Friday, July 17, 2009

Why not here?...

Perhaps at some time more Americans will really look at health statistics and reach a slightly different conclusion about how good American health care is compared to other OECD countries, especially considering what we pay.


To date, the big gripe I have heard is "You have to wait!"  To be fair, others on the right are ready for some change.

This may be valid, but it turns out that tradeoff could be one most folks could embrace  - especially if they have no insurance at all due to unemployment.  And more importantly, if first-hand stories like this got more exposure:

There’s all this talk in the United States, mainly from conservatives, about how woeful a public health care insurance option would be in the United States.  They talk about “socialized Medicine”, and use “Canada” and “France” as curse words.
And they speak of the government getting between you and your doctor.  The government paying a proportion of my fee in no way “gets between me and my doctor”.  I have lived in the US with really good quality health care coverage*.  But I have never, ever had a doctor like my current one.  She knows me, she cares about my health in a holistic way, not just in diagnosing a particular problem.  She wants to know about my past, and my lifestyle, and integrate it into her understanding of my health.  On my third visit to her, I broke down into tears about something not directly related to my health, and she listened, and said that it was probably affecting me more than I realised.  She gave some advice about how I might deal with me problems better, and assured me that any time I needed her, she was there.
We have a wonderful balance here in Australia.  If you need health care and can’t afford it, you can get it.  Everyone can get it.  There are a multitude of doctors who bulk bill.  And you can use the public hospital system.   But if you have a little more money, you can choose the extra cover.  The government doesn’t decide what access I have- they just set a level of access, and everything beyond, I have to pay for.
Is that “rationing”? Perhaps.  But at least we all have access to pretty good basic cover.  At least a major illness will not bankrupt us.  But, at the same time, if we have access to the extra funds, we can use them and pay for extra cover.  Oh, and if a particular treatment isn’t available here, the government will pay for us to have it overseas- a fact Glenn Beck grossly misrepresented in his recent rant (Do Australians go to the US for certain treatments? Yes.  But he neglected to mention the fact the federal government provides funding for that).
I am thankful for a system in which I can access a basic level of care regardless of my income, where I can choose to spend additional funds if I have them available, and where I have both public and private hospital options.  For that, I’m happy to pay an extra $1.50 tax for every $100 I earn.  It’s worth it. [More]

I appreciate many of you have written me off as a turncoat socialist, but try to look past that label to the actual product. For what we pay we get too little - and it could be better.

The argument of cost is valid, and I think the best way to contain it is to a) offer a public option to make insurance companies competitive, and b) utilize comparative effectiveness analysis to allocate (OK-ration) what public dollars will be spent on, allowing individuals to either pay for private coverage or just buy the care themselves.

We had a story this weekend on USFR about how Nebraska rural residents are postponing health care due to the recession. Their problems may heal on their own, or they could end up costing the sufferers and the rest of us a whole lot more.

If you have good health insurance now, it is understandable how you could discount the problems of those who don't.  But more of us will fall into the latter category as health costs mount and employers balk.  Meanwhile, advanced screening diagnostics will declare more of us "uninsurable" each year.
Competition and freedom of choice would be tonics for the health system, the thinking goes. But there may be a problem. Findings from a survey of individual insurance shoppers show that 15% of people looking for insurance online were deemed “uninsurable” for standard coverage by most insurance carriers.
The  survey, conducted by Norvax, an online service for health insurance, analyzed data from 446,500 online insurance shoppers who either requested a quote or to be contacted by an insurance broker this summer. The people deemed uninsurable either had a pre-existing medical condition or provided height and weight information that produced a body mass index of 39 or higher, indicating serious obesity.
The report’s authors point out that the findings don’t necessarily mean the uninsurable will never get health insurance. But if they do, it would be extremely expensive and probably wouldn’t cover the pre-existing condition at issue. [More]
Few would support the idea of only having private schools, allowing the free market to decide who gets education or not.  This analogy holds for me in that a parallel private system should always be an option while basic needs are guaranteed by the public purse.  I would suggest health care falls into the same fundamental rung of the economic and social mobility ladder as education.
This whole issue will likely push to resolution as fewer of us can feel comfortable we can afford to be sick. 


Anonymous said...

John I really don't think that in urban America that you can honestly say that more government involvement in education has has increased the profiency level of students, as the level of people who are marginaly literate continues to climb.

Anonymous said...

EVERY discussion about health care should first ask the participants if they are writing their own check for health insurance or is someone else. If you are not writing your own check, then you are receiving socialized health insurance. If you are writing the check, you have to ask at what point of my income will health insurance costs stop, 50%? 80?%

It is a darn shame with all the talent in this country we cannot devise the best health insurance program the world has ever seen, but instead people have let it (make that made it due to their beliefs) become a battle of conservatives and liberals.

John Phipps said...


If you read that assertion into my comparison to health care, I miscommunicated. I was suggesting that just as we offer high school education to all children, I feel we should offer "high school" level health care in some fashion.

Those can pay for it can get more/better care through private means.

As for the outcomes in our education system, I agree we are doing a poor job, but I'm not sure it is because it is publicly funded.

Well put. I notice few on Medicare seek to reverse that program or even see it control the costs.

Anonymous said...


Just a few opinions for you. Maybe a nationalized health care system is not what we should be focusing on. Maybe we should get to the root of the problem, and start controlling costs. Why does it cost so much money to see a doctor or have some surgical procedure done? Two things pop into my mind immediately when asked this question.

The first thing is malpractice lawsuits. Doctors must charge an exorbitant amount of money in order to be able to afford their malpractice insurance. Shouldn't we understand that doctors are human, mistakes can be made, and that we should be responsible for the risk in the unlikely event that a mistake is made. Sure, cases of negligence and incompetence are out there, and those doctors should be punished to the fullest extent of the law. However, if we did our homework before we entrust our lives to these doctors, the marketplace would put them out of business.

The second thing that stands out to me is our policy of providing free emergency room care to anyone who can't afford it. Someone has to pay for those visits and that someone is me and you. We pay for it through higher prices charged to us for our health care. Higher prices at the hospital equates to higher prices for health insurance. I don't know how to solve this problem, because I don't think that someone with a bad illness or injury should be turned away from getting help when they need it, but there should be a better way than to have us cover the costs.

So, in my opinion, we should focus on methods to decrease health care costs, in turn decreasing health insurance premiums. Trying to nationalize our health care system, in my view, is going down the wrong road.

John Phipps said...


Maybe I should make sure we are all using the correct terms. None of the legislation under consideration establishes nationalized health care (e.g. UK) or single payer system (e.g. Canada).

Nor do I support either. The reform is aimed at 1) controlling costs via CRE and 2) universal health care coverage.

I'll try to post about the basic terms soon.

Unless the waiter brings more fruity drinks around...