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Massachusetts Makes Health Insurance Mandatory
Iron Condor writes "Massachusetts is the first state to require its residents to secure health insurance, a plan designed to get as close as practically possible to statewide universal health care. Presidential hopeful and former Massachusetts governor Mitt Romney originally introduced the idea in 2004. Effective July 1, 2007, the law, which uses federal and state tax dollars, is aimed at making health insurance affordable to all residents of the state, including low-income populations. Those who fall below the federal poverty line may be eligible for health care at no cost."
You know, a few years back I was in San Diego and went to Toorcon (excellent conference by the way - please support it) and I got in to this discussion late at night on socialised health care.
For those that don't know, the United Kingdom spends eighty billion pounds a year on healthcare, funded directly through taxes. His central point was: "Don't you feel like you're being ripped off paying for the health care of jobless people when you're busting a gut earning a living?"
I think it's an important question and one that needs answering if the United States is going to replace their broken healthcare system. My answer is simply that even ignoring the people who don't work, it is still a better deal for you if you have socialised health care.
Free market economies work best when prices are elastic; that is, where changes in price affect the demand for the product. This allows price to signal the level of available supply and prevent shortages of goods. The problem with healthcare is that it is not elastic. If I have cancer, a broken leg or some other ailment I have to get it fixed - regardless of the cost.
In a profit making company, this means raising the price indefinitely sees no reduction in demand. This leads to an ever increasing cost that outstrips inflation. The American system compounds this because a lot of white-collar workers get insurance plans from their companies. Companies have deeper pockets than an individual ever could so the prices increase still further!
Socialised health care delivers better value for money because of the enormous purchasing power of the government. The NHS can purchase millions of shots in one go. That allows you to hammer the drug companies on price and share the proceeds with the population. In the American system, it is you against the drug company and you are needy; you are willing to pay anything to fix yourself. In short you're screwed.
There are also other economic benefits. Heathier and less desperate neighbours translates to less crime and increase productivity. It pays to insure that the daughter of a crack-addict prostitute get first class health care and education - if only to increase their chances of escaping the poverty trap and contribute more to the economy.
It also pays because you can remove the inefficent insurance companies. If everybody is covered then there is no need to have a bureaucracy to decide if a person is covered.
Socialised health care is not evil communism, it is a practical solution to the health care of your nation. I don't see anybody complaining about the socialised road, garabage collection, fire, police and military. When you trust the security of your nation to the government, why do you not trust your healthcare to them too?
I'd I've seen the benefits first hand. When a friend of mine, at the age of 20 developed Lukemia, put his Computer Science course on hold, checked in to the local hospital and began his treatment straight away. He was cured and back in education the following year. I fear that had he born in the United States, he would not have been able to continue with his studies, in fact, he probably would have been bankrupt. Socialised healthcare not only save his life, but his future.
Simon
So, from here on, Massachusetts residents are obliged by law to make money for a profit-oriented company (that may or may not actually cover their ailments).
Wow, that's progress.
No, no sig. Really.
ThePromenader
...what's the point in having insurance for all, if insurance companies will just deny all the claims due to conditions obscured in legalese?
I have looked at the Mass health insurance plan. I may be misunderstanding something, but their idea seems to be to get rid of uninsured by declaring it illegal. The closest equivalent I can think of is to stop New Orleans floods by declaring it illegal for levees to break.
They haven't gone a single step forward in fixing the underlying problem of why healthcare costs so much.
(disclaimer: I live in Mass. and my health insurance has not gone down. In fact it went up)
i highly recommend for people to watch sycko
after watching this i am shocked, USA is in a bigger mess than i taught!
as a European i am happy i don't have to make tough choices when it comes to my health, if i need treatment i would get treatment with little hassle
i highly recommend for any Americans with Irish roots to come back here (u wont get hassle getting citizenship!) the economy in last 10 years has grown so much the country is unrecognizable, and u get quality health care (its not perfect but compared to the US...)
Does this mean that someone who is denied health insurance in any other state will be able to move to Massachusetts and be guaranteed to be approved for health insurance? Will high risk people who are denied in other states have higher insurance premiums to pay than "lower risk" insurees in Mass?
Will there even be an application process if accepting me is compulsory? Will this give insurance companies less loopholes to try to out of paying for my expensive procedure. For example, as pointed out in "Sicko", insurance companies routinely deny expensive insurance procedures by finding things on the insurance application to invalidate their contract with the patient. If one can argue to a judge that the insurance company had to approve them no matter what, I'd assume that this makes Massachusetts a much safer place to be able to depend on the health care and insurance that you are paying for than anywhere else in the country.
I think these are pretty important questions, but I can't seem to find the answer anywhere.
This is simply a mandate that each resident carries some form of health insurance. Read that again: this is not subsidized health care; this is simply a law that creates an annual tax penalty for residents who cannot prove that they are insured. Bottom line - it ensures that any health insurer who operates within Massachsuetts is virtually guaranteed to earn business from the constituency here.
In the first year of this program, residents who elect to defy the mandate and do not purchase coverage will be subject to a paltry $219 lien on their taxes as punishment. Given that this is far less of an economic burden than paying the mandated premiums, anyone who can do math and is healthy would be advised to consider paying the penalty. Anyone who doesn't fit into either of those two categories probably already has health insurance - and those who don't more than likely exist at polar ends of the economic spectrum: they either print their own money and can pay for health-care as needed or they are poor and can't afford the tax penalty or the premium. Of course, for this group (earning 30K or less per year as an individual and 60K per year or less as a family of 4) - the premium costs are gratis under the new Massachusetts law.
Massachusetts has found a way to make public health policy in this country even more ludicrous than it already is. They have taken a system that was a dangerous marriage between public policy and corporate interest and have fully endorsed the idea that health insurance should be the business of private enterprise and that mandating the purchase of that insurance by enacting silly laws and tax penalties is the business of the state. Taken together, the whole thing seems rather sinister at the surface, and that's because it is. It shows either an utter disregard for the concept of insurance or a determined attempt to exploit the public ignorance of personal risk assessment. It's hard in fact to find ANY real benefit for the citizens of Massachsuetts in this mess.
The sales pitch by proponents of the legislation is that it will lower the average premium cost for the entire populace; as healthy individuals are forced to subscribe to an insurance plan, the revenues generated from their participation will offset the increasing costs of paying out benefits to subscribers who are sick. This really is like any other insurance that you can buy: the insurer needs to have as many (if not more) low risk subscribers who pay their premiums such that formerly low risk subscribers who become high risk can be paid the proper benefit when the time comes. But in this instance, the insurance industry won't have to break a sweat to get those low-risk subscribers on board. In fact, they don't even have to get off the couch - the statewide mandate ensures that unless there is some pandemic that makes everyone in Massachusetts sick, there will always be a pool of low-risk subscribers who generate a reliable revenue stream.
People wonder how this is a bad thing? Why would decreasing the average cost of health insurance for all individuals actually be a detrement to people? Well, first of all - because everyone must participate or be penalized financially, this is less of an insurance system and more of a welfare system: everyone is putting their money into the pool, and those who need the money more than others are allowed to take from the pool. In this case however, the twist is that the people responsible for managing this money are actually taking ownership of it and making business decisions on its use. While in a government-regulated welfare program revenues can have no other purpose than to cover expenses, insurance companies have a profit motive - an extra hand that dips into the pool of contributed funds every so often and takes a little something for itself. This isn't in and of itself evil - we deal with big corporations every day. However, there aren't any laws out there that require me to buy $10 of goods at Wal-Mart each day, that is precisely what Massachusetts has done with health insur
Or about £1750 per year per person, or £3500 per taxpayer. How does that compare to health insurance costs in the US?
"Those who fall below the federal poverty line may be eligible for health care at no cost."
Wow! I guess there *is* a such thing as a free lunch.
"The average reporter we talk to is 27 years old......They literally know nothing." - Ben Rhodes
The law should mandate health insurance like it does car insurance. It's not necessarily for the protection of the driver but for other drivers on the road. I absolute don't buy the argument that people should be free to make choices, including NOT buying health insurance. Just like you are not free to drive uninsured, we should not be free to go about without health insurance because when we don't go see the doctor, who knows what potentially contagious disease we are carrying? How can we fight SARS and bird flu when many won't go to doctors simply because they can't afford it? I think it's a wise way to spend my taxes to help other people in need even when a small portion of them are "free-loader" of the society. At least people can go to the doctor when they begin to feel sick. The alternative is that they won't go to the doctor until it's too late and cost even MORE of my taxes or spread some uncontrollable disease in my community. Then there is the collective bargaining power of the government to hospital and drug companies which will also drive down the cost of medical service.
The only possible interpretation of any research whatever in the 'social sciences' is: some do, some don't
I consider it a step in the right direction. Yes, it's "socialism at its finest", but it's a matter of being human, IMO.
Yes, the ones that need this the most are also the ones that can hardly pay for it. So you, the healthy guy, spend more on your insurance than you'll ever get out of it, most likely. Still, I prefer being healthy and "ripped off" to being sick and "enjoying" my stay in the hospital on someone else's expense.
But that doesn't mean that we have to "level" the field. You can still get "better" plans for more money. Here, the solution is simple: You have a standard insurance. Which covers most of your medication, operations and a stay in the hospital. You want more, you can get more, you just pay more. You want a certain doctor? Pay for it. You want to lie alone in a room in the hospital? Pay for it. You want certain medicaments instead of the standard? Pay for it. You want painkillers where there are usually none required (like in most tooth related issues)? Pay for it.
Yes, the "extras" cost more than they're worth. Most of the time (a shot of painkiller for a simple tooth drilling costs about 15 bucks, a room for yourself in a hospital is a few hundred bucks extra a day). But that's how it works here. You get what you need from your health care. You want comfort? Pay for it.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
I'm from Australia here, and I've never understood how the US health care system worked until I saw Moore's documentary, SiCKO.
I would watch American movies and TV shows, and wouldn't understand when you guys talk about, getting a job with 'health benefits'. Here in Australia, the only thing I worry about getting a job is if it pays right.
If I go to the GP (family doctor in the US), or need to go to the hospital, paying the bills is the last thing on my mind. It's all taken care of. Medicines are also subsidised by the government. You collect virtually any prescription for $3.
Honestly, I was surprised you guys let it get that bad. Then again, I wasn't surprised the reason it went the way it did: through greed and politics.
(I am a licensed insurance agent)
:)
Those middle class people in Massachusetts who have pre-existing conditions, will be driven into homelessness. For absolutely certain. No questions asked. Out the door and to the loaves and fishes NOW.
These people will pay $1000 premiums per month - I work with these insurance companies and I see it happening daily in California - and in many cases their contractually agreed upon coverage will get denied.
The raw numbers cannot be denied, and cannot be resisted. The numbers - the the number of people with pre-existing conditions, their income, and their health insurance premiums - all clearly say that a large number of lower and middle-middle class will start paying fines, or going homeless, or leaving Massachusetts.
This is all out war on the middle class, and many will leave, and when they do, the rich will be paying more to support the health care-driven tax increases to support the poor and then the rich will start leaving and badebadebadethatsallfolks!
I hope this law is rigorously enforced. Tie it into SSN's and whichever SSN isn't insured, fine 'em. That'll bring quite a swift end to this law.
--- Grow a pair, liberals... stop letting the Republicans bully you!
the United Kingdom spends eighty billion pounds a year on healthcare
Hm, nominal spending is more than that. Now I don't know much about the NHS (other than that it doesn't work) but I do know a bit about government contracts in the UK, and I would be very surprised indeed if more than about 50-60% of that went on anything of even peripheral value to healthcare.
Here, the Times (rapidly becoming a tabloid but never mind) has something on it:
Annoyingly chatty but probably basically correct article.
To put it another way, the UK NHS is like the US DoD; they're both ways to funnel money from the taxpayer to those who position themselves to recieve it. The NHS, however, which is regarded almost with veneration by most British people and which doesn't have to fight actual wars, is far more corrupt; buildings built, bought, sold and knocked down within the space of a few years, and so on. But the NHS long ago passed the point where it's powerful enough to keep going forever -- it's quite a political power broker in fact, which is why you *do* get reasonable free healthcare from it in much of Wales and Scotland.
Meanwhile, in England, health care does cost money -- you pay over the counter for even a basic dental checkup. You don't want to? Then take out some private health insurance. It's a fast growing sector in the UK. Good!
I imagine that there are people who find it hard to afford, though, what with all the taxes they're paying. And that's bad. But what can you do?
Whence? Hence. Whither? Thither.
...to tax everyone, and have the state provide the healthcare, like in Australia, the UK and most other sensible Western countries?
Compulsory health insurance will just make the insurers raise their prices, because they know that everyone just has to put up with it.
-- Even if a god did exist, why the fsck should I worship it?
It compares pretty well. Two years ago the US spent (in nice round numbers) USD5200 per person on healthcare. At current exchange rates, that's GBP2600-ish. Using a two year old exchange rate it was GBP4200.
A few comments from this Massachusetts resident...
First off, this wasn't Romney's idea at all - the entire thing was proposed and implemented by the (extremely Democratic) state legislature. The MittFlopper had zero to do with it - absolutely nothing - he simply made sure to grab credit at the time (now he's distancing himself).
Personally, I think our country is jaw-droppingly stupid to not implement single-payer health care (aka Medicare for Everyone, aka What Almost All Other Industrialized Countries Do). That being said, the Massachusetts initiative has produced a number of very affordable plans, so I do think it's better than nothing.
Here are my ideas based on what I know about it (I don't live there but I have watched enough US hospital shows on TV to know a little about it :)
:)
1.Completely ban health insurance companies from specifying which treatment options a patient must take if they are to be covered (e.g. "you must use our preferred hospital" or "we wont cover you for that really expensive test even though the doctor says you should have it") or from charging differently based on what options are picked. This change doesn't mean they have to provide coverage for stuff like baldness cures (ala that one Simpsons episode) or whatever other non-life-threatening treatments they don't currently cover
2.Do whatever is necessary to increase choice of provider. If there are more options for people to pick from then we will see insurance companies competing for business (here in Australia, health funds spend big money trying to convince you to switch to their policy)
Those 2 provisions would be a good start in fixing the system. Feedback from those who know more about the system would be nice
Studies have shown that healthcare is not perfectly inelastic. A 1970s RAND study, the most comprehensive one ever conducted (in that it utilized a true double-blind experimental setup spanning multiple years and involving thousands of participants at a total cost of $300 million dollars), demonstrated that people that have insurance with lower copays do, on average, rack up a lot higher healthcare expenses than those without insurance. (I forget the exact numbers, but it was something like people with 20% copays on average spend some ~50% more on healthcare than people with 95% copays). This demonstrates that healthcare demand is clearly NOT perfectly inelastic, but instead does depend quite strongly upon private price levels.
> "Don't you feel like you're being ripped off paying for
:)
> the health care of jobless people when you're busting a
> gut earning a living?"
You make good points in your post and feeling ripped off is a feeling everyone gets when paying taxes.
In Ireland it is free to some extent but not totally free, however if you do incur medical costs you can claim the money back from your taxes to almost the same amount. Also certain things are free by default (eg. Eye/Dental check ups). So it is not like you are being ripped off.
I will disagree with you. I cut myself last year. It wasn't particularly deep, but it scared me enough from the huge gash it left behind. Only the skin got cut, but because it was on a Sunday, my doctor's office was closed, and I had to go to the hospital. I had to get 20 some stiches (actually, just staples). I never saw a doctor, just a type of nurse. I also got a tentanus shot and 2 X-Rays done to make sure no metal was left in the wound. I was expecting the cost to be $1000 max, probably less as it was just 45 minutes. My doctor said he would have charged me $250 for the same service.
/.er is a rare thing. Don't stare at me too much.)
I got a bill for $3000. I got this bill because I was uninsured. I know the insurance would have paid only $500 but the hospital screws you if you are uninsured. This system would bankrupt me if it was anything more serious. I'm a person too poor for insurance, but still have assets (a car) and thus don't qualify for government help (until I'm broke - i.e. lose my car). I could not fight the bill - I was told that since they did not bill me fraudulently (no double billing basically), the bill was what it was.
I can't go to the doctor for fear of high bills. Even if it would be cheaper in the long run. If I need to get tests done, I can barely afford it, I'm just scraping by. I am young and relatively healthy, but I still have issues time to time. It makes me sick to my stomach when I think of how much I get charged as a private person and what the breaks the health insurance industry gets. It's downright unfair.
Since I have relatives up there, I am moving to Canada soon. I know many Canadians complain about the system, but none would trade it in for the American system. I see the light, I'm moving out of here. I won't miss it. I'll pay the higher taxes if it means that I don't have to worry about rotting in the street or being close to my death before I get help. Fuck all of you blasting Socialized Medicine - it's a safety net for people like me - like the original poster of this thread said: healthcare is a necessity, not a luxury - unless you don't mind dying early or being crippled for life.
(Yeah, I know being a poor
And they might succeed again with the FOX Noise crowd.
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k oUSFactCheck,00.html
Always best to know your enemy before you talk trash about them:
http://www.foxnews.com/story/0,2933,273875,00.htm
http://www.foxnews.com/story/0,2933,286006,00.htm
Two AP writers had this to say:
http://www.foxnews.com/wires/2007Jun30/0,4670,Sic
What a ridiculous statement. My grandparents are all deceased but my all four of my partner's ones are still alive, thanks in no small part to the NHS.
In the last few years one has had a pacemaker fitted, one has had knee surgery and also a heart attack, and a third has had surgery on both knees. All three at least 80 years-old and all three had these operations and treatments in timely manner, all on the NHS at no cost to them at all. All three could not praise the staff that treated them high enough.
To suggest that the old get poor care from the NHS is ridiculous. If that were so then these people wouldn't have received the excellent treatment that has allowed them to carry on not just living, but living full, pain-free lives.
"Accept that some days you are the pigeon, and some days you are the statue." - David Brent, Wernham Hogg
I'd prefer to skim-read and then write a post about my cock, actually.
Is that it is primarily corrective instead of primarily preventative.
"God fights on the side with the best artillery." - Napoleon, Marshal of France - speaking truth to power
I'm a Canadian that used to live in the USA. One of the things that always amazed me is how your health insurance can obligate you to stay working for a company.
:(
Essentially, once you're diagnosed with a disease or condition, it's impossible to change to another provider because they won't cover pre-existing conditions. This means that if you leave a job (or are fired), you have to personally keep paying very high rates to your old company's provider in order to keep insurance. Your new employer (if any) will usually not take on those costs, because they have their own provider and plan - which you don't qualify for due to the pre-existing condition. It's a vicious circle.
However, I lived in Massachusetts as well, and I did like some aspects of the co-pay system there. In Canada, anyone can go to the doctor whenever they like, and it's free. So, you get mothers dragging their kids to the doctor every time they sneeze, and all kinds of other useless visits to hospitals and so forth. Having even a token co-pay (exempted for those below poverty) reduces needless visits. I think most visits on my plan in the USA were $10 or something, which is enough.
So - my ideal world would be the Canadian system, plus a small co-pay. Unfortunately most of Canada's best doctors move to the USA so they can get rich instead.
MadCow.
I used to have a sig, but I set it free and it never came back.
So for now you are required to get insurance. What next, required genetic testing? Pre-natal screenings for possible conditions, requiring you to get an abortion if the fetus is not "in the acceptable range"?
Yeah, I know it's way out there... but have you seen Gattaca? The rate the US is going, I'm... disturbed.
Vote monkeys into Congress. They are cheaper and more trustworthy.
Absolutely not, New Zealand has been shipping patients to Australia for cancer treatment in the last twelve months.
It has been well publicised in NZ newspapers.
MA is using community rating in combination with the requirement for coverage. Unsubsidized health plans run about $350/month, for those making over 50k. I don't see the problem. (the law subsidizes health plans for those under a certian income).
You don't have to go all the way to Europe to find an example of socialized health care. Try up North in Canada. Canadians generally like to complain about the short comings of medicare. The popular perception amongst Canadians and Americans alike seems to be that, if you're able to afford it, care in the U.S. is better. However, some studies have shown that this isn't the case at all, and the quality of care is actually about equal or even better in Canada in some areas. This seems difficult to believe when you consider how much less Canada spends per capita on healthcare than the U.S., and even more so when you consider that, for that money, they cover everyone. However, bear in mind that, in addition to the advantages mentioned above, we don't have an entire industry of insurance-men and lawyers riding piggy-back on top of our hospitals the way they do in the U.S..
Socialized healthcare works. I'm glad we use it up here and will never vote for a politician that even dares to dream dismantling it. That being said, Canada's system has some drawbacks which you should study and try to avoid. It's a tad off topic, so I won't go into too much depth. However, one of the biggest problems with socialized healthcare is drawing the line between necessary procedures/drugs that everyone is entitled to and procedures which they have to pay for themselves, while at the same time not making it inordinantly difficult to pay for those procedures.
If you want perfect teeth in Canada, you pay for it. Braces are not deemed a medical necessity. However, private dentist clinics are everywhere so this is not a problem. Lots of companies offer dental plans, and you can also buy private insurance very similar to medical insurance in the U.S.. Finding a place that will do esoteric cosmetic surgery that has no non-frivolous applications can be difficult. Facial reconstruction? No problem. Labia sculpting? Good luck. Also, good luck finding a company plan that includes boob-jobs. (To be totally honest, there is one bar in town that has gained notoriety for it's policy of funding breast augmentations for employees. Let's consider them an exception to the rule.)
Another, somewhat chilling aspect of socialized medicine is that the state has to do cost/benefit analysis when deciding what procedures to perform. If an ninety-year-old in the U.S. can pay for hip replacement surgery he or she will get it if it kills them. In Canada, the cost of the operation, the risk to the patient, and the low benefit (a ninety-year-old is statistically unlikely to get much use out of a new hip) may mean that the patient won't get anything other than a wheelchair. This is not a system in which the patient is always right.
It's not a good system, but everything else is worse.
"And yet everything has a value."
Unobtainium is worthless. Next up, a rant....(not aimed at "you" personally).
The Australian system is similar to the UK's NHS, so much so that we look after each others tourists for "free". I was an asthmatic teenager when the "establishment" told us universal health care was a communist plot that was crippling the UK and would bankrupt the country. 30+yrs later and we are far from bankrupt, we have "world class" prevention, care, teaching and research. I belive "the system" saved my son's life and it definitely kept me out of bankruptcy.
As for footing the bill for "non-taxpayers" (depending on political expediency the Australian term for non-taxpayers is either "bludgers" or "battlers").
I spent all of my 20's at the "trailer trash" end of the socio-economic scale. Happily, I am now in the "high income" bracket where I am supposed to "top up" with private cover for stuff such as dentistry and silcone tits - personally I prefer the extra $500 "fine" at tax time and pay for my own dentistry...anyway...When you do the math it turns out I am paying to cover 5-6 non-taxpayers, yet I have only two (grown) kids and I'm no longer married (to the lazy bitch...sorry...that just slipped out, see the "political expediency" comment earlier).
The reason I am not only glad but proud to pay the levy is that I hope the system works for those 5-6 people as well as it did for me in the past. The reason I don't buy "mandatory top up" insurance is because it is medicinal "fluff" that I can afford. Most of all I don't want a return to the partisan politics where one side refuses to acknowledge the inherent "social evil" in a system that can routinely take eveything the patient's family has, and then promptly hang the patient with red tape.
How do my costs compare to the cost of similar cover in the US?
From comparing notes with one or two US slashdotters in the past I belive my 1.5% levy on taxable income is considerably less than HALF of what similar cover (and care) would cost in the US, the exact ratio varies from state to state. Not very scientific I know, but I also know that the death rate from asthma in the US has now overtaken that of Australia, this is despite Australia having one of the highest incidence rates in the world. Make what you will of the facts and figures and competing "-isims", I know first hand it's not me and my five "battlers" who are getting "ripped off".
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
So where do you draw the line between "wasted" money and money well spent?????
This is the problem when you start thinking like you do. The moment you start qualifying who should and shouldn't get medical care, then you have to start making HARD decisions -- like who gets it and who doesn't.
So, in this case -- the guy goes out, gets drunk, and cuts his hand. You complain about footing the bill because he was drunk and did something stupid. All I am saying is that if you are going to do this, you'd better be prepared to start drawing lines in cases where it isn't so clear. How about a car accident that wasn't their fault? Would you be comfortable paying for that? Is that wasted money? After all, maybe they were stupid and pulled out in front of someone. What about an accident where someone fell off a ladder? That's pretty dumb if you ask me. So is that money any more or less wasted than the guy who cut his hand while drunk?
My point is this: the moment you start qualifying *why* someone should or shouldn't get care, it forces you to clearly define those lines. And by doing that -- you have to leave someone out. Lines get drawn for a reason, otherwise, your answer would simply be "healthcare for all people, regardless of why". So how do you draw those lines and determine what is "wasted" vs. "well spent???
I cut off the end of my finger with a drop saw. Picked up the piece and off to hospital. Emergency surgery for reattachment, in hospital for 5 days with leeches, lots of drips and painkillers. After 5 days the tip died, so back home for another week before it was removed and I had a skin graft to cover up the end. Numerous trips back to hospital for checkups, as well as weekly hand therapy to get movement & desensitation of my "new" finger. The therapists told me to come back whenever I liked if I was having problems. The interesting part (especially after seeing an extract from Michael Moore's movie about someone in a similar situation in the US and how he had to choose which of the two fingers he cut off he could afford to have reattached) was that the total cost to me was... $0. It's this way for most everyone in Australia.
Then of course you add private health insurance on top to bypass the waiting lists.
I'm a little tired of this excuse.
Let's be honest here. If you are well-off enough to have your own health insurance in the US (and your procedure is covered, and they okay whatever procedure you need done, which are not always givens), then you don't generally have the huge waiting lists for elective surgeries like hip replacements because we have an insane number of specialists here. (Things depending on donations... well, good luck.) That's because there's a HUGE disparity in the amount specialists make versus the amount general practitioners make, so something like 70% of our MDs specialize, whereas in other countries the numbers are flipped or much closer to equal.
On the other hand, if you DON'T have your own health insurance, you either get to fight the Medicare red tape (which is new to me, now that my parents have retired, and it is truly impressive) or you don't get it at all.
Add on to that all the uninsured and underinsured people who are raising health care costs for everyone in the United States by being unable to pay for basic preventative check ups or procedures and letting medical situations go until they reach crisis stage, and really? We're not doing ourselves any favors.
I was married to an Australian. My Australian in-laws have both government and private health insurance, and it's not exactly breaking the bank for them. On the other hand, back here in the good ol' US of A, if I'd wanted to add my husband to my health insurance provided by my workplace because it was better than his, it would have cost us $300 per month. We were both in our twenties at the time. I can't even imagine what adding kids to that plan must cost. (Adding me to his plan was cheaper, but his plan was worse.)
I'd also like to comment that I spent several months in Australia about 5 years ago. Inevitably, I picked up a few illnesses while I was there, so I saw a doctor. Not being a citizen, I had no insurance coverage. Cost for an office visit? $20 Australian. At the time, that was like $13 American--which is about what I'd expect to pay as a copay with my private insurance in the US. Right out of college, I was uninsured, and I can tell you that the uninsured office visit price for my local doctors was between $60 and $80 per visit.
So we can keep our system where we're all currently paying out of our noses for a health care system that ranks something like 37th in the world with costs that are spiraling out of control because there are no real limits on what doctors and hospitals and drug companies and insurance companies can charge, or we can institute something that gives every person some basic level of coverage, eliminating some of the really expensive medical procedures that come about from lack of medical care (for example, the amputation of a leg of a diabetic who should have been having regular medical check ups), which MIGHT end up with slightly longer waits for some people to see specialists for elective surgeries.
Of course, since we currently have more specialists than you can shake a stick at, and many of those people who would have to wait are the same people who wouldn't even have a chance in hell at even getting basic health care right now, I'm not really seeing the big downside here.
"People who can afford it don't want to go on waiting lists if they are in a life threatening situation."
If you are in Australia and also in a "life threatening" medical situation you are taken the BEST CARE POSSIBLE, even if this means putting the patient in a fucking helicopter to get to a surgeon who can (say) unblock the vien in the patients temple. Note also that the "best care possible" is almost certainly going to be a public hospital and treatment will be "free". The helicopter and the cable-TV above the hospital bed are not "free" but everything else is, including drugs and outpatient care. BTW: Ambulance cover for said helicopter is dirt cheap due to the regulatory absence of middle-men.
"Which is why private insurers still do good business in a market where free health care exists."
The reason "insurers still do good business" in Australia is beacuse the taxman gives those who have it a $500 rebate and "high income earners" who don't have it are "fined" an extra $500 on top of the flat 1.5% levy on taxable income - I pay the $500 corporate walfare contribution and I am still getting a much better deal financially than any US citizen. I say "corporate welfare" because the levy was introduced obstensibly to save what was left of the rapidly shrinking private industry from "totally collapsing".
IMHO: The primary reason why we have such "world class" care at bargain basement prices is that UHC is no longer a partisan issue in this country and it has been that way for at least the last 10yrs. As often displayed by the US military, a bipartisan attitude puts "mission before cost" particularly in a "life threatening situation".
All the predictions of long waiting lists, financial ruin, communist plots, medical brain-drains, ect that we are seeing in the current US debate were also made in Australia during the 70's. In Australia the dire prdictions failed to materialize, what happened instead was the miles of red tape and army of middle men all but evaporated and our national health outcomes have for decades consitently hovered around the top of any serious study you care to mention.
I'm not saying we don't have our own inefficientcies and injustice, I'm just thankfull "bankruptcy to pay for health care" is not one of them.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
"(Things depending on donations... well, good luck.)"
Slashdotters make their own luck. Whenever I need a kidney, I spread roofing nails on I-95.
Another thing social healthcare dose is pay 1st rate GPs the same as 1st rate specialists. So in places with social healthcare, not only do you get a better balance of Specialist vs General Practitioner. You also get referrals based on need, rather than helping out a pal from med school.
And finally, since MDs in Britain are on fixed salaries rather than per hour or per visit fees, treating you once and leaving you cured suites them better than having you come back twice a week for the next 3 years.
Strangely enough, that is what actually happens when it is within the skill of the British doctor.
--= Isn't it surprising how badly I spell ?
IMHO our medical industry is in fine condition. We have the best state of the art medical equipment, better doctors, research and development and more access points to them than most countries in the world. What mucks it all up is the greedy, exploitive, inflationary, predatory, over-complicated concept of insurance...An industry that does not produce one damn physical product. Take insurance out of the equation and it would be easy to repair any damage already done by this type of out of control avarice. One should be able to see how this is true of anything that exists in the current American system of "business as usual". If I am a contractor I am mandated by law to possess all kinds of insurance, too numerous to list them all, from liability to workman's comp and not to mention an insurance rider on any piece of equipment or tool (human or non-human) I may need to run an effective business. In order for me to pay for all this, as I see unnecessary crap, I have to pay my employees less and charge my customers more to try and eek out a living. Why should I pay a good percentage of my income to some jerk sitting at a desk somewhere pushing a pencil in a high-rise building surrounded by the trappings of wealth to not produce one damn viable product but manages through a ridiculous game of chance to grab the entire economy by the balls ?. You will find this ludicrous and inflationary trend in any and all business and private arena's. My jaw dropped when auto insurance was made mandatory by penalty of law. The fact that there are millions of people out there that in their wildest dreams simply cannot afford it just seems to whoosh over people's heads. What are they supposed to do with the paltry wage that most employers pay their minions ?. Live in a box , don't eat, but pay that insurance extortion.
I was trying to think of something that has not been approached as insurable by these predators and the only thing I could think of that insurance has not exploited YET (insert drum roll)... is a Fart. Of course I am sure that if, some representative of this heavily marketed seemingly so necessary non-product producing industry reads this, they are probably thinking about having Britney Spears or Paris Hilton fart in a bottle and cap it so they can insure it for a million bucks. Our health care is fine folks, the problem is all the greedy government lobbied and sanctioned profiteering hands holding the door closed between the people and their health care. Imagine a world where one simply pays for whatever product or service that is offered. It's a slippery slope and Massachusetts has one foot on the downhill with the insurance industries lobbies hands on their back.
And what about those who are opposed to health care? Are there religious exemptions? I know several people who won't see a "real" doctor (some are Amish, some are 'naturist' freaks), but will go see the local "natural healer". Are these people to be left out, or forced to pay for something they will never use and are opposed to?
I also believe that many who have posted here underestimate the cost of health insurance. For my family, it would cost us around $700 a month for health insurance. That's more than some of you pay thru your employer because your employer has the power of buying in bulk, which you do not have. My last employer to offer insurance had a policy costing a little over $500 a month.
How is a low-paid worker going to afford health insurance if he's over the poverty line? If you make $30k, and have to pay $8400 a year in insurance costs, you will soon be homeless and on the dole!
HexaByte - he's a square and a half!
Man
you guys have it tough! The problem to me seems to be that Americans are wedded to 'freedom'. I'm quoting the word on purpose. In many ways I am more free in the Netherlands (can smoke dope, can afford healthcare, will have at least 25 days of vacation a year etc...). But... I pay more taxes, on pretty much everything. The state decides; if I don't pay, I go to jail. I have no choice not to insure my health; i'm not free!
You in America are more free in that respect. Unfortunately, you are also f***ed over by pretty much every large company that's out there, be it Wallmart, Microsoft, big Pharma, you name it. But you are 'free' not to be their customer. Yeah right! You have to eat, you have to have healthcare etc....
The word freedom is the red flag for the American bull. Any time anyone (typically Democrat) suggests anything that might actually improve the living of the Americans (healthcare, labor laws), all any Republican has to do is spout some crap about loosing "freedom", and everyone backs off; oh dear, don't want to lose my "freedom".
A more rational approach would help the U.S. people a lot. It used to be that the U.S. was the shining example for the world, but that definitely has passed.
Good luck
Bart
You can get affordable health insurance - with the ability to go to ANY doctor - if you look for it. Too many in society just expect it to handed to them, or refuse to actually do some basic research. In my case, it meant calling an insurance broker out of the Yellow Pages, and talking for 5 minutes.
Affordable health insurance is available if you just look for it. Given that - worst case, after maximum deductibles - I'm responsible for $3500/year. About half the UK average. And I don't have to wait to see a doctor, don't have to deal with queues, get to choose - and stick with - my doctor, and have a very affordable copay.
My last contract gig offered health insurance; I was shocked how many of my fellow contractors took it! By turning down the insurance, I was able to negotiate for an extra $4/hour, which means that AFTER I paid for my own health insurance, I'm still up $550/month in income...
Browsing at +1 - no ACs, I ignore their posts. So refreshing!
Just one data point from a Massachusetts resident. A neighbor who is an oncologist and experienced observer of the scene said one of the main impetus for the Massachusetts plan is the reduced number of very wealthy individuals from Saudi Arabia who since 9/11 no longer come with their cash to the Boston area for top-flight medical care: they are more likely to go to Germany or Switzerland now. These were the people that were replenishing (indirectly) the free care pool which has been dramatically drying up over the last few years. For many decades this was a generous and essential ingredient of the health care environment here. It sounds odd, but this is one of those backstories you would only hear from someone in the arena, and certainly not from the media.
... see the movie Sicko.
The parent comment, and others, minimize the issue. The issue is fraud by the medical profession. The medical system in the U.S. is broken.
Okay, this is an exaggeration to try to be funny: If you open your window on a quiet night, you can hear the crying of hundreds of people. Film studio executives in Hollywood are crying because they have to spend $20 million to market a movie that cost $20 million to film, but Michael Moore is invited to sell his movie Sicko from the podium in the U.S. federal government's House of Representatives, and the New York Times publishes a photograph, shown in the NYT article For Filmmaker,`Sicko' Is a Jumping-Off Point for Health Care Change. Quote from the article: "Even the haters agree this film is genius!"
When I last checked Fandango.com, there were 1651 "must see" ratings, 115 "go" ratings, and only 62 lower ratings. Sicko is the highest rated movie ever, apparently.
Complaining about Michael Moore is evidence of ignorance. He does the best he can. Do not demand that your evidence be sugar-coated and delivered on a silver plate. Get it where you can, and cross-check it carefully, or know you are purposely avoiding being part of the solution to the problems.
For those whose real purpose is having a way to act out their anger, while hiding it from themselves, get help. Work on resolving your anger, rather than listening to anger sellers like Rush Limbaugh.
One last thing: If you had educated yourself about what the U.S. government is doing and has done, you would have known that Michael Moore's movie Fahrenheit 451, while faulty in presentation, was entirely based on fact. For example, George W. Bush really does hold hands in an affectionate way with Saudis who control the Saudi government. Osama bin Laden's major complaint was that the U.S. government was supporting a Saudi government he thinks should be replaced. I'm against violence from any source, but certainly a Saudi citizen like bin Laden has a right to object to a regime in his own country that many Saudis say is repressive.
Not just factually dubious, factually bullshit.
It is so interesting hearing conservative whack jobs talk about the bottom line as the ultimate measure of success in an endeavor. Then have them develop selective hearing loss when the bottom line is revealed for a social justice policy like universal health insurance. For example, average life expectancy at birth in the UK is 78.7, in the US its 78. Average spending on health care in the US as a percentage of GDP is 15% in the UK its 9.4%. (And remember for that 15% we don't cover about 15% of the population, while the UK covers 100%.)
So either the British are significantly healthier than us, it is cheaper to provide inexpensive preventative care for all in the long run, or there is a large sucking sound that is coming from the health insurance industry and Pharma taking about 30% off the top of what we spend.
I will tell you the only two thing that is keeping my partner and I from immigrating to Canada is the fact that it would be hard(er) to take his parents with us and I hate cold weather. With global warming and time, Canada looks a whole lot better. And this is a sentiment that I have heard from a lot of my colleagues. Few physicians want to work in a system where 15% of people are uninsured, where people die for lack of simple basic preventative care, where in order to write your patient an rx for an antibiotic, you have to check one of a thousand formularies to determine which they will pay for. For a group of people who, when they started medical school were largely idealistic and wanted to help people, this is a soul-crushing system. However our kids, parents, whatever obligation prevents us from moving. But leave it for a few years, and you may find that the trend of Canadian Physicians emigrating to the US, which slowed and then halted in 2004, may reverse course with US physicians emigrating to Canada.
Nick
That's just the thing - socialized medicine doesn't remove all of those layers. While the advertisements and marketing goes away - the (private) insurance company people are merely transformed in the (public) bureaucracy. The paperwork doesn't go away - just the forms change. The decisionmaking over what care you get when doesn't go away - just the entity that writes the paychecks of the decisionmakers changes.
It gets cheaper because the goverment can now force you to use cheaper generics. And because the goverment limits who gets what treatment and when. And because the goverment can mandate the salary paid to health care workers...
It always utterly astonishes me that Slashdot - home of the most stalwart dyed-in-the-wool get-the-goverment-out-of-my-life crowd I know of... Rolls over and begs the goverment to come in and take control of this aspect of their lives.
Suddenly, insurance companies would have to compete because they know that it is easy for clients who are sick of paying insane premiums while getting denied service will bolt no matter how many boob jobs they approve.
My company pays about $900/month to insure myself and my wife. We could be similarly insured for about $250/month in the private market, since we're young and healthy.
The problem is, since we're young and healthy, it costs far less to provide us with healthcare than the people I work with who are, say, 45 years old. So what happens when you let people just take the money instead of the insurance? People like me leave the employer insurance pool and get private insurance, and then the company ends up spending $1600/month to insure the people who are left. Except now at $1600/month, even more people would pay less with private insurance, so now THEY leavue the employer pool, and you're left with a company that is now paying $5,000 a month for the diabetics and others with chronic diseases and the rest of us are all on private insurance.
Of course, this doesn't really happen. Because once isnrance starts costing $1,600, $5,000 month, and the company is BOTH paying that for the people who actually take the insurance, and giving it ot the people who don't take the insurance, the company just decides to stop offering insurance at all. Now nobody is insured.
Employer-provided health insurance works the way it does because it's the only way it can work.
paintball
"People who can afford it don't want to go on waiting lists if they are in a life threatening situation."
Sorry, but that's essentially bullshit. My mom works in public health, and has her master's degree in Health Services Administration.
Here in Canada, we're getting the same story pushed by people who want a US-style system (one difference between Canada and the US: US doctors make dramatically more money, on average) that our health-care system is in crisis, and the bogeyman of "waiting lists" comes up all the time.
What conditions have waiting lists? Slow, progressive, conditions like knee replacements or cataract surgery. A condition that's been developing for years (if not decades), I don't care if that person waits 6 months or a year for surgery. It's often suggested that the long wait for MRI's is indicative of a need for private health-care.
Well, actually, if the reason for an MRI is potentially life-threatening, you get in in 24 hours or less.
The argument that long waiting lists mean the single-payer, socialized medical care is flawed has no more validity than Microsoft's "235 patents are infringed by linux".
Pure, simple, FUD.
The plural form of "anecdote" is "anecdotes", not "evidence".
Some of the health care reforms and HMO take-over in the 90s drastically lowered Doctor incomes. They had to change how they practice medicine, and start ordering extra tests to keep their incomes up, etc. This caused a temporary savings in spending as they ratcheted down reimbursements, and then an increase as they over treated... basically, the doctors had become accustomed to a lifestyle and kept supporting it.
However, the newer, younger doctors, were unable to start practices as easily in the 80s, as it became difficult to get on the HMO lists, etc. More of them work for the older doctors for lower pay, more work at hospitals, coops, clinics, etc. Doctors make less money.
But, you won't see the effects for decades... you SEE it in Canada and Britain, whose single payer systems are starting to suffer, badly. The best and brightest don't go into medicine, or leave for the US, you're importing your Doctors.
Why don't you see it for decades? Let's look at the status quo...
Imagine you're a 45 year old specialist, making great money, $500k/year. You're living on $400k, putting away $100k, and planning to retire in 5 years at age 50. Now, your income is cut by the HMOs by 20%, you're now making $400k, living on $400k. You now have to wait for your older investments to fund retirement, so you wait until 60. Nobody is going to shed a tear for this guy, but the income cut kept him in practice an extra 10 years, so you see an increase in doctors.
Now, shouldn't less income mean you work less, or find other work, it depends. If you're a 21 year old biology major junior, you might decide that instead of spending 4 years in medical school and 6 years in residency, you'll spend 3 years in law school, expecting to make more money. Sure SOME Doctors make half a million, but lots "get by" at $100k-$200k... sure that's a lot of money, but remember that they have an extra $200k in education, plus 6 years as a resident to specialize in elite specialties. So at age 32 they are making $100k+, but all their friends that went to law school are making $100k+, and have been working for 7 years, own a house, etc.
Another scenario, you're 31, in your 5th year as a resident for your specialty, and the HMOs start chopping pay. Now, if you could go back at 22, you might decide to go to law school and be on your way at 25, but if you switch to law school now, you'll be 34 when you finish, competing with 25 year olds. You do your 6th year and suck it up and bear.
When pay cut, the older doctors stayed on longer, so we saw no shortage. The people in the residency track trucked on, because the "wasted time" is a sunk cost... Those in their 1st year saw the changes, and cut their losses and went into family practice. Others in med school found specialties that didn't take 6 years before you earned a living.
Basically, for a good 10 years after the HMO crack-down, we had a surge in doctors, as retirements got delayed. We also kept all our doctors in the pipeline because their next best alternative sucked. A 4th or 5th year resident was better off spending 2-3 more years to complete their specialty than they were switching to a new option...
However, in another 10 years, we're going to see the consequences of cutting doctor pay... we'll have more intelligent lawyers, and less intelligent doctors. We'll import doctors because American doctors are still better paid than British or Canadian doctors, and they'll import doctors from India who speak fluent English and find the British/Canadian doctors paid better. However, this model isn't sustainable.
If you compare most doctors in their 30s with those in their 50s, really talk to them, the former are NOT as intelligent as the latter. We have a decade or two of doctors that aren't that bright (the brightest got a JD), and we're going to lose our elite older doctors to retirement.
I'm really excited to see if the Massachusetts experiment works. Each state needs to tailor theirs differently, New York with its