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Privacy Fears Send DNA Tests Underground
biobricks writes "The New York Times is reporting that people who could benefit from genetic testing are too afraid their health insurance companies are going to raise their rates or deny them coverage to find out the health information contained in their own genes. There is a growing "genetic underground" where people pay for their own tests so they won't have to share the results with insurers, and beg doctors not to divulge their genetic status in medical records. A bill that would ban genetic discrimination by insurers and employers — and presumably make people feel safer about taking care of their health — is stalled in the Senate. We've discussed these types of personal DNA tests in the past."
can they change the colour of this thing in my hand?
bomb the us up set someone
An insurance is a way for the insured to get an acceptable cover for risks and an insurance company also has to take a reasonable risk. Even if a certain genetic predisposition exists doesn't mean that it actually is triggered in an individual.
If builders built buildings the way programmers wrote programs, then the first woodpecker would destroy civilization.
was that the results are mailed ONLY to the test subject. The paper the patient gave me with the lab address to mail to specifically stated that they will not release the results to anybody else, not even the doctor unless there is a signed document declaring that this is the patients decision. Granted this is only one lab, but Im hoping its the same for all labs.
People already do this with tests other than genetic ones. I have heard many times: "Don't write this in my record but..." with regard to 'stealth' health care problems. In most states you can order labs without a doctor's prescription through direct to consumer labs, so you can find out all sorts of things that can effect your insurability. Heck, go to a pharmacy and you can check your BP for free.
The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single payer, but lets be honest, the US is far too much a classist society to adopt that... sigh.) Though what's particularly stupid about such a bill is that it would outlaw discrimination from insurers if I noted in your record that you had a blood test that said you were predisposed to diabetes or hypertension, but it would not outlaw the same discrimination that would occur if I noted in your chart that your BP was 160/100 or your fasting blood sugar was 160. If we diagnose your hypertension or diabetes with a $2000 test, you are safe, but if I diagnose it with a $3 lab test or by taking your BP several times, you are hosed.
Brilliant.
*sigh* So now we have to hide information in the fear of the privately owned companies, who operate for profit and nothing else - as well they should; that's how the system works - increasing our rates. How bad are things going to have to get before we let our taxes take over where insurance companies currently operate? Yes yes, it's "taking away our freedoms." Y'know what, though? I'm willing to give up my right to die from a treatable wound or illness.
More and more aspects of that movie are becoming reality. I am not comfortable with this aspect of our future, guys. This is not good.
"The agriculture ministry is not in charge of Gundam" - Japanese ministry official.
The movie Gattaca. Not the best movie out there, but definately not a horrible movie. It is about the future when people are discriminated against because of their genes. Looks like we are getting closer to the sci-fi world that we dreamt about 20 years ago...
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Would they lower rates due to a clean genetic test compared to the normal now?
How long before insurance companies proactively raise rates, but then offer a discount back to normal if you provide genetic test results?
Is the bill worded such that neither penalties nor bonuses can be given out due to a genetic screen?
How much different really is it from family history, just a more accurate measure?
Insurance is all about modeling the risks for an individual based on available medical data. In *theory*, if genetic screening can increase the accuracy, then people with clean genetic situations should get decreased rates from what they pay now, while those with the dispositions carry the burden of the risk. If all goes according to the hypothetical, neither way is particularly feels 'fair'. On one hand, your rates go up because you got stuck with some genetic predisposition for heart disease that you couldn't control, that may never manifest. On the other hand, someone with a genetic disposition that will never suffer a particular ailment, will have to pay for the risk of that ailment anyway.
Of course, the chances insurance companies would *lower* any rates is slim, just jack up rates with the excuse of apparently increased risk individuals without ever acknowledging the class of reduced risk individuals.
XML is like violence. If it doesn't solve the problem, use more.
From a health insurer's perspective you'd be foolish to cover a disease for an individual if they have the bad gene. This isn't discrimination. It's facts and statistics, common sense from a business perspective. Arguably they could charge higher rates to those individuals (like they do to smokers). Health insurers already "discriminates" against you if you've prior disease. They can continue to do the same and it will be no more wrong than it is now. Discrimination is unjust. Medical facts are not discrimination.
No. Because no one is subject to random economic events. Yes, people unexpectedly lose their jobs, but anyone who is well prepared won't be subject to significant risk because of that. They will have savings set aside and they understand that they will have the (federally mandated) option to continue their current coverage for up to 18 months if they chose to pay.
Except that (given the current model of insurance and health care as a commodity rather than a human right) when you purchase and insurance policy they have every right as a business interested in making money to say: "Do you have any pre-existing medical condition or genetic predisposition to any significant medical illness?" If you say no when the answer is truly yes, you are violating your end of the contract. If that can be proved in the future by subpoenaing your private health care records or if you actually do something like the woman in TFA that reveals your genetic status in your health care records, they can cancel your policy, since you lied when entering the contract for health insurance.
And since this is a business contract, your medical privacy is meaningless since the insurer can also (as a condition of selling you the policy) require you to allow access to all medical records and tests. Of course they likely won't do that unless you actually become sick and they have to pay money for your care. If they do, they hire people to scour your medical record for one slip up (like you may not have revealed you had a cold in December 1987 for which you were prescribed robitussin with codeine) as a means to void your policy.
Events like the recent ruling in favor of a woman whose insurance was canceled while she was undergoing treatment for breast cancer (because she had failed to reveal a history of a heart ailment and she mis-estimated her weight) are unusual - but only in that the arbitration judge ruled in her favor. Most of the time, arbitration (which you must agree to when buying any private insurance - they all require it) goes in favor of the side with the best attorneys to back them. No surprise that the insurers love arbitration. However this case was so egregious that even the arbitration judge was shocked - for example by the fact that healthnet maintained there was no real harm to the woman from dropping her (since after a couple of months she was able to get care in a state program) or the fact that company documents revealed that employees of healthnet actually got bonuses based on the number of policies the were able to cancel for patients on whom the company was losing money (i.e. sick ones.) http://www.latimes.com/features/health/la-fi-insure23feb23,1,2680255.story
Consider that the National Association for the Self-Employed offers the following on their policies: you pay a monthly premium from now until you're 65. Your premium never goes up. When you get there, they say, ok, lets look at your claims against the insurance. They add them up. Then add up the premiums you've paid. And they give you the difference if anything is left over. Apparently, they invest the money because i was told that if I started today, i would have about $800k in premiums paid. Then they would deduct the claims and give me the difference. They are the first company I've heard of that does this. Had I know about this, I would have done it a long time ago.
The diversity and expression of human opinion is essential to human survival.
Don't sweat the small stuff, people. At the moment, the insurance companies can't accurately enough correlate your DNA to your future expected healthcare costs - Your familial history and general current health indicates that far more accurately.
So don't worry about taking your curiosity underground, the evil bastards simply don't care yet; and when they do, you'll simply get your test date in the mail (or the option to drop your coverage).
Wait until someone's genome is copied without their permission from when they donate blood, and the privacy backlash leaves blood banks dry, patients dying.
Individuals should get the same explicit copyright protection on our personal data, including our genetic and other health data, as corporations get on recorded products. Personal data must be destroyed once the transaction for which it was initially transmitted is complete, with short timeouts, unless explicitly permitted into some specified other scope. Violations should be criminal violations of our privacy rights.
Probably we need a Constitutional Privacy Amendment to make indisputable the force and clarity of this protection of our rights. The Fourth Amendment already protects our private data, but the government hasn't been enforcing it. Since the 4th is itself redundant to the Constitution's lack of a created power to invade our privacy, it's clear that the fundamental line between private and public that is the basis of our liberty must be reiterated strongly or be ignored.
As our entire world becomes defined by the Info Age, the people better get our government to properly protect our privacy soon, or there will be blood.
--
make install -not war
Don't be ridiculous. Here in the UK, as in Canada and a lot of other developed nations, technological advances such as this are hugely advancing prevention of inherited diseases. My ex, for example, discovered she had a gene which made her prone to a certain type of cancer, so the NHS (national health service) put her on regular screenings for it.
Free health care doesn't have to mean lower standards. All the bull in the USA slating universal healthcare is coming from.... you got it, the medical insurance industry. Joe public believes what his TV tells him and falls for it hook, line & sinker. Sicko was a little biased, I'll give you that, but the points Moore made were 100% valid. I needed some antibiotics on a recent business trip to the USA and for a 5 minute consultation and 20 tablets it cost me $300. 'The greatest nation on earth'? Do me a favour!
Go Clinton, I say. The USA needs a serious kick up the ass in terms of its view of healthcare.
I think this is pretty interesting, because 100% of the time, I have to fight to get a solid copy of lab reports on blood work, and half the time the staff at the doctor's office (across several offices) will look at me like I'm some kind of freak because I want copies of my own medical tests and doctor's notes. I can ask that copies of whatever's produced by a test be sent to my home address as well as the ordering doctor's office and they never, ever come. Not once.
The only effective way I've found to actually get records is to tell them I want records faxed to another doctor... at a number I receive at.
If my experience is any indication, most patients don't have *access* to their own medical records, let alone control over them.
Tweet, tweet.
Under the condition that the subject of the test must not be coerced or required to take the test, I agree. That would include any form of explicit or implicit requirement, e.g. for employment the employer would not be allowed to require or encourage DNA tests (by preferring candidates who subject themselves to the test).
Justice is the sheep getting arrested while an impartial judge declares the vote void.
You begin living as frugally as you can, but the bills keep mounting. Your insurance has a $2,000 deductible per year, then you have to pay 10% of costs up to a maximum out of pocket of $6,000 per year. So the first several months, you pay out $6,000, but then the first of the year hits and you again have to pay $6,000 in the first few months of the next year. So your $50,000 in savings is now down to about $25,000 just with your out of pocket costs and paying 18 months of EMTALA coverage.
The chemo and radiation you receive gives you profound weakness and nausea/vomiting. Unfortunately the inexpensive antiemetics phenergan, compazine, and reglan all give you a severe dystonic reaction. So the only one you can take is zofran, which your insurer refuses to pay for because its non-formulary. You only use it for the worst days after your rounds of chemo and split pills when you can, but its the only thing that will help. Even ordered online at the cheapest Pharmacy you can find they cost $10 a pill. So you end up spending an extra $300 per month for medicine in addition to the $15 per month copay each for your other half a dozen medicines. So your out of pocket drug costs are $400 per month. That plus your bare minimum living expenses (food, utilities, tax on your house, travel to and from the hospital) are about $2000/month. So by the middle of the year, your savings have dwindled to almost nothing.
So you begin borrowing by taking a loan out on your home, this gets you through the end of the year and into the beginning of the next. Unfortunately, as a result of the treatments, you suffered a mild stroke and now have to walk with a walker. So you begin the laborious process of applying for disability. You are initially denied, and hire a lawyer who works on commission, but he tells you it will probably be a year or more before you get disability (and hence medi-medi coverage as well.)
I'm getting tired of writing this, and depressed because its all too common. Over half of people in the US in 2006 who filed for bankruptcy did so because of health care bills. Over half of those were employed and insured when they became ill. Don't fool yourself into believing that you can render yourself immune from this should you lose your health and hence your usefulness to a capitalist society. We discard 'useless people' like yesterdays newspaper. And the only reason it hasn't happened to you is you are still producing.
- The more intelligent solution is to outlaw discrimination based on pre-existing medical conditions (thus destroying the business model of the insurance industry as it exists now in the US, which wouldn't be a bad thing). The point of the medical industry is to cure people. The point of the medical insurance industry is to make the most money possible. They are contradictory goals for which only legislation can facilitate a more rational change.
And a point from the article: A bill that would ban genetic discrimination by insurers and employers -- and presumably make people feel safer about taking care of their health -- is stalled in the Senate. I will tell you that if insurers have this information then they will take steps to discriminate and obfuscate this discrimination as best they can. Like any other multi-billion dollar industry, these people are not fools or philanthropists; they will use creative accountants (think Enron), statisticians (think Ford Pinto), lawyers (just think, no explanation required), lobbyists, MBAs, etc to get what they want and minimize any adverse effects of their image.
DNA testing will just be another way to make it more "fair" and "rational.'
... but that means nothing here. Our bureacracies are very different: their's works very well and has a much higher degree of trustworthiness than ours ever will.
That is, profitable.
I see some people from Europe and Canada posting here about how wonderful their respective medical systems are, and how America should move towards a socialized approach for our health care.
Might as well try to institute such a system in Mexico, or any other nation with thoroughly corrupt government and private sectors (like the U.S.) I mean, hell, we've been throwing money at the education system for years (sixty percent of my property tax dollars go to "education") and for all that we're near the bottom of the education heap. Why does anyone believe that throwing vast sums of Federal money at the medical system, thereby subjecting all of us to even more government scrutiny, will have a positive outcome? When will we understand that these people can't be trusted with the power they already have? Yes, I know that countries like Germany have a fine socialized medical system
Besides, people forget that we've already had socialized medicine in the U.S. for decades: it's called Medicare. Do want more of that? Yes, it's only for older people, or those of any age who have specific conditions (such as total renal failure) but it can hardly be pointed to as a successful operation from a cost-benefit perspective. Any national health-care system as proposed by some of our Presidential candidates would, in effect, expand the Medicare tax base to theoretically include everyone. Given the fraud and malfeasance and gross inefficiency of the current Medicare system, I simply don't believe that our government (or our health care providers) can be trusted with even more power than they already have. The way they handled Medicare has conclusively demonstrated that they are incapable of acting honestly and in good faith when it comes to health care.
I'm not saying they'd just make Medicare bigger: they'd probably establish an entirely new bureaucratic organization to handle a national medical system. What I am saying is that any such organization will be just as efficient and trustworthy as the DHS, the TSA or FEMA. It can't help but be anything else, given how our government works today. Furthermore, given the propensity for certain three-letter agencies to ignore their charters and lie to Congress, you can bet that socialized medicine would be a privacy disaster.
We'd probably be better off getting the food lobbies out of Congress and spending some serious money on public education, to teach people how to eat. Hell, if we just got a significant number of people to lay off the fast food it would cut the number of new diabetes and cancer cases. In the long run, if we became a healthier nation overall, we'd have less dependence upon advanced medical services.
The higher the technology, the sharper that two-edged sword.
Insurance is all about modeling the risks for an individual based on available medical data.
No, Insurance PROFITS are all about modeling the risks. Insurance is actually about distributing unknown risk among a large number of people. If I had a time machine and could look into the future and see if I'd ever need insurance, the whole thing would become completely pointless, as I'd know exactly what was going to happen. If the insurance company had access to my "time machine test results", they'd either cancel my health insurance if I was going to get sick, or I'd just sock all that money away in a bank account if I wasn't.
In *theory*, if genetic screening can increase the accuracy, then people with clean genetic situations should get decreased rates from what they pay now, while those with the dispositions carry the burden of the risk.
I think what people are really concerned about here is that certain individuals will just not be able to get health insurance. We don't really worry about that for car insurance, or flood insurance, or whatever, since you can always choose to not drive, or live somewhere else. Without health insurance, the only real alternative if you get gravely ill is death, or bankruptcy and losing your job (then maybe medicaid will take over). I think most people would say those aren't very good alternatives.
AccountKiller
taking care of you.
They are in the business of evaluating risk and spreading that risk to all of their share holders while charging a premium based on the risk in order to MAKE A PROFIT.
You, as an individual, don't matter. In fact you, as an individual, don't exist.
If you fall into the cost side of the equation, they will try to eliminate you as you are reducing their profits.
You can't run health care for profit.
The United States is the LAST hold out in the civilized world where people think it can be. (Actually, they DON'T but the major shareholders, being anonymous pools of capital, DON'T CARE about the suffering of individuals.)
You aren't even a line item on a spreadsheet somewhere.
The only way to actually run a health care system (as opposed to the health-don't-care system currently in place) is with socialized medicine, just like we have a socialized military (you don't want a bunch of militias running around after all.)
Health is a social responsibility.
Insurance is an actuarial game played for profit. (As long as you don't need it, you don't mind losing a little bit since it is spreading risk around to all the players. The problem comes when you DO need it and the companies DON'T WANNA PAY. [With health care, you might very well DIE!!])
MSBPodcast.com The opinions expressed here are my own. If you don't like 'em... Think up your own stuff.
Its not rocket science: You can do health care for people or for profit. Not both simultaneously.
Best regards,
UTW
I like the idea of a Health Savings Account in conjunction with a High-Deductible Health Plan. The idea is that you contribute a limited amount annually to a special IRA. Each year, you pay (tax-free) for your medical care out of that IRA until you hit your deductible. Then, everything's free. Next year, you contribute the same limited amount, the deductible resets, wash-rinse-repeat.
The neat thing is that you benefit from leading a healthy lifestyle, but you're still covered in case of some catastrophic health issue.
One secondary effect of using an HSA is that it makes routine healthcare decisions economic decisions. I think that's a good thing. Others might not agree. But I suspect that if everyone used these things, the cost of healthcare would decrease. Just my opinion.
First, with more and more people who are uninsured or underinsured, the experience of finding oneself with a serious illness and no way to get help without bankrupting yourself and your family is becoming more common. This experience is also entering into the middle class (and even upper middle class) ethos because its not just a poor person's problem anymore.
Second, any idiot with a modicum of intelligence can see that the US health care system is failing the US population. Even those who are insured cannot be guaranteed care when they need it. The US is undergoing an emergency care and on call crisis due to the problems created by uninsurance. If you are a specialist and agree to be on call for a hospital, or you are a hospital who has an ER, or if you are an ER physician on duty in those hospitals, you are bound by the EMTALA law which says you have to provide care for all medical emergencies regardless of ability to pay. This unfunded mandate is pushing emergency care to the breaking point. From 1993 to 2003 in the US, 425 hospital EDs closed their doors; the number of ED visits rose by 26% during the same period (Institute of Medicine, 2006). Moreover try to find that on call neurosurgeon you need to drain your epidural hematoma or the hand specialist to reattach your finger in under 4 hours. Specialists are now refusing to take call because it makes them vulnerable to provide uncompensated care. So while years ago, it was only the poor who suffered, now even the insured are suffering because ERs are overcrowded and specialists are just unavailable. (See what's going on in LA's now as its emergency system implodes if you would like an example.)
Third, (and this is the only thing that has kept me from leaving the US to practice in Canada), I genuinely think the American people are good and want a system that provides people health care just like we provide every child an education and other services like EMS, fire, and police. When bad things happen to others, I think Americans really do want to help. I saw that when I was a chief resident in the ER at Brooklyn's largest trauma center on Sept 11, 2001. We saw it in the actions of individuals and organizations to help NOLA after Katrina when our government stood by with its hand up its ass. Most of us, at heart, are not hateful neocon hawks. However, the hateful neocon hawks have pretty mighty propoganda machines and they were able to fool a lot of people a lot of the time. But eventually we do come around. Witness the phenomena of Evangelical Christians who won't vote Republican because while they don't support abortion rights, or my right to marry my partner, they think that the US's inaction in Darfur, the war in Iraq, the fact that Americans are dying as I type this from preventable diseases, the fact that poor children are abandoned in drug and gun infested warehouses that used to be schools are far worse tragedies than the fact that I have buttsecks with the man I call my husband.
And I would damn rather work in an organization with one of those folks or have one as my neighbor than you. Because she and I would both be Americans who love our country and understand that diversity of beliefs are OK, but that first and foremost we have to ensure that there is social justice, that every child has an education, that every person has health care when they need it, and that our military and our political capital is spent on real problems like resolving the tragedy in Darfur and creating freedom in China rather than creating a profit for Haliburton.
Nick
Institute of Medicine. (2006). Hospital based emergency care: At the breaking point. Washington, DC: National Academies Press.
What we call health insurance in this country is actually a pre-paid health maintenance agreement. There is an insurance component, but by and large the costs are associated with routine care, not insured healt disasters. Right now, the closest thing we have is the high deductable health plans which work with a health savings account. In the HDHP, you pay every dollar of care out of pocket until you reach your deductable - about $2.5k for a single, or about 5-6k for a family. This excludes just about all routine care, which means that it doesn't kick in until you've hit a real stumbling block, healthwise. In return, the gov't lets you put away money, pre-tax, into an account (savings or investment) which you draw on to pay your health expenses.
Everyone on insurance already has a "single payer system," it's just that the "single payer" is the group of health insurance companies instead of the government, but they act and think with close to one voice. Right now we aren't covering everyone, though we could for about 1.2T/yr through the existing private system*. It would be a significant burden if the cost were borne by employers, as most businesses just can't foot the bill for $8-12k/yr/employee, especially when the coverage could cost more than the employee's salary.
Anyway, the point is that there may be two systems needed - one for health maintenance, and one for catastrophic coverage (which I like to call "hit-by-a-bus" coverage). As with all things, there are some gray lines at the boarder between the two. And this doesn't really address the DNA problem, though it would be reasonable to expect a test to get a rate for the catastrophic coverage, since that is a pretty straight forward way to more accurately determine risk, and no different than charging 22 year old males with sportscars more for auto insurance - even if the never drive more than 35 mph, and only take trips to church on Sundays. That's what probability and risk determination is about. If you don't like it, save your money yourself for that rainy day.
I will say that I would prefer cancellable "term" policies rather than the annual individual policies that are common today. Right now, if you're too expensive, you can simply not be renewed. With a term (say, 30 year) policy, you have a guarantee of coverage for your term with embedded annual escalation and whatnot, just like life insurance. You might even get a product similar to whole life insurance, which guarntees your coverage until you die. (Note: just like life insurance, health insurance has caps on your benefits).
As with all other things, there ain't no such thing as a free lunch, so the total money into the system = total money out of the system. There profit on gross in healthcare insurance is probably small, just like most businesses (2-8%). My point is that everyone can't just put in their $120/week, get routine healthcare (office visits, minor events, maintenance prescriptions, and some elective procedure) taken care of and then have a heart attack and run up a $280k tab, and expect the system to stay solvent. Healthcare is one area where manpower is necessary to get things done, and people who are competent and reliable cost a _lot_ of money to hire, train, and retain. Most people would be surprised to find that the job which pays them $25/hr requires billing them out at $75/hr to be worth while for the company (you know, that 2-8% profit margin). And hiring reliable people to work on the most basic parts of your health costs quite a bit more than $25/hr most places.
*extend the federal employee group for BCBS standard to count every citizen, paid at roughly 100M policies at 12,300/yr, per http://www.opm.gov/insure/health/08rates/2008non_postal_ffs.pdf
Is it just my observation, or are there way too many stupid people in the world?
No, I was just told a story by someone who can't even take the time to lookup which laws are relevant to the situation. The story was no more reality than your average night of WWE.
Here's some problems with his story:
- $6000 year maximum? Not at any job I've ever had. Think $1500 for deductibles and then you're done paying. Everything beyond that goes on the policy.
- EMTALA is a subsection of COBRA and has nothing to do with continued coverage after termination. It has to do with refusing coverage and transferring patients. Another section of COBRA says is that after you leave your job, you can continue to pay the premium at the rate the company paid. No company pays $700/mo for their normal employees. The number is in the area of $200-$300/mo.
- Employers with medical coverage also offer short term and long term disability coverage. For about $10/mo you're covered in the amount of 70-80% of your salary for varying lengths of time depending on the specific program. You don't need to stop receiving a paycheck because you're sick.
- $2000/mo in expenses (not including a mortgage or rent)? I don't think so. My entire cost of living including rent, car payment, food, utilities, gas, auto insurance, etc. is about $2200/mo. Over half of that is rent. Someone who already owns their home (as posited in his story) will have living expenses in the sub $700 range. Add in his $400/mo meds and you're only at $1100.
- For a home owner you're looking at somewhere around $100,000 (minimum) in equity that can be tapped. More likely in the area of $250,000 and possibly as high as $500,000-$1,000,000 (in the north east/north west metro areas.)
He wanted to tell a story, and I'm fine with that. But don't think that his work of fiction is common. His story churned through $50,000 in 18 months. According to this the average cancer patient runs $36,000 in uncovered medical bills. The average seriously ill patient has $13,000. And these are the people who are declaring bankruptcy. Which is the point I was making. People who are prepared won't have this problem as they have been living prudently and have some savings set aside for a rainy day.
Using the corner cases to determine your health care policy is dumb as they will suck up 100% of your resources.
They already foot the bill for the military, let 'em foot the bill for health care and for the same reasons.
... I'm glad the DHS and TSA aren't very efficient at what they do. But when it comes to providing certain kinds of services you don't want the Feds directly supplying them: traditionally, the best solution is usually a heavily-regulated private sector (the old Bell System was a good example of this.) Unfortunately, our government's ability to effectively develop and enforce such regulation is severely handicapped nowadays.
..." they own you. If you think government types aren't as addicted to that power as those who run insurance companies, you're fooling yourself. You can bet your left kidney that any legislation written to create a nationalized health care system would grant the bureaucrats the same (or greater) power that Medicare officials have in determining who gets treated and for what. They won't be able to resist the opportunity for a further extension of their already-excessive power base.
... just because socialized/nationalized medicine works for other societies, other cultures, has no relevance to whether it will work for us. Our own history is pretty clear on the fact that it won't. One wonders where our Canadian friends will go for lifesaving treatment when their system puts them on a waiting list, and we Americans have completely screwed up by letting the Feds run the show.
Do you have any idea how corrupt and wasteful the military/industrial complex is? It's too bad my father isn't still around: he'd enlighten you in great detail. The reality is the government does nothing efficiently. That's not always bad
That would be the federal government's sole responsibility, not deciding on treatment or deciding anything else.
You making, I believe, the fundamental mistake of assuming that the government would handle matters any differently. It won't. Both gain and maintain power by a form of elitism created by having the power to exclude. Once they can tell you "no, we won't treat you for this condition unless
The ultimate problem is one of the middleman. The system has completely divorced the cost and availability of medical care from our ability to pay for it. That's what middlemen do, when you get right down to it, all the while picking off a healthy chunk of each transaction for themselves. In the long run, it's irrelevant whether that middleman is a regulated publicly-held corporation, or a ballooning government agency. Corruption will occur, bureaucracy will grow exponentially, with health care providers and equipment suppliers milking the system all down the line. That's the way things run in this country today, it's the way Medicare has always been operated, and expecting a completely nationalized system to work any differently is naive. When leaders (or potential leaders) claim otherwise, they are being utterly disingenuous, and immediately disqualify themselves for my vote.
I'll say it again, because it bears repeating
The higher the technology, the sharper that two-edged sword.
Just to finish addressing your point, most of which was already well covered by the previous poster:
Newsflash, free shitty health care is available right now in the united states it's called the emergency room and just don't pay the bill.
You do realise that you already pay for that out of your state taxes right? For the many millions of uninsured Americans (and illegal immigrants) without a primary physician or any form of preventative medicine, when a condition gets so bad that they have to turn up to the ER for treatment it is already funded by the hospital?
The steps are thus:
1 - Poor person has high blood pressure
2 - Poor person has no primary physician and doesn't take antihypertensive medications because they're too expensive
3 - Poor person has a heart attack/stroke
4 - Poor person comes to the ER and if they're not already dead...
5 - Poor person has angioplasty/bypass/coiling of stroke/neurosurgery - the US does have the best care available after all
6 - Poor person spends days in hospital/ICU
7 - Poor person discharged home without any means to pay for preventative medications etc..
8 - Poor person is less able to work and contribute to the economy
9 - Lather, Rinse, Repeat 35 million times over...
Now, interventing at step 2, like most western nations with universal healthcare, prevents the number of people reaching step 3 and hence the much higher relative costs of steps 5 onwards.
I'm not saying that steps 3 onwards don't happen in Canada, the UK or France, just that we have more people hovering at step 2.
The kicker is this - you already pay for steps 4 through 6. Just as you say 'turn up to the ER and leave without paying the bill' - well, someone has to pay for it. That someone is the hospital, as mandated through a congressional bill. The hospital is not funded for this compulsory treatment however and therefore skims a little bit off everyone who actually has insurance instead. This puts your insurance costs up and hits you in the wallet, the only place you seem to care about.
No, actually, not at all. A Health Savings Account is an individually-owned savings account. Anyone who wants to do health insurance this way has to have their own, and provide all the money that goes into it. The catastrophic insurance is provided by private insurance companies, much like car insurance.
Not at all like the NHS, the Canadian system, the French communal insurance system etc..etc.. at all...
Correct. It's not at all like any of those things. In fact, I'm actually very relieved that it's nothing like the NHS. I prefer my healthcare *not* to kill me...
See, it all sounds good until you call it 'socialised medicine'
No, I think an HSA is probably as close as you can get to the polar opposite of Socialized Medicine.
In reality, you know it's better than the status quo, you just can't bring yourselves to admit it.
Once again we see why commercial health care doesn't work. The profit motive provides HUGE incentive to deprive people of coverage. A universal system, funded either by a universal flat levy or a tagged portion of tax, would make such exclusions both irrelevant and contrary to the PRIMARY goal of providing appropriate and sufficient health care to people who need it. The young and healthy of course subsidise the care of the very young and the old and the injured. That is what insurance IS: spreading risk across a broad enough group to make the final cost an average of the wellbeing of EVERY person. The US health care model is deranged and dysfunctional...and the big profits that generates sees it stay that way...and the propaganda that money pays for has for decades tricked Americans into thinking there is no better way. If they stopped warring with the world, the cost of meeting health care requirements would be easily funded by7 what is currently wasted on "defense" spending. Obvious enough to pretty much everyone everywhere.......
Only boring people are ever bored.
It is a horrible idea, because market conditions do not apply to health care - there can be external costs when you decide not to seek care.
Because many diseases are contagious, your failure to seek care can affect not just you but everyone in the community. It is very bad policy to have a healthcare system that discourages you from seeking care - if you might have SARS, bird flu, TB, hepatitis, AIDS, herpes, or any infectious disease, it's in everyone's interest that you get your ass to a doctor before you spread your germs around. But high deductible plans encourage subscribers to not seek care: "Oh, it's probably just a cold, why pay for an office visit to find out for sure?"
The potential costs only get higher as the threat of bioterrorism grows. I can see it now: "We would have known about the attack sooner, but the vector was released at a Libertarian Party meeting. The first infected group all had HSAs and high deductible health plans, and most decided to save the cost of an doctor's office visit and tough it out...now the epidemic is raging out of control..."
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood