurance — and not getting it,” health affairs 21(4); july / aug. 2002)
- despite spending far less per capita for health care, canadians are healthier and have better measures of access to health care than americans.
  (lasser et al. “access to care, health status, and health disparities in the united states and canada: results of a cross-national population-based survey,” american journal of public health; july 2006, vol 96, no. 7)

http://pnhp.org/single_payer_resources/pnhp_research_the_case_for_a_national_health_program.php

HM2VikingRN, RN · Feb 4, 2008

see also:

in this article from the international journal of health services, dr. geyman identifies and refutes six myths employed by the opponents of single-payer:

1. the uninsured and underinsured get the care they need.

2. the u.s. does not ration health care.

3. the free market is the best way to resolve our health system problems.

4. incremental changes can solve our health system problems.

5. the u.s. has the best health system in the world.

6. national health insurance should not be given attention because it is politically unfeasible.

the references are also useful as a bibliography for those seeking evidence refuting these myths.

“myths as barriers to health care reform in the united states” (pdf) at: http://www.pnhp.org/single_payer_resources/myths_as_barriers.php .

Jolie, BSN · Feb 4, 2008

It is much easier to self insure against a $10,000 loss with a $150,000/yr annual income than a $60,000/yr annual income. A 6.7% loss of income can be absorbed much more easily than a 16.7% loss of annual income.

Those are choices that individuals should continue to be free to make on their own, acording to their household budgets. Forcing citizens into one-size-fits-all government plans is not the answer. Encouraging personal responsibility is. Families that choose high-deductible plans have clear-cut expectations for their yearly out-of-pocket expenses and can budget for that amount.

carolinapooh, BSN, RN · Feb 4, 2008

See the Conservative Nanny state at http://www.conservativenannystate.org/cnswebbook.pdf . We spend far more on administration of health care in the US than any other country. 25% of our health care costs are for administrative costs and profit. Social Security is administered for less than a penny on the dollar. Medicare operates at about 3-5%. THE PRIVATE SECTOR IS MORE EXPENSIVE!

Warning - I'm about to get on one of these: :spbox:

Medicare is one of the biggest ripoffs in this country. It's inefficient, poorly run, and terribly underfunded. It is a total embarrassment in my opinion and a benchmark by which government waste is effectively measured - not success.

Being married to a Brit, what I know about socialized medicine is from the UK.

Actually, Americans spend more on health care as a proportion of income, not as a general proportion. This figure does not take into account that the NHS is heavily funded in the UK by VAT, a 17.5% tax that is included in the price of every good sold in the UK. (Essentially, it means sales tax in the UK is 17.5%.) We spend the most because we have no nationalized health system (as opposed to just about the rest of the developed world). Speaking as the wife of a Brit, I can tell you that completely socialized medicine is definitely NOT what we need here; I was in an NHS hospital and unless you want to go back to putting patients in eight-bed wards (to save costs) and pulling your eye teeth out to get a GP appointment (seen that firsthand more than once) - you don't want it.

In addition, NHS nurses make squat. LESS than squat. Try living in the UK on the equivalent of $35K a year when your gas is ELEVEN BUCKS A GALLON (yes, that was the going rate there when I was there from December 10 to January 15). To fill a Ford Focus, my DH and I spent almost one hundred dollars a tank. My brother-in-law spends $160 to fill a VOLVO. My house is half-over as big as my brother-in-law's (he lives about 40 minutes outside of London in a nice subdivision - probably comparable to how a good many of us live here in the States) and his cost just shy of four times as much as mine. Grocery shopping weekly (you have to go weekly because the average house has a refrigerator that fits UNDER the kitchen counter) can cost as much as $100 a week - depending on what you need to buy and where you buy it. (Just as an example, Bounce dryer sheets - which I couldn't live without! - are seven dollars for a box of fifty. I pay eight dollars for a box of 250 at Sam's. A Coke in a restaurant is four bucks - two pounds a pop. And NO REFILLS - you want a refill, you pay. 17.5% of each price is VAT - and gas is taxed at something like 62%.)

Funny I mentioned dryer sheets - a good number of homes over there don't even have dryers - unless you have a few bucks and either have the room for one [read: a house big enough to have one], or can afford one of those combo washer/dryers - yes, a combo - that fits again under the kitchen counter. No lie - the washers are often in the kitchen! Many of the houses are too old or are built in such a way that the pipework can't be altered (lots of plaster walls), and where are the pipes easily accessible? In the kitchen, of course.

So no - we don't want a completely socialized system. It would bankrupt the nation - I don't even know that it's possible.

And remember, the Brits also pay about 40% in income tax.

I can't find the exact figure now, but when I was over there there was a huge discussion on every news station about the percentage that funds the NHS - and it was something like 38 to 45 percent of all tax revenue collected. They're having a bit of trouble with the figure because the money doesn't really come out of a separate pot labeled "NHS" the same way ours does. The NHS is described as being in big trouble, and Gordon Brown really has a mess on his hands as a result.

This is for a nation (the UK) of about sixty million people. We're FIVE TIMES that. No way.

They can have it. I would love to see some sort of nationalized "primary/preventative care" here in the US, because I'm a firm believer in the principle that if we mandated primary care, we'd eliminate a whole lot of chronic problems. But complete nationalization? Count me OUT.

Sorry for the rant. :) I'm OK again...:dzed:

Simplepleasures · Feb 4, 2008

My relatives in Canada and Germany tell me they would not trade their health care system for ours. My grandmother,in Germany, got round the clock home care when she was dying, paid for by the government run heath care system. I also want to add this, both my relatives in Canada and Germany have lovely homes and do not live the way you describe in England, maybe we are smart enough to learn from England's mistakes and set up our system more like Germany or France. Why is it that we as a leading world power cannot come up with a health care plan that is fair for rich and poor alike?

carolinapooh, BSN, RN · Feb 4, 2008

Marketplace Money had an ainteresting story last night about the experiences of a man living with diabetes and his access to health care. (at http://marketplace.publicradio.org/display/web/2008/02/01/living_with_and_paying_for_diabetes/ and audio at http://www.publicradio.org/tools/media/player/money/2008/02/01_soundmoney?)

If the free market was going to work patients would pay 20 cents per test instead of a dollar/test. The companies would still make 100% markup on test strips at that price. I think the only way to push these costs down is to have an entity in the room that can aggressively bargain prices down.

We have one - but the pharmaceutical companies already have it in their back pockets.

The federal government.

Because no one (and I'm speaking very broadly here - easy on taking offense) wants the government involved in free enterprise, there is no governmental control over pharmaceutical companies (which have taken the term "free market" and raised it to such a high art as to be ridiculous). We are the ONLY developed nation that doesn't look, say, AstraZeneca (who is currently being investigated by the Feds in a drug scandal related to the US's 'oil for food' program with Saddam's former regime) in the eye and say, hey, JACK, we are NOT paying "x" for "y", we're gonna give you "z" for it - last offer.

That is the MOST useful thing about socialized medicine for Canada, the UK - go into any pharmacy in the UK and pick up a bottle of Flonase (known as Flixonase in the UK) - which is TWELVE BUCKS and available OTC and you'll see what I mean. Here it's $150 if you're unfortunate enough to not have insurance or have inadequate insurance - PLUS the doctor visit. Give me a break. It's FLONASE - there's no real reason for it to cost $150. And please don't talk about R & D; if they'd ban commercials here (like they have in the UK -look, no stupid Levitra commercials - it's the BEST PART of British TV!) they wouldn't have this need for the money. Look up what they spend on R&D, and then look up how much your typical commercial costs to make. Please.

The feds can't touch free enterprise. I'm all for making money, but these are DRUG COMPANIES. To me, the Feds - who regulate this stuff eventually anyway - should be able to step in and say "you're fleecing the country and the irony is just too much - KNOCK IT OFF".

But they won't anyway, because the lobbyists for our friends at A-Z, and GlaxoSmithKlein, and Bayer, and McNeil, and the rest of the lot are too busy schmoozing up to Congress. Drug companies should not be allowed (for that matter, NO ONE should be allowed) to have lobbyists, as in my opinion lobbyists defeat the intended purpose of government "of the people, by the people, for the people" - how can I be heard when the lobbyists are so much sexier, if you get my drift? And they're doing it with our health care and our ability to access it to the point that most of us just can't afford it any more.

Again - I apologize. This just really :angryfire:flamesonb:sasq: :banghead: :spbox:, you know?

:oornt: Thanks for "listening".

allnurses Guide · Feb 4, 2008

Warning - I'm about to get on one of these: :spbox:
Medicare is one of the biggest ripoffs in this country. It's inefficient, poorly run, and terribly underfunded. It is a total embarrassment in my opinion and a benchmark by which government waste is effectively measured - not success.
Being married to a Brit, what I know about socialized medicine is from the UK.
Actually, Americans spend more on health care as a proportion of income, not as a general proportion. This figure does not take into account that the NHS is heavily funded in the UK by VAT, a 17.5% tax that is included in the price of every good sold in the UK. (Essentially, it means sales tax in the UK is 17.5%.) We spend the most because we have no nationalized health system (as opposed to just about the rest of the developed world). Speaking as the wife of a Brit, I can tell you that completely socialized medicine is definitely NOT what we need here; I was in an NHS hospital and unless you want to go back to putting patients in eight-bed wards (to save costs) and pulling your eye teeth out to get a GP appointment (seen that firsthand more than once) - you don't want it.
In addition, NHS nurses make squat. LESS than squat. Try living in the UK on the equivalent of $35K a year when your gas is ELEVEN BUCKS A GALLON (yes, that was the going rate there when I was there from December 10 to January 15). To fill a Ford Focus, my DH and I spent almost one hundred dollars a tank. My brother-in-law spends $160 to fill a VOLVO. My house is half-over as big as my brother-in-law's (he lives about 40 minutes outside of London in a nice subdivision - probably comparable to how a good many of us live here in the States) and his cost just shy of four times as much as mine. Grocery shopping weekly (you have to go weekly because the average house has a refrigerator that fits UNDER the kitchen counter) can cost as much as $100 a week - depending on what you need to buy and where you buy it. (Just as an example, Bounce dryer sheets - which I couldn't live without! - are seven dollars for a box of fifty. I pay eight dollars for a box of 250 at Sam's. A Coke in a restaurant is four bucks - two pounds a pop. And NO REFILLS - you want a refill, you pay. 17.5% of each price is VAT - and gas is taxed at something like 62%.)
Funny I mentioned dryer sheets - a good number of homes over there don't even have dryers - unless you have a few bucks and either have the room for one [read: a house big enough to have one], or can afford one of those combo washer/dryers - yes, a combo - that fits again under the kitchen counter. No lie - the washers are often in the kitchen! Many of the houses are too old or are built in such a way that the pipework can't be altered (lots of plaster walls), and where are the pipes easily accessible? In the kitchen, of course.
So no - we don't want a completely socialized system. It would bankrupt the nation - I don't even know that it's possible.
And remember, the Brits also pay about 40% in income tax.
I can't find the exact figure now, but when I was over there there was a huge discussion on every news station about the percentage that funds the NHS - and it was something like 38 to 45 percent of all tax revenue collected. They're having a bit of trouble with the figure because the money doesn't really come out of a separate pot labeled "NHS" the same way ours does. The NHS is described as being in big trouble, and Gordon Brown really has a mess on his hands as a result.
This is for a nation (the UK) of about sixty million people. We're FIVE TIMES that. No way.
They can have it. I would love to see some sort of nationalized "primary/preventative care" here in the US, because I'm a firm believer in the principle that if we mandated primary care, we'd eliminate a whole lot of chronic problems. But complete nationalization? Count me OUT.
Sorry for the rant. :) I'm OK again...:dzed:

Thank you for your rant. :bow:

steph

HM2VikingRN, RN · Feb 4, 2008

The VA and DOD can bargain for bulk pricing on medications. As a result they purchase medications at a 52% discount from medicare. The prohibition on bulk price discounts is a prime example of how the conservative nanny state was used by the Republicans in congress to protect PHRMA and its profit structure at the expense of the public.

I agree that Medicare is underfunded. However we could in effect obtain significant increases for patient care by ending federal subsidies of the supposedly efficient Medicare advantage plans. We pay 20% more on behalf of medicare advantage beneficiaries than we do for traditional medicare beneficiaries. Another example of the Republican party raiding the public purse to enrich its cronies at the expense of the public. The greatest threat to our economy is double digit health care inflation.Our inflation averages 16%/year while our peers in the OECD countries hold that rate down to single digits.

scottlgarrett · Feb 5, 2008

Quoted from HM2Viking

On a deeper philosophical level we all use services organized and provided by government. For example:

Safe roads

public health

municipal water and electric systems

public parks

public schools

public libraries

public universities.

medications developed through government research

police servies

fire departments

and so forth....

For those unfortunate enough to become disabled and/or need vocational rehabilitation those services are available.

It is very difficult to say "I don't want anything from government" when we use these services on a regular basis. These are all services that act to improve the overall health of the community.

End Quote

GAS TAX

LIQUOR TAX

SALES TAX

INCOME TAX (FEDERAL)

INCOME TAX (STATE)

FEDERAL & STATE TAXES ON TRANSPORTATION

TAX

I for one believe I am capable of determining where my pay check goes

In the United States of America each man and woman has the opportunity to stand on his or her own two feet, and make his or her own way in life. He or she can be from the poorest family in the U.S and have the same opportunity to sink or swim on his or her own accord, just as the rich kid has the same opportunity to sink or swim.

There are already programs in place for those in this country whom are unable or unwilling to take care of themselves for what ever reason.

HM2VikingRN, RN · Feb 5, 2008

i actually think that part of the problem is that your employer is not providing health insurance to their employees. providing access without contribution is not the same as assuring access to insurance. pnhp has a very interesting proposal for funding uhc.

a

universal public system would be financed this way: the public financing already funneled to medicare and medicaid would be retained. the difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). the payroll tax would replace all other employer expenses for employees’ health care. the income tax would take the place of all current insurance premiums, co-pays, deductibles, and any and all other out of pocket payments. for the vast majority of people a 2% income tax is less than what they now pay for insurance premiums and in out-of-pocket payments such as co-pays and deductibles, particularly for anyone who has had a serious illness or has a family member with a serious illness. it is also a fair and sustainable contribution.

http://www.pnhp.org/facts/singlepayer_faq.php#raise_taxes

responsible coporate employers provide health insurance to their employees. failing to provide health benefits on a corporate level is the same as not paying your taxes as an individual. part of the solution is to adopt a pay or play requirement for business.

taxes are the price we pay for a civilized society. i don't think that from a heaalth policy standpoint it is feasible for individuals to pay for their own medical research or pay to build the road that takes them to work etc. some taxes are levied to provide common services for everyone.

Chaya, ASN, RN · Feb 5, 2008

I for one believe I am capable of determining where my pay check goes
In the United States of America each man and woman has the opportunity to stand on his or her own two feet, and make his or her own way in life. He or she can be from the poorest family in the U.S and have the same opportunity to sink or swim on his or her own accord, just as the rich kid has the same opportunity to sink or swim.
There are already programs in place for those in this country whom are unable or unwilling to take care of themselves for what ever reason.

Actually a serious loophole here is that if you suffer a catastrophic illness or accident causing you to lose that paycheck and your medical insurance along with it, you will fall between the cracks (or under the wheels of the bus, as it were) in a matter of weeks. One of the major reasons for bankruptcy/ mortgage default, etc. Affordable replacement insurance, especially family coverage is almost impossible without any income, especially if you now have an ongoing illness/ medical condion.

ZASHAGALKA, RN · Feb 5, 2008

The VA and DOD can bargain for bulk pricing on medications.

And how can they do that, after you run the 'evil' drug companies out of business?

Those dang evil drug companies, providing people with miracle cures for evil profit. Shut them down. Shut them all down.

(While we're at it, shut down all the oil companies, too.)

~faith,

Timothy.