Healthcare in the U.S. and Canada

[johnsantangelo]

Canada is one public healthcare system. There are plenty of other countries to model our system after if Canada isn't the ideal one. I personally think that a German-like system would be best. Germany has the oldest universal healthcare system and is mostly paid by employers like here.
http://www.npr.org/templates/story/story.php?storyId=91971170

I know when I got sick over there is was more affordable for me to pay out of pocket - just a few dollars  - than to try and get my US insurance to cover it and have higher co-pays than the total cost of treatment.

[Dog Walker]

There are a number of models for "universal health care" out there that work.  Our model isn't working anymore.  All models, even ours, will and do involve some rationing mechanism.  The British are at least rational and open about it.  $500,000 to extend the life of an 80 year old by six months?  Sorry, we won't pay for that.  Canada does it with waiting lists.  We do it by ability to pay.

[Shwaz]

There are a number of models for "universal health care" out there that work.  Our model isn't working anymore.  All models, even ours, will and do involve some rationing mechanism.  The British are at least rational and open about it.  $500,000 to extend the life of an 80 year old by six months?  Sorry, we won't pay for that.  Canada does it with waiting lists.  We do it by ability to pay.

I find this statement pretty funny... So, you're in such a rush to get the “47 million” uninsured "free" health care that it's ok if many die on waiting list's or agonizing pain because they're too old in the new system. It's funny because the people against govt health care are always pigeonholed as greedy and heartless.

[Dog Walker]

People in this country die in agonizing pain because they are too poor to get early diagnosis and treatment.

Medical care will be rationed one way or the other.  All we can do is choose the way.  I'm not being greedy and heartless, just realistic.   

[tufsu1]

So how come most of the other countries that have universal coverage have longer life spans than we do?

On the other hand (and not that anyone will admit it), but one of the biggest issues we have in this country is that people are living longer than ever....I mean, how much are the medical/prescription costs for all those old people?

Some rationing of services is and should be a must.

[Tripoli1711]

Working solely on accepting your premise, which I do not, that we are going to get rationing, etc. either way: How does it possibly make sense to spend hundreds of billions of dollars that we do not have?  Essentially you argue that we are damned if we do and damned if we dont, but maybe this will work better.  This country is going totally bankrupt in large part due to swelling entitlement programs.  Such as, what?  Oh yeah, medicare.  OK.  Well, given that we are doing so amazingly well keeping that properly funded let's take a flier on expanding that program tenfold.  After all, maybe a different kind of "rationing" will be better.

There is no reason that the free market cannot be utilized properly to create true competition among health insurance and health care providers.  We are not doomed to a lifetime of rationing if we do not embrace socialized medicine.  If we dive head first into it, we should all become accustomed regardless of our means.  

[BridgeTroll]

how much are the medical/prescription costs for all those old people?

Some rationing of services is and should be a must.

I wonder who will be rationed the most?

[Tripoli1711]

Some rationing of services is and should be a must.

Who gets to choose?  You?  Lord help you if your services are rationed someday because.. well, you just lived too long.  I mean damn, all that exercise and eating well.. way to create a burden on us.  Why couldn't you have fallen into a wood chipper or eaten McDonalds 3 times a week and saved us all the trouble.  

How much nonsense is this!  And why??? Why are you so perfectly content to sit here and essentially say "I am just thrilled to give away such a large portion of my own personal freedom!  It just makes me feel sooooooo fuzzy inside."  

The system needs to be reformed, but the just blindly dogmatic statements such as yours make me want to leap out of my skin.  "Well, of course the government should decide who has pretty much outlived their usefulness and should just go ahead and die already."  Amazing.  I hope you didn't gush about the virtues of liberty and freedom too much on the 4th of July because that sounds rather hypocritical at the moment.

[Tripoli1711]

It's vastly better.  There are many variables that factor into one's income.  Even in 2009 in America, the number one variable is still one's work ethic.  This nation was founded on equality of opportunity, not outcome.  Every American is afforded an equal opportunity to work as hard as they possibly can throughout their lives to provide for themselves and their family.  The number one provision should be your health and safety.  Healthcare does need to be more affordable.  I have yet to say the system is perfect right now.  In fact, I repeatedly say that it needs to be changed.  The marketplace needs to be truly opened.  People should treat their health insurance like they do auto insurance.  You buy coverage at a reasonable price to guard against the catastrophic.  Typical usual healthcare you buy with pretax dollars, or buy with a full tax refund, in an open marketplace, which will drive prices down.

Yes, your income should dictate your entry into any marketplace because one's income is the fruit of their labor.  Your labor is your time and your time is your life.  The amount of work you do is the amount of your own life you put into earning money to pay for things like healthcare.  I will always choose to let the fruits of one's labor dictate his access to healthcare before I will allow politicians or bureaucrats to make that choice.

[Tripoli1711]

If you are asking me to tell you a system where everything in life ends up fair and how "it should be" then I am sorry, I must leave you wanting.  Your example is noteworthy as a very undesirable result of life.  No system, governmental or private, can allow everyone to keep up with the Joneses, even when Ma Jones got her money through hustling good honest people.  The healthcare available in the United States of America is unparalleled on Earth.  Can everyone, even through working very hard, achieve the "highest quality healthcare", well no.  Not everyone can drive a BMW and live in a 12,000 square foot house either.  People can make a good honest living and provide a nice home and environment for their family.  What's so awful about that?  The point remains that if the marketplace is allowed to properly function, those who work hard can have healthcare if they choose to spend their hard earned dollars on it.  This includes the gentlemen laborers you mention.  They won't have to worry about someone in Washington DC giving them the romanesque thumbs up or thumbs down.

Will all of those guys have healthcare?  Of course not.  It was never supposed to be about equality of result.  Some may have multiple children out of wedlock and have to pay child support rather than properly save for healthcare.  Some may gamble too much.  This is unfortunate but it should not be the responsibility of government or the taxpayer to create an equal result for them.  They made the choices and must live with that particular consequence.  Those workers who lived prudently and within their means, worked hard and saved should not face a 'rationing board' toward the end of their life in a vain attempt to equal the result of the healthcare issue for their imprudent coworker.

Lastly, since I know its the logical next argument.. I have never said we should ax governmental benefits for those who truly need it.  The very poor.  The disabled.  I don't want to throw these people to the wolves, but the woeful inefficiencies and abuse of the system currently in place to address this noble cause should make anyone stop and reevaluate their support for government healthcare.

[Tripoli1711]

Ha.. no you got that right, I am not that obtuse!  What I said initially is that one's labor and/or productivity is still the single greatest contributor to their personal wealth.  There are tons of wealthy who have worked their tail off to become wealthy.  There are lots more who did so through impropriety.  Others just inherited it.  It isn't a perfect world but I would still rather put the keys to the healthcare vehicle in the hands of working Americans and leave it to them to make the right choices and decisions and secure health coverage for themselves.  The overwhelming majority of the time those who work hard and do not make horrible decisions should be able to afford coverage under a free market system.  That's where I want us to get.  I don't want the government running it.

[Tripoli1711]

I am not sure I fully understand your question.  I do not want the government to be an active player in how a typical American (again, not the disabled, etc) pays for or gains access to health care.  I do not want the government to run the system.  If government inserts itself as just one of many "insurance providers" they will ultimately become the only insurance provider.  For profit businesses cannot long compete with an entity who has no mandate to make a profit.  Private insurers would be driven out of business by the government in short order.  Maybe not in 6 months, but it would be less than 15 years, I think.

What I would like to see happen is the market unleashed and Americans more responsible for their health care choices.  In the age of the internet, it has never been easier to shop for coverage, and read reviews about particular plans and even service providers.  I heard a report the other day that we as a society trust word of mouth more today than we ever have since they started tracking such data.  People are more than equipped to make informed choices in this area.  I am no health care expert, and my plan will be rather vague (not much different than what you get on the Sunday morning shows from Washington in that regard), but here goes:

Treat health insurance more like car insurance.  You don't have insurance for when you need an oil change or new tires.  You have insurance for when the transmission breaks or you get in a gnarly accident.  People should have the option to purchase catastrophic health insurance.  If you break your back, get cancer, adult onset diabetes, your insurance is there.  In a free market, you can shop for a plan that suits you.  Want cancer coverage but not diabetes because you have no history of that in your family and you think its not necessary.. that's your call.  It will cost less w/o the diabetes coverage.  Are you wanting to play it safe and guard against everything?  There would be a plan for that too, but at a higher cost than other plans.  I think you see where I am going..

The flu, blood tests, etc.. that is more like a flat tire or an oil change.. hell, even a 14 point inspection if you like.  Nurse practitioners can perform a ton of these tasks, why not let them?  Doctors performing these services are thrust into competition with each other and costs would lower.  You get the flu and maybe it costs $50 to go see a doctor.  Every American has the option to have medical savings accounts.  You take pre tax dollars and place them into these accounts for when you need them.  They can accrue interest tax free.  Put whatever you want in there a month, its up to you.  When you get the flu and it costs $50 to go to the doctor, you use your debit card from your health savings account.  In good years (early in one's life), you could save quite a bit of money in this account to cover yearly checkups, cancer screenings, etc.  When the unfortunate ultimately beings to happen later in life, that's where your catastrophic insurance kicks in.

I could go on, but that's a rough outline of the way I think it could and should work.  Like I said, I am no expert and would be happy to find out where I have got this wrong. 

[Tripoli1711]

The debate is over the fact that they are one and the same.  If the government runs health care, they run it.  If the government introduces their own insurance coverage into the fold, they will push out all other insurers, leaving only themselves, and they will run it.

The plans call for mandated insurance.  Thus, every citizen must have some sort of health insurance.  If the government is the only game in town, then everyone will have insurance through the government, and the government will run the health care system. 

Well, what if some others survive by just charging an arm and a leg, I'll just buy that...

No.  My understanding is that the current bill, from what I heard it is on page 16, although in truth I have not personally read the bill, makes it illegal for you to purchase your own private insurance.  If your employer provides private insurance to you, that's fine.  If you go to an employer who determines it costs to much to go with a private plan and puts all its employees on the government plan, you will have two feasible options:  quit and find a job somewhere with a private plan, or go on the government roll.  As previously mentioned, these private plans will not exist or if they do they will be insanely costly.  Good luck getting a for-profit business to go with the insanely costly plan over the government plan.

Oh yeah, and if the employer doesn't provide insurance coverage of some kind, government or otherwise to the employees, they have to pay a pretty large penalty to the government.  How is this going to help the economy?  But that is a different can of worms.

[Tripoli1711]

By and large I think they currently do.  There are lots of pretty good health plans out there, but for the most part, if your insurer will not cover something, you aren't going to get it.  The way people get their health insurance.. which the vast majority of the time is through an employer, is the problem.  Give the individual the choice.  Put the power in his or her hands to save, buy the policies they want, they need.  Give the individual the option of what doctor to go to, not just the list of doctors your insurance plan is in bed with.  This is the idea I expressed earlier.