Our Great Helath Care System

[Minimalist]

The answer is single-payer and put these insurance company crooks out of business.

[Dystopia]

Why not just implement a universal healthcare system on a State level and quit the bullshit?

Attempts by states to exert any independent control over anything meaningful results in the federal government withholding funds. The open secret is that plenty of programs are managed at the state level, but heavily subsidized by federal coffers. The federal government lays down the law and if a state strays too far it will stop sending money.

Would it be legal for a federated State to implement a universal healthcare system (mostly public funded)? If not, then States should thrive for it, it's more or less like the death penalty, the tendency is to abolish until all States are done with it and no one talks about it anymore.

[Ryantology]

Would it be legal for a federated State to implement a universal healthcare system (mostly public funded)? If not, then States should thrive for it, it's more or less like the death penalty, the tendency is to abolish until all States are done with it and no one talks about it anymore.

Massachusetts has done it for years.

[Minimalist]

Vermont is well on its way.

http://en.wikipedia.org/wiki/Vermont_health_care_reform

California is working on it.

http://www.healthcare-now.org/ca-senator...-committee

SB 810 creates a private-public partnership to provide every California resident medical, dental, vision, hospitalization and prescription drug benefits and allows patients to choose their own doctors and hospitals. This single payer, “Medicare for All” type of program works by pooling together the money that government, employers and individuals already spend on health care and putting it to better use by cutting out the for-profit middle man.

With all the talk about the shitheads in the bible belt it helps to remember that there are progressive states in the union also.

[downbeatplumb]

At risk of sounding *gasp* conservative, which I am fiscally, the problem with healthcare is that it's divorced from the market.

We mostly pay for healthcare with insurance. The insurance is not analogous to fire or auto-insurance as it's intended to pay for ordinary expected expenses as well as catastrophic ones---sort of like if your auto insurance paid for oil changes. The result is something like this: Suppose that unless you had grocery insurance, you had to buy groceries at a highly inflated price to allow the government and grocery insurance companies to get 80% discounts from the grocery store. You take your cart into the dirty ill stocked store with only one brand name per item and no prices. Some items have been deemed unnecessary by the government (like chocolate, wine and inexplicably wheat gluten) and are not carried or must be bought elsewhere or cannot be bought on your plan though they are there on the shelves tantalizing you. You fill your cart with this non-competitive stuff and pay a $5 co-pay at check-out. A year later your grocery insurance is doubled because you and the people in your grocery insurance group bought too much.

The problem with your health care is it is linked to the market.
The whole thing is a money making engine.
What is needed is an altruistic service where everybody pays for the good of everybody so that health care is free to all at the point of need.
A National Health System if you like.
If my family had to pay for every injury and illness we've had we would be homeless.

[Dystopia]

I'll admit that in spite of thinking the american healthcare system is not an adequate model for any society, I hold my skepticism regarding free healthcare systems too. I live in a country with free healthcare systems, and I've quit going to public hospitals because of waiting lines, I'll just pay and use private. What I'm saying is, don't think universal healthcare will be a paradise with no flaws, it certainly is better than the insurance system, but there's still a lot to work on. There are people who died waiting for surgery. I'll give the example of a female friend of mine, she had to remove her breasts because of some lumps that could develop into tumours (malign), public healthcare offered her 6 months of waiting and no reconstruction surgery. In private healthcare, she paid about 300€ and got the surgery in 2 weeks plus instant reconstruction to get the aesthetic necessity satisfied. The only public health service I still use is my family doctor's clinic.

[Jaysyn]

At risk of sounding *gasp* conservative, which I am fiscally, the problem with healthcare is that it's divorced from the market.

We are talking about emergency services here. You are a fool if you think you can shop around during a medical emergency, however, Hanusz-Rajkowski could have done just that since his injury wasn't life-threatening.

My local clinic (a Minute Clinic inside of a CVS Pharmacy), is staffed by Nurse Practitioners & would have charged him a small fraction of the ER's bill, $80 to $135 tops. There are your damned market forces.

[Zack]

I was in a car wreck a several years ago and was taken by ambulance to the emergency room. The only reason they took me to the hospital was because of some soreness in my neck/upper back area. Most of the time I just laid in the bed and answered questions from doctors and cops, but they did give me an MRI and urinalysis with a tube. I hope nobody here EVER has to get a piss test like that. Think large plastic tube inserted into external urethral orifice then pushed up into the bladder. When I literally walked out of the hospital, seven hours later (no treatment, no medicine, no follow ups recommended), I was given a bill for 7K dollars. I didn't have insurance and told the EMTs this before they put me in the ambulance. I told the people in the hospital the same thing several times. I tried to get out of there as fast I could because I knew they were going to stick it to me. They did literally and figuratively. The phone calls started about a week later wanting to know if I preferred to use cash or credit and would like to use a payment plan. I find it hard to believe that an MRI and urinalysis cost THAT much. Who in the hell do they think can afford medical treatment at $1,000 per hour?

[Jenny A]

We mostly pay for healthcare with insurance. The insurance is not analogous to fire or auto-insurance as it's intended to pay for ordinary expected expenses as well as catastrophic ones---sort of like if your auto insurance paid for oil changes.

Because that is what the customer wants and that is what the market demands. You gonna tell me that both the customer and the market are wrong? People like to get something for their money. Insurance companies still have a mint practically attached to them - so I don't want to hear any bitching from that corner either.

Medicare, tax incentives for employer paid insurance, and requirements that employers provide insurance provide artificial incentives for the current system.

As the system is currently set up, it would be insane to want anything but insurance. Insurance companies get discounts of 30% and more from health providers. Medicare also demands discounts. As insurance and Medicare make up over 85% of the market, such discounts are not tenable. So the healthcare providers jack up the "normal price" (which is only actually charged to the uninsured) and discount from there. Thus if you are uninsured you must pay a 30-80% or more premium to pay in cash without paperwork. Of course we want insurance. Under the current system we can't afford not to have it.

But that doesn't mean we wouldn't be better off if there were no insurance, or if health providers had to charge the same prices to both the insurance companies and individuals paying in cash.

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The problem with your health care is it is linked to the market.
The whole thing is a money making engine.
What is needed is an altruistic service where everybody pays for the good of everybody so that health care is free to all at the point of need.
A National Health System if you like.
If my family had to pay for every injury and illness we've had we would be homeless.

I disagree. You pay heavily for your National Health System in taxes. There really is no such thing as "free."

The question is who pays for it, and how is it rationed? And it will be rationed either by market forces or by other means. If the market is not allowed to determine how much healthcare will be available and what it will cost than other forces will do that. If the government will not adequately pay doctors or pharmaceutical companies, doctors and drugs will become scarce. In no case will they ever be in unlimited supply. So some rationing is inevitable. The market does this by price. Under national healthcare it's the government's decision what to provide or not to provide (based ultimately on the government's budget) and/or the public's willingness to stand in line or wait long periods of time for appointments that rations supplies.

The market system of course assumes someone will make a profit. So does the National Health Care System because at a minimum doctors and administrators will make a salary.

But profit is not a dirty word, at least I don't think so. It is the need to make a profit that tends to cause prices to go down, not up in a competitive market. The fact that there is no profit making what no one can afford, and plenty of competitors to provide lower cost items is what keeps prices at a reasonable level in just about every area of the economy from computers to groceries, to fuel.

The areas where this breaks down come in several types: monopolies (which simply must be regulated); areas of asymmetrical information (like investments); and areas where the person receiving the goods is divorced from the expense of paying for them by third parties.

Right now the U.S. healthcare system is a system in which the patient's decisions about healthcare are almost entirely divorced from the cost of that healthcare. Either insurance or Medicare/Medicaid pays for so much of the service the patient is cost indifferent, or he has no insurance and no real ability to pay for any services at all because the cost to the uninsured has been raised so high to provide artificial discounts to insurance companies. Thus the patient is unwilling to make hard choices about what healthcare is actually necessary.
With the patient divorced from the economic cost of his choices, it's no wonder health costs are soaring.

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At risk of sounding *gasp* conservative, which I am fiscally, the problem with healthcare is that it's divorced from the market.

We are talking about emergency services here. You are a fool if you think you can shop around during a medical emergency, however, Hanusz-Rajkowski could have done just that since his injury wasn't life-threatening.

My local clinic (a Minute Clinic inside of a CVS Pharmacy), is staffed by Nurse Practitioners & would have charged him a small fraction of the ER's bill, $80 to $135 tops. There are your damned market forces.

I agree that emergency services are a special case because the patient can't shop around. However, don't you think it's possible to regulate emergency services without divorcing the entire healthcare system from market forces?

[Isun]

Problem with your proposition is that the market system of healthcare in the US has been a total failure.

1) It has led to the highest cost healthcare system in the world
2) higher death rate for patients
3) highest bankruptcy rate due to health care costs
4) one of the lowest among industrialized nations in longevity.
5) One of the lowest quality healthcare systems among industrialized nations.

So a for profit health care system clearly doesn't work. Worse, because of profit being the motivation it leads to insurance company's refusing to reimbursed covered expenses. They figure that most of those that they don't reimburse won't argue, and the few that will, doesn't cost as much as the profit earned by refusing to cover those that don't challenge the insurance company.

They will refuse to provide healthcare to anyone that has a pre existing health care issue.

This leads to millions without healthcare. Those millions raise our cost. The hospitals potentially go bankrupt because of too many that can't pay their health care costs. (Look at Georgia who didn't expand medicaid and the results is that rural hospitals are becoming rare to non existent). All of which leads to poor healthcare around the country which leads to thousands (estimated at 18,000) dying every year because of lack of healthcare.


I have no problems with a governmental healthcare system like medicare for everyone. If private insurance wants to do business, they can cater to those that can afford their price.

But having a market driven healthcare system is a failure and it is time to work with a different system that ensures a healthy country for everyone (depending on factors of health withstanding).