Poll A "Free Market" System is Not Sensible

[MacLeod]

I remember when my family was in Ireland for my nephew's wedding, my sister fell and broke her wrist on a curb. She went to a local ER, and they applied a cast that was much smaller and less supportive than the type of cast they would normally apply in an American ER. A cost saving measure perhaps? It wasn't providing my sister's wrist sufficient support, and when she got back to the states, she had to go back to the ER to get a real cast. I realize this is an isolated incident, and it certainly didn't cost my sister her life, but I have never heard of an American emergency room fucking up something as basic as a cast. It makes me wonder what other things they could have screwed up.

Also, my cousin is married to a German heart surgeon. He blasts the German Health Care system all the time and claimed there was medical equipment he was forced to use that was held together by duck tape because they just didn't have the same kind of funding that an American hospital would. Another isolated case, I know, but I would not be more inclined to subject myself to a Health Care system that is expected to do more with less.

The current state of America's Health Care system definitely needs improvements, as does the public's responsibility for their own personal health, but my provider network hasn't let me down yet where treatment is concerned. I'm good with it. I would like to see the American Health Care system strive to improve without the restrictions of socialized medicine.

And no American Doctor ever complains about their places of work? I suspect a great many people complain about theri places of work.

Re: Your sisters cast, perhaps in the US they use larger casts as a means of price gouging. thats the other side of the coin to your statement that smaller casts are a cost saving measure.

If these Helath care sysems have to do more with less doesn't that mean they are more efficent at using what resources they have?

 

[fonzob1]

And no American Doctor ever complains about their places of work? I suspect a great many people complain about theri places of work.

Of course, but you missed the point of his complaints.

Re: Your sisters cast, perhaps in the US they use larger casts as a means of price gouging. thats the other side of the coin to your statement that smaller casts are a cost saving measure.

Naah. The cast was insufficient and her wrist was more susceptible to further injury. My sister is a nurse practitioner, and she was pretty unimpressed.

If these Helath care sysems have to do more with less doesn't that mean they are more efficent at using what resources they have?

One would hope.

 

[Spot261]

Federal government employees in the U.S. are not at all treated like military personnel. They are coddled by comparison.

My point is historically a lot of healthcare systems have derived much of their structure and project management style from military experience. This makes perfect sense since warfare is typically the ultimate test of nurses and doctors skills. It has also provided a test bed and proving ground for the fundamentals of modern healthcare.

Much of the skills involved in running a successful military are transferable to other public bodies and it's hard to deny that if the US does one thing right, it is run an effective military.

But many economists would agree with.

And many would disagree with, but pointless circle is pointless. U til you substantiate your claim there's nothing to discuss

I thought you didn't value PhD's, nobel prize winners, and the like? Or, is that only relevant in instances where they support your views?

Of course I do, I'm currently based on a university campus, I spend my time around academics, I'm a serial post grad myself and part of my current secondment is a lecturing role, which is kind of the point. It takes more to substantially impress me with a person's legitimacy or authority than a degree and publishing record half the people I know can match or surpass. If the article had been more substantial, better referenced and generally more academically credible I would have acknowledged the fact.

I don't see how you can possibly say that efficiency isn't part of the equation in Health Care. Is efficiency not important in the emergency room? Providers need to be efficient when a person's life depends on it. The business side of the Health Care industry needs to be efficient because lack of efficiency in business processes/managing reimbursement can raise the cost of Health Care. Efficiency is definitely an important aspect of Health Care.

I didn't say it isn't part of the equation, I said it is a means rather than an end in itself. It is a positive thing but it isn't sufficient to be a measure of success alone. The most efficient organisation in the world can still be a failure if the motivations, end goals or methods do not match the purpose. It should really be obvious that some aspects of public services will just never be profitable and attempting to make them so detracts from the purpose. What matters is they serve the public, not that they do so at a profit.

I understand that underlying both of our arguments are fundamentally different philosophies, but as a health professional I see my duty as being to benefit the sick, not to make doing so an efficient business model. Thus far globally the evidence is the former requirement is met most effectively when not hindered by the latter. Efficiency serves me, not I it.

Then America should trail blaze that path, and remove inefficient government mandates from the system, instead of settling on a socialized delivery system.

Yes, America should be blazing that path, but you aren't and it's because as a nation you aren't learning from the experiences of others. You are making the case that private health is the way forward despite the plethora of evidence it is in fact the very thing holding you back. Public health delivers consistently delivers far more effectively and does so without prejudice, it is the very essence of your founding principle that all men are created equal, but the constant eye on the bottom line keeps you from making best use of the resources you have.

• Waiting lists

• Lack of choice in providers

• Non-covered services

We've covered waiting lists. When the conservative health secretary is publicly apologising for cutting public spending as it is starting to cost lives surely we are past the point we could blame socialism for the consequences of public sector cuts? Reduced public spending is to blame, not public spending in and of itself and the free market loving conservative politician responsible for those cuts has openly apologised for the consequences. This might actually be the strongest argument AGAINST your case.

Lack of choice is an interesting one, and actually untrue. It is mandated under law in this country that a person has the right to choose the trust, hospital and doctor they are treated under and by. The NHS is not monolithic, on the contrary its structure could very easily be compared to a conglomerate of providers (called trusts) which all operate under an umbrella of financial and policy oversight from NHS England. Each, however, operates it's own budgets and internal policies on both the operational and strategic levels. It's more complex than that and there exist a great many safeguards and watchdogs but the point stands that patients do actually have a meaningful choice. Furthermore even within those trusts provision has to be made for providing second opinion doctors (sometimes by franchising into our own private sector but more commonly to other NHS bodies). This isn't nominal, it is a meaningful safeguard against poor practise.

As for non covered services, you keep bringing this up and I'm curious why. There are commonly services which aren't provided within specific branches of the NHS (after all, many trusts specialise), but actual instances of a global lack of provision are few and far between and typically if a trust does not have provision they will fund sourcing it elsewhere.Typically when papers report that a particular service is being made unavailable as a headline the fine print will tell you it is a local decision with patients being referred elsewhere. Sensationalism does not endear itself to sober factual reporting. Far more people would miss out on treatment if they were priced out of healthcare than lack of provision could ever represent.

Sorry to hear about your sister by the way.

 

[Australis]

Average Americans, I'm guessing.

 

[fonzob1]

My point is historically a lot of healthcare systems have derived much of their structure and project management style from military experience. This makes perfect sense since warfare is typically the ultimate test of nurses and doctors skills. It has also provided a test bed and proving ground for the fundamentals of modern healthcare.

Much of the skills involved in running a successful military are transferable to other public bodies and it's hard to deny that if the US does one thing right, it is run an effective military.

No other areas of the U.S. federal government function at all like the military.

And many would disagree with, but pointless circle is pointless. U til you substantiate your claim there's nothing to discuss

The history of socialist economies, and the perspective of a great many economists, supports my claims. Historians are not economists. I agree that going in circles is pointless.

Of course I do, I'm currently based on a university campus, I spend my time around academics, I'm a serial post grad myself and part of my current secondment is a lecturing role, which is kind of the point. It takes more to substantially impress me with a person's legitimacy or authority than a degree and publishing record half the people I know can match or surpass. If the article had been more substantial, better referenced and generally more academically credible I would have acknowledged the fact.

I am willing to bet you didn't even read it. It doesn't support your views, which makes it irrelevant to you. That is perfectly fine.

I didn't say it isn't part of the equation, I said it is a means rather than an end in itself. It is a positive thing but it isn't sufficient to be a measure of success alone.

Efficiency in Health Care is paramount under some circumstances and the efficiency of business operations can have a direct impact on the cost of Health Care.

The most efficient organisation in the world can still be a failure if the motivations, end goals or methods do not match the purpose. It should really be obvious that some aspects of public services will just never be profitable and attempting to make them so detracts from the purpose. What matters is they serve the public, not that they do so at a profit.

I understand that underlying both of our arguments are fundamentally different philosophies, but as a health professional I see my duty as being to benefit the sick, not to make doing so an efficient business model. Thus far globally the evidence is the former requirement is met most effectively when not hindered by the latter. Efficiency serves me, not I it.

Increasing efficiency, without sacrificing quality of care, to keep the cost of Health Care lower benefits patients and contributes to the ultimate goal.

Yes, America should be blazing that path, but you aren't and it's because as a nation you aren't learning from the experiences of others. You are making the case that private health is the way forward despite the plethora of evidence it is in fact the very thing holding you back. Public health delivers consistently delivers far more effectively and does so without prejudice, it is the very essence of your founding principle that all men are created equal, but the constant eye on the bottom line keeps you from making best use of the resources you have.

America is not currently blazing the path with it's delivery system because it is a Frankenstein's monster of free market, social programs, and government mandates that are not working well together. Politicians guided by powerful lobbyists have not done well. Socialism is not the answer for us. I am glad you like your system though.

We've covered waiting lists. When the conservative health secretary is publicly apologising for cutting public spending as it is starting to cost lives surely we are past the point we could blame socialism for the consequences of public sector cuts? Reduced public spending is to blame, not public spending in and of itself and the free market loving conservative politician responsible for those cuts has openly apologised for the consequences. This might actually be the strongest argument AGAINST your case.

Yep. We have covered it, and it remains an issue for the American consumer. There is something to be said for quality of life if you have to wait months (or years) to see a specialist. The video below touches on the wait lists experienced in the Candadian Health Care system...

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Lack of choice is an interesting one, and actually untrue. It is mandated under law in this country that a person has the right to choose the trust, hospital and doctor they are treated under and by. The NHS is not monolithic, on the contrary its structure could very easily be compared to a conglomerate of providers (called trusts) which all operate under an umbrella of financial and policy oversight from NHS England. Each, however, operates it's own budgets and internal policies on both the operational and strategic levels. It's more complex than that and there exist a great many safeguards and watchdogs but the point stands that patients do actually have a meaningful choice. Furthermore even within those trusts provision has to be made for providing second opinion doctors (sometimes by franchising into our own private sector but more commonly to other NHS bodies). This isn't nominal, it is a meaningful safeguard against poor practise.

America's system has far more choice, which is why we don't have the lengthy wait lists. Providers are abundant here.

Your care is rationed. Your choices are less.

As for non covered services, you keep bringing this up and I'm curious why. There are commonly services which aren't provided within specific branches of the NHS (after all, many trusts specialise), but actual instances of a global lack of provision are few and far between and typically if a trust does not have provision they will fund sourcing it elsewhere.Typically when papers report that a particular service is being made unavailable as a headline the fine print will tell you it is a local decision with patients being referred elsewhere. Sensationalism does not endear itself to sober factual reporting. Far more people would miss out on treatment if they were priced out of healthcare than lack of provision could ever represent.

Yeah, I posted a couple of articles that you discounted as being fabricated to sell papers. There are a great many sources that report there are non-covered services with socialized coverage. We certainly have that here with Medicare, and it's not simply a matter of going "elsewhere" (whatever that means). But, regardless of whether or not we can believe the sources that report these stories, simple math supports it. It's not realistic to think socialized medicine will create a utopia where everything under the sun is covered. All programs have a budget and socialized medicine is not really a bottomless pit of funding for Health Care services.

Sorry to hear about your sister by the way.

Thank you so much! Once she got the new cast, she was on the fast track to recovery.

 

[CorporalCaptain]

No areas of the U.S. federal government function at all like the military.

lulz

 

[Avro Arrow]

I am willing to bet you didn't even read it. It doesn't support your views, which makes it irrelevant to you.

Reminder: post, not poster.

Yep. We have covered it, and it remains an issue for the American consumer. There is something to be said for quality of life if you have to wait months (or years) to see a specialist. The video below touches on the wait lists experienced in the Candadian Health Care system...

Generally speaking, we are aware that wait times are probably the worst part of our system, and they are the aspect we complain about the most. However, your video does highlight some of the benefits of our system as well:

• The couple who went out of country for their hip replacements had to put a second mortgage on their house to do so. For those staying within the system, this is a choice no Canadian would have to make.
• The video decided to compare our heath care system to veterinary practices. You have to pay for every little thing when you take an animal to the vet. Some people won't be able to afford the cost of the office visit, so they just won't go. No Canadian ever needs to worry about getting into the system due to lack of financial resources. And if your animal has an actual health issue, the treatment costs can run up to many thousands of dollars. If you can't afford this, what happens? Your animal doesn't get treatment. No Canadian patient would have to forego treatment due to not being able to pay for it.

I will admit that I am currently on a wait list to see a specialist, and the wait time is currently around 16 to 18 months. But under your system, most insurance plans would not cover the cost of treatment, and IIRC, it would cost me somewhere around $50,000 or more... which means it just wouldn't happen. So I know which system I would pick, hands down.

And yes, as the video mentions, our system does not allow you to pay for health care. This is to treat everyone equally: in theory, everyone is in the same system, and everyone has go through the same wait times. If you have money, you cannot buy your way to the front of the line, thereby bumping back other people already on the waiting list. This is actually something that I (and a lot of other Canadians) am fully in favour of, BTW. Sure, in practice it just means that wealthy people can travel out of country and buy their way in (as your video mentions), but at least when they go out of country, they are not pushing back other Canadians who are already waiting.

 

[fonzob1]

lulz

No areas of the U.S. federal government function at all like the military (except the military) is where I was going with that. lol

Reminder: post, not poster.

Generally speaking, we are aware that wait times are probably the worst part of our system, and they are the aspect we complain about the most. However, your video does highlight some of the benefits of our system as well:

• The couple who went out of country for their hip replacements had to put a second mortgage on their house to do so. For those staying within the system, this is a choice no Canadian would have to make.

From what I understand, there are Canadians along the southern border that use to buy into American Health insurance plans from Blue Cross Blue Shield and travel south of the border for easy access to treatment. I doubt they can do that anymore due to the Affordable Care Act exchange, which has driven up the cost of buying plans outside of the exchange.

• The video decided to compare our heath care system to veterinary practices. You have to pay for every little thing when you take an animal to the vet. Some people won't be able to afford the cost of the office visit, so they just won't go. No Canadian ever needs to worry about getting into the system due to lack of financial resources. And if your animal has an actual health issue, the treatment costs can run up to many thousands of dollars. If you can't afford this, what happens? Your animal doesn't get treatment. No Canadian patient would have to forego treatment due to not being able to pay for it.

My interpretation was that he had relatively inexpensive health coverage for his animal. Maybe that coverage wasn't all-encompassing like you say, but I think their intent was just to demonstrate the easier access.

I will admit that I am currently on a wait list to see a specialist, and the wait time is currently around 16 to 18 months. But under your system, most insurance plans would not cover the cost of treatment, and IIRC, it would cost me somewhere around $50,000 or more... which means it just wouldn't happen. So I know which system I would pick, hands down.

How do you know it would not be covered? I don't know what type of treatment you are referring to, but American health insurance plans tend to cover medically necessary treatment.

And yes, as the video mentions, our system does not allow you to pay for health care. This is to treat everyone equally: in theory, everyone is in the same system, and everyone has go through the same wait times. If you have money, you cannot buy your way to the front of the line, thereby bumping back other people already on the waiting list. This is actually something that I (and a lot of other Canadians) am fully in favour of, BTW. Sure, in practice it just means that wealthy people can travel out of country and buy their way in (as your video mentions), but at least when they go out of country, they are not pushing back other Canadians who are already waiting.

All of that is going to be pretty frightening to the American consumer. The lengthy wait times, and inability to pay out of pocket for non-covered charges (when feasible), seem pretty outrageous. And, if America converted to a similar socialized health system, Canadians would no longer have the option of flying south and paying out of pocket. At least you're honest though. There are many proponents of socialized health care that paint it as a utopia and either choose not to volunteer the dirty details, or don't know about them because they haven't really tested the system yet. Once you implement a socialized delivery system, it becomes near impossible to remove it's foundation and suddenly replace it with a free market option. It is not the answer for the U.S. There is a better option, but it feels impossible at the moment for politicians puppeteered by powerful lobbyists to come together and get it done.

 

[Jayson1]

I don't know where all these Americans are that don't have to wait for medical procedures. Maybe that is something only the poor have to do because health care has always been a obstacle for me and my family. My mom had to work months even though she couldn't stand because of waiting for insurance to do it's job. I went to ER several times before they bothered to run any test to see why I kept showing up almost ever day when I had viral menigititis. I literally had to faint when walking into the ER before they did anything. If you apply for disability everyone knows you don't get it on first try. I went so long without being able to see a dentist that the tooth basically fell out and I might have swallowed it. Also everyone knows the insurance business is not about offering care but trying to find one excuse after another to not pay anything because it hurts their profits. Emergency Rooms are more interested in processing the customer as fast as possible so they can move on to the next guy or lady. Basically it's the fast food version of health care. Give you the most minimal effort and as fast as possible to deal with the constant flow of new customers.


Jason

 

[Relayer1]

I'm sure those people unable to get treatment helps keep waiting times down. Stops them cluttering up the system...

 

[fonzob1]

I don't know where all these Americans are that don't have to wait for medical procedures. Maybe that is something only the poor have to do because health care has always been a obstacle for me and my family. My mom had to work months even though she couldn't stand because of waiting for insurance to do it's job. I went to ER several times before they bothered to run any test to see why I kept showing up almost ever day when I had viral menigititis. I literally had to faint when walking into the ER before they did anything. If you apply for disability everyone knows you don't get it on first try. I went so long without being able to see a dentist that the tooth basically fell out and I might have swallowed it. Also everyone knows the insurance business is not about offering care but trying to find one excuse after another to not pay anything because it hurts their profits. Emergency Rooms are more interested in processing the customer as fast as possible so they can move on to the next guy or lady. Basically it's the fast food version of health care. Give you the most minimal effort and as fast as possible to deal with the constant flow of new customers.


Jason

And, for whatever period of time you actually had to wait (for treatment or diagnosis), you expect that a socialized system in America will improve all of that? The socialized Health Care "utopia" where all treatment is readily available and covered for "free?" I think you will be disappointed if that is the case. Health Care providers will have a tighter budget, reduced staff, and lower wage staff if we convert to a socialized delivery system. Whatever problems you have today in regards to waiting, would be exacerbated by that change.

Too bad the Affordable Care Act wasn't the fix to the Health Care problem you were looking for.

 

[Spot261]

Increasing efficiency, without sacrificing quality of care, to keep the cost of Health Care lower benefits patients and contributes to the ultimate goal.

Efficiency in Health Care is paramount under some circumstances and the efficiency of business operations can have a direct impact on the cost of Health Care.

Your lack of clinical background is seriously showing. It is telling that the world's most effective system (the Japanese) requires that what private providers they allow to exist be headed by clinicians who actually understand the service they are supposed to be delivering, not business people. I keep talking about saving lives, you keep answering in terms of costs and profit margins. Cost saving is not a success metric in healthcare, it helps, but only where it allows us to improve the service, not as an end goal in and of itself. As I keep saying, efficiency is a means, not an end.

The purpose of healthcare is not to make money, it detracts from the actual process looking after sick people. The idea of private healthcare is in my view fundamentally flawed and is exactly the reason the US lags behind. the evidence is strongly in favour of that position.

It's not realistic to think socialized medicine will create a utopia where everything under the sun is covered. All programs have a budget and socialized medicine is not really a bottomless pit of funding for Health Care services.

Of course it isn't and no one has claimed it is, but given that virtually every country which has implemented it enjoys longer lifespans, healthier lifestyles, fewer health inequalities and lower instances of most major disease categories than the US surely you can concede the point that socialised healthcare works?

Again, the US should be ahead of the game on these things, should be the benchmark by which the world measures itself. It isn't and the single major identifiable difference is the lack of true socialised healthcare.

No areas of the U.S. federal government function at all like the military (except the military) is where I was going with that. lol

This wasn't my point, nor do I believe you thought it was. The point is the fundamentals of nursing are based in military experience and have been for centuries. The expertise gained running a massive publicly funded military would be readily transferable to such a project, after all, it is simply moving the lessons learnt from one major pubic body and applying them when establishing another). That is typically how such systems have been set up in the past, by drawing on the military model and adapting the lessons learnt there.

Health Care providers will have a tighter budget, reduced staff, and lower wage staff if we convert to a socialized delivery system.

Depends on the political will. Taxation is generally cheaper per capita than health insurance and such a system does not discriminate between the rich, the poor, the employed, the unemployed at the point of delivery, a point you seem not to value.

I actually like your idea of removing the insurance lobby but agree it is even less likely than socialising. Even there though, you still end up with a system which required people to have a certain income level before they have equitable healthcare standards.

No matter how you frame it, socialised healthcare demonstratably delivers and ultimately that is the point being made. I can live without proving to you it is superior (although it is), but accepting that it is functional as a system shouldn't be difficult given the results.

 

[fonzob1]

Your lack of clinical background is seriously showing. It is telling that the world's most effective system (the Japanese) requires that what private providers they allow to exist be headed by clinicians who actually understand the service they are supposed to be delivering, not business people. I keep talking about saving lives, you keep answering in terms of costs and profit margins. Cost saving is not a success metric in healthcare, it helps, but only where it allows us to improve the service, not as an end goal in and of itself. As I keep saying, efficiency is a means, not an end.

You are correct. I am not clinical at all (although I have several relatives and co-workers that are). The way the business side of the house is run does matter though. The less efficient the business side of the house is the more it costs to deliver care, and keeping the cost of operating lower expands access.

The purpose of healthcare is not to make money, it detracts from the actual process looking after sick people. The idea of private healthcare is in my view fundamentally flawed and is exactly the reason the US lags behind. the evidence is strongly in favour of that position.

Profits in Health Care though go back into research, upgrading technology, and investing in clinical staff, so it definitely matters.

Of course it isn't and no one has claimed it is, but given that virtually every country which has implemented it enjoys longer lifespans, healthier lifestyles, fewer health inequalities and lower instances of most major disease categories than the US surely you can concede the point that socialised healthcare works?

I don't believe it would work well for most American consumers. I do think we can do better than socialized medicine.

Again, the US should be ahead of the game on these things, should be the benchmark by which the world measures itself. It isn't and the single major identifiable difference is the lack of true socialised healthcare.

This wasn't my point, nor do I believe you thought it was. The point is the fundamentals of nursing are based in military experience and have been for centuries. The expertise gained running a massive publicly funded military would be readily transferable to such a project, after all, it is simply moving the lessons learnt from one major pubic body and applying them when establishing another). That is typically how such systems have been set up in the past, by drawing on the military model and adapting the lessons learnt there.

Depends on the political will. Taxation is generally cheaper per capita than health insurance and such a system does not discriminate between the rich, the poor, the employed, the unemployed at the point of delivery, a point you seem not to value.

I actually like your idea of removing the insurance lobby but agree it is even less likely than socialising. Even there though, you still end up with a system which required people to have a certain income level before they have equitable healthcare standards.

That is not necessarily true. You could still have Medicaid and Medicare subscribers, but instead of dealing with the process of seeking authorization and filing claims, Medicaid (for the impoverished) and Medicare (for the elderly) would just pay a monthly membership fee in behalf of the patient. I don't see why they would be treated differently from anyone else. If you eliminated the waste associated with collecting from Medicaid, Medicare, and the insurance companies on the back end, it would reduce the cost of everything across the board.

No matter how you frame it, socialised healthcare demonstratably delivers and ultimately that is the point being made. I can live without proving to you it is superior (although it is), but accepting that it is functional as a system shouldn't be difficult given the results.

Once you establish a socialized delivery system, there is no going back. I do not want to see America settle on the disadvantages of socialized medicine.

 

[Spot261]

You are correct. I am not clinical at all (although I have several relatives and co-workers that are). The way the business side of the house is run does matter though. The less efficient the business side of the house is the more it costs to deliver care, and keeping the cost of operating lower expands access.

But not as wide as socialising it, which gives everyone access, which is something you can't reasonably dismiss.

Profits in Health Care though go back into research, upgrading technology, and investing in clinical staff, so it definitely matters.

Yet even in spite of those profits being pumped back in, delivery lags behind your socialist counterparts on the national scale.

I don't believe it would work well for most American consumers. I do think we can do better than socialized medicine.

Based on what though? No system has ever delivered better, there is no precedent for that belief.

Once you establish a socialized delivery system, there is no going back. I do not want to see America settle on the disadvantages of socialized medicine.

Which disadvantages? Show me the top twenty most effective healthcare systems history has known, I guarantee they are all nationalised.

 

[MacLeod]

You are correct. I am not clinical at all (although I have several relatives and co-workers that are). The way the business side of the house is run does matter though. The less efficient the business side of the house is the more it costs to deliver care, and keeping the cost of operating lower expands access.



Profits in Health Care though go back into research, upgrading technology, and investing in clinical staff, so it definitely matters.

Then why do pubically run Health care systems generally cost less than private, could it because they are more efficent and can thus deliver care at lower operating costs?

Profit is what is left after all expenditure i.e Taxes, Operating costs, Utility Costs, R&D etc... So only some of the Profits are plowed back into those things.

 

[fonzob1]

But not as wide as socialising it, which gives everyone access, which is something you can't reasonably dismiss.

Yep. But, everyone access to what? What will it look like? I can't speak from much experience in European Health Care systems, but if it resembles Medicare (plus the wait lists) then it is not anything I want to change my current coverage for (and most Americans will probably agree with me).

Yet even in spite of those profits being pumped back in, delivery lags behind your socialist counterparts on the national scale.

By that you mean the equity of our delivery system. The American Health Care system serves many millions every year.

Based on what though? No system has ever delivered better, there is no precedent for that belief.

There was no precedent for socialized medicine before that was implemented on a national scale either.

Which disadvantages? Show me the top twenty most effective healthcare systems history has known, I guarantee they are all nationalised.

Waiting lists, fewer providers to choose from, and non-covered services.

Then why do pubically run Health care systems generally cost less than private, could it because they are more efficent and can thus deliver care at lower operating costs?

Have you ever heard of the VA in the United States? That has not been our experience.

Profit is what is left after all expenditure i.e Taxes, Operating costs, Utility Costs, R&D etc... So only some of the Profits are plowed back into those things.

Of course. I was referring primarily to profit margin, but clinical staff salaries would be included in operating expenses.

 

[Ovation]

Waiting lists, fewer providers to choose from, and non-covered services.

All features of numerous American HMO plans. I have lived decades under the American and Canadian systems. Neither is perfect. However, there’s one system where I will never have to mortgage my house if I need heart surgery—and it ain’t in the USA (my parents have only recently finished paying that second mortgage, 25 years after my mother’s surgery).

I’ve waited 15 hours to be seen in an American ER and I’ve gotten near instant treatment in a Canadian ER (the reverse is also true, to be fair). I have far more choice of doctors and pharmacies than my parents ever had under their HMO (thankfully they are now on Medicare—a vast improvement over the private insurance they had access to when younger).

Again, no system is perfect, but let’s not pretend Americans don’t face choice limitations and waiting lists and uncovered procedures. That’s a laughable lie.

 

[Avro Arrow]

From what I understand, there are Canadians along the southern border that use to buy into American Health insurance plans from Blue Cross Blue Shield and travel south of the border for easy access to treatment. I doubt they can do that anymore due to the Affordable Care Act exchange, which has driven up the cost of buying plans outside of the exchange.

I wouldn't know about that. Although I do know that since our system doesn't typically cover the full amount of treatment when we are out-of-country, we are strongly encouraged to buy temporary insurance coverage when we travel in the US and other foreign destinations, so that we don't end up bankrupting ourselves if we fall ill or get injured while travelling. (Sadly, not all get the message. Of course, some do and then still run into problems.) Maybe that is what you were hearing about? Blue Cross did use to provide such coverage, and I used it when I used to travel to the US. However, I haven't visited the States since 2001, so I don't know what the current costs would typically run.

How do you know it would not be covered? I don't know what type of treatment you are referring to, but American health insurance plans tend to cover medically necessary treatment.

I don't really want to get into personal medical details on a public internet forum. But my comment about "most plans" not covering it was based on my own reading, and talking to similarly-affected American women. While some were covered, more appeared to be not. I don't necessarily know the reasoning behind why some plans wouldn't pay for treatment.

Fortunately, here, I am covered.

All of that is going to be pretty frightening to the American consumer.

Perhaps it might be less frightening to those who currently lack adequate coverage.

And, if America converted to a similar socialized health system, Canadians would no longer have the option of flying south and paying out of pocket.

Well, as I mentioned, I fully support the current single-tier system, so I'm honestly not going to lose a lot of sleep worrying about the queue jumpers. Although presumably those wealthy enough would just travel to another country that did have a private option.

And this is just total speculation, but maybe if you were on a socialized system, it would possibly remove one of the factors contributing to our GP shortage.

At least you're honest though. There are many proponents of socialized health care that paint it as a utopia and either choose not to volunteer the dirty details, or don't know about them because they haven't really tested the system yet.

I doubt any system is going to be a "utopia". And there's really no sense trying to hide the wait time issue, since anyone could find out about it with five seconds of Googling. Our governments acknowledge the problem... you can find information about this issue on our government health care websites.

But again, I would personally take our system over your system any day. Health care should not be determined by how much money you have available.

Once you implement a socialized delivery system, it becomes near impossible to remove it's foundation and suddenly replace it with a free market option.

And thank whatever deity you believe in for that!

Also everyone knows the insurance business is not about offering care but trying to find one excuse after another to not pay anything because it hurts their profits.

QFT.

 

[Spot261]

By that you mean the equity of our delivery system. The American Health Care system serves many millions every year.

Whilst openly offering second rate services to those who need it most, many of whom literally rely on charity. The unemployed, the learning disabled, the chronic mentally ill, those on low incomes, these groups all represent the highest need, the likeliest groups for co morbidities, the highest exclusion rates. These are the people a government exits to look after, the people to which a responsible health care system has the greatest duty of care.

There was no precedent for socialized medicine before that was implemented on a national scale either.

True, but there is precedent for privatised healthcare, the evidence suggests it underperforms on the very health outcomes it is exists to improve.

Private healthcare may in local instances provide better care to its subscribers, but only insofar as it is profitable to do so and they can afford it. The role of government is not to selectively ascribe value to the lives of it's citizens. On the contrary it has a duty to serve the most vulnerable members whose neglect is the very reason your system so drastically lags behind.

Waiting lists, fewer providers to choose from, and non-covered services.

You keep referring to non covered services, completely failing to realise that there are whole sectors of healthcare that simply don't exist in the US in a meaningful sense because they aren't profitable. To be fair your lack of a clinical background might partly explain this (it's like expecting an accountant working for the DoD to understand combat tactics), along with cultural immersion in a system with a particular philosophy, but to constantly equate effectiveness with financial measures is to utterly misrepresent the role of healthcare professionals. The two can co exist, one can even facilitate the other, but this isn't always the case and you are prioritising the lesser of the two.

The US focus is on normative healthcare, providing a cure to an illness, with an inherent bias towards the medical welfare of those in stable employment who can afford to pay the premiums whilst simultaneously representing the least vulnerable demographics. The provision for social care or care for the most needy groups in society is substandard or in some cases virtually non existent. The fact that you consistently refer to waiting lists, cost saving and patient turnover times as measures of success shows the total disconnect between your mindset and that of a responsible public healthcare provider whose very reason for existing is to serve the public good, not to cut costs.

Learning disability nursing barely exists as a profession because long term efforts at person centred planning, social inclusion and community support simply aren't ever going to be attractive as business models. This means that as a group these most vulnerable people. This is a group requiring investment in social care which will rarely if ever be profitable, who experience high levels of co morbidity and life shortening illnesses and are the least capable of independence or self reliance. Efficiency is way down the scale when it comes to the priorities for these people (in fact in certain regards a focus on it is actually contrary to the underlying philosophy of committing resources on the basis of need). What is required is investment without the end goal of a profit or gain for the provider along with a willingness to accept a life long commitment to that person's holistic needs, social inclusion and inequality reduction in this group whose neglect drives down life expectancy and quality of life.

Severe mental illness has poor provision for the bulk of the population, again because those who are in most need of both acute and chronic provision statistically tend to be those who can least afford to pay premiums due to lower incomes, unemployment and the expense involved in long term provision of medication and therapy whose efficiency is difficult to quantify. By the very nature of the patient base and the capacity reducing illnesses the consequences lead to worsening physical health outcomes due to spoor self care, financial hardship and consequential malnutrition, medical non compliance and frequent homelessness. This also drives life expectancy down.

Health education is considered a major role of healthcare provision in most countries and is sorely lacking in the US, precisely because there is no financial incentive to preventing the very illnesses whose treatment is a revenue generator. Co operation between the education and healthcare systems is an acknowledged driving factor in improving health outcomes for patients and improving public health to prevent people becoming patients in the fist place. Yet again, the lack of profit margin results in the lack of (or bare minimal) provision of a whole sector of healthcare which is considered essential in other countries. As a result, public health suffers and life expectancies drop.

 

[fonzob1]

All features of numerous American HMO plans. I have lived decades under the American and Canadian systems. Neither is perfect. However, there’s one system where I will never have to mortgage my house if I need heart surgery—and it ain’t in the USA (my parents have only recently finished paying that second mortgage, 25 years after my mother’s surgery).

I’ve waited 15 hours to be seen in an American ER and I’ve gotten near instant treatment in a Canadian ER (the reverse is also true, to be fair). I have far more choice of doctors and pharmacies than my parents ever had under their HMO (thankfully they are now on Medicare—a vast improvement over the private insurance they had access to when younger).

Again, no system is perfect, but let’s not pretend Americans don’t face choice limitations and waiting lists and uncovered procedures. That’s a laughable lie.

Some plans are definitely better than others, but wait times are no where's near as long as they are in Europe or Canada (especially if you are situated in a major metropolitan area in the U.S. with a large network of providers). Americans often have a greater number of providers available sooner. As far as Medicare being "better" than an HMO, you would have to have a pretty terrible HMO plan. Medicare has "non-covered" services that private plans typically include in coverage.

I wouldn't know about that. Although I do know that since our system doesn't typically cover the full amount of treatment when we are out-of-country, we are strongly encouraged to buy temporary insurance coverage when we travel in the US and other foreign destinations, so that we don't end up bankrupting ourselves if we fall ill or get injured while travelling. (Sadly, not all get the message. Of course, some do and then still run into problems.) Maybe that is what you were hearing about? Blue Cross did use to provide such coverage, and I used it when I used to travel to the US. However, I haven't visited the States since 2001, so I don't know what the current costs would typically run.

My understanding is that people who live near the southern border can benefit from this on a regular basis.

I don't really want to get into personal medical details on a public internet forum. But my comment about "most plans" not covering it was based on my own reading, and talking to similarly-affected American women. While some were covered, more appeared to be not. I don't necessarily know the reasoning behind why some plans wouldn't pay for treatment.

Fortunately, here, I am covered.

That is understandable, but I can't speak to it.

Perhaps it might be less frightening to those who currently lack adequate coverage.

Most of those who lack "adequate" coverage do so by choice. People have to take some responsibility for their own choices.

Well, as I mentioned, I fully support the current single-tier system, so I'm honestly not going to lose a lot of sleep worrying about the queue jumpers. Although presumably those wealthy enough would just travel to another country that did have a private option.

In it's own way, I think that is kind of a crass perspective. I totally understand someone not wanting to suffer any longer than they have to.

And this is just total speculation, but maybe if you were on a socialized system, it would possibly remove one of the factors contributing to our GP shortage.

Or, maybe it would tax the resources available in your system even more. The care available to those people in Canada is already bought and paid for through taxes. If they no longer sought treatment out of country, they would eventually have to receive that treatment in the Canadian system and utilize those resources instead.

I doubt any system is going to be a "utopia". And there's really no sense trying to hide the wait time issue, since anyone could find out about it with five seconds of Googling. Our governments acknowledge the problem... you can find information about this issue on our government health care websites.

I realize this, but there are some who claim media hype.

But again, I would personally take our system over your system any day. Health care should not be determined by how much money you have available.

And thank whatever deity you believe in for that!

I am glad you like your system.

Whilst openly offering second rate services to those who need it most, many of whom literally rely on charity. The unemployed, the learning disabled, the chronic mentally ill, those on low incomes, these groups all represent the highest need, the likeliest groups for co morbidities, the highest exclusion rates. These are the people a government exits to look after, the people to which a responsible health care system has the greatest duty of care.



True, but there is precedent for privatised healthcare, the evidence suggests it underperforms on the very health outcomes it is exists to improve.

Private healthcare may in local instances provide better care to its subscribers, but only insofar as it is profitable to do so and they can afford it. The role of government is not to selectively ascribe value to the lives of it's citizens. On the contrary it has a duty to serve the most vulnerable members whose neglect is the very reason your system so drastically lags behind.



You keep referring to non covered services, completely failing to realise that there are whole sectors of healthcare that simply don't exist in the US in a meaningful sense because they aren't profitable. To be fair your lack of a clinical background might partly explain this (it's like expecting an accountant working for the DoD to understand combat tactics), along with cultural immersion in a system with a particular philosophy, but to constantly equate effectiveness with financial measures is to utterly misrepresent the role of healthcare professionals. The two can co exist, one can even facilitate the other, but this isn't always the case and you are prioritising the lesser of the two.

The US focus is on normative healthcare, providing a cure to an illness, with an inherent bias towards the medical welfare of those in stable employment who can afford to pay the premiums whilst simultaneously representing the least vulnerable demographics. The provision for social care or care for the most needy groups in society is substandard or in some cases virtually non existent. The fact that you consistently refer to waiting lists, cost saving and patient turnover times as measures of success shows the total disconnect between your mindset and that of a responsible public healthcare provider whose very reason for existing is to serve the public good, not to cut costs.

Learning disability nursing barely exists as a profession because long term efforts at person centred planning, social inclusion and community support simply aren't ever going to be attractive as business models. This means that as a group these most vulnerable people. This is a group requiring investment in social care which will rarely if ever be profitable, who experience high levels of co morbidity and life shortening illnesses and are the least capable of independence or self reliance. Efficiency is way down the scale when it comes to the priorities for these people (in fact in certain regards a focus on it is actually contrary to the underlying philosophy of committing resources on the basis of need). What is required is investment without the end goal of a profit or gain for the provider along with a willingness to accept a life long commitment to that person's holistic needs, social inclusion and inequality reduction in this group whose neglect drives down life expectancy and quality of life.

Severe mental illness has poor provision for the bulk of the population, again because those who are in most need of both acute and chronic provision statistically tend to be those who can least afford to pay premiums due to lower incomes, unemployment and the expense involved in long term provision of medication and therapy whose efficiency is difficult to quantify. By the very nature of the patient base and the capacity reducing illnesses the consequences lead to worsening physical health outcomes due to spoor self care, financial hardship and consequential malnutrition, medical non compliance and frequent homelessness. This also drives life expectancy down.

Health education is considered a major role of healthcare provision in most countries and is sorely lacking in the US, precisely because there is no financial incentive to preventing the very illnesses whose treatment is a revenue generator. Co operation between the education and healthcare systems is an acknowledged driving factor in improving health outcomes for patients and improving public health to prevent people becoming patients in the fist place. Yet again, the lack of profit margin results in the lack of (or bare minimal) provision of a whole sector of healthcare which is considered essential in other countries. As a result, public health suffers and life expectancies drop.

We could continue to argue in circles until the end of time. As a consumer, I want fast access to medically necessary treatment that I can afford (which I presently have). My hope is that the American public at large never commits to the philosophy of socialized medicine and instead America makes real efforts to improve the access/affordability of a free market delivery system.

The end. lol