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Discuss the US Presidential Election & Health Care
Yesterday we discussed the war and how foreign policy will matter in your decision next Tuesday. Today our series of election discussion pieces continues with Health Care. With an obesity epidemic, a failing economy, and ballooning health care costs, which candidate has the best answers to making sure that Americans are able to stay healthy without America being bankrupted in the process?
Alright, after reading a bit on both their websites, I'm going to try to state the facts and my opinion.
McCain : Actually puts numbers out there on how much you're going to "save" according to your tax bracket. But it's confusing to me how one column is showing a flat tax credit of $5,000 for this and then another column (after factoring something called "Income Tax Liability") showing what you save. He concentrates on guaranteeing me a "Better than Congressman" health care plan when I have no idea in hell what kind of health care they get. He also spends more time talking about Obama's health care plan than his own--which I would prefer to read myself and draw my own conclusions. I guess he focuses more on "net tax benefit" to each tax payer which sounds very enticing from a utilitarian standpoint.
Obama : First off, his health care page has a lot of really bland generic bullshit slurry--quite different from his Iraq withdrawal plan. While he doesn't spend anytime attacking McCain's plan, I don't see how some of these bullets are going to do anything for Health Care. Every talking point sounds good but nowhere do I see a plan of A) how/when this will be implemented or B) what the net effect will really be. For example: "Reduce the costs of catastrophic illnesses for employers and their employees." What is a "catastrophic illness"? Reduce by how much? Who's footing this bill? What percentage is going to the employer Vs the employee? While he offers some lengthy PDFs on his site (that I don't have a lot of time to read), I'm skeptical he has any objective, measurable, attainable goals.
So that's my quick take on this topic. Honestly, I'm not impressed with either candidate. I give a nod to McCain for actually throwing some numbers out there and wonder where the $2,500 per family figure is coming from in Obama's promises. This isn't going to factor into my voting because the roots of this. I grew up on MinnesotaCare so I'm probably going to lean toward the plan that makes the most of providing basic health care to those who can't afford it. My parents never could have afforded vaccinations and I don't think I ever went to the hospital aside from that. Others aren't so lucky. Call me biased or misinformed but I don't see either candidate really doing anything creative/ingenious with health care to the point of it being worth arguing over.
My work here is dung.
Got some numbers on Cuba's healthcare being a failure?
Wikipedia: http://en.wikipedia.org/wiki/Health_care_in_Cuba
References the World Health Organisation.
Despite the US embargo on Cuba.
Dude, you just fucked up. Cuba's health system is the best in "Latin" America, and is in many ways better then the USA's. Tell me how that is a failure?
I wank in the shower.
Wow - you criticize Obama for not providing the details, but when you remark that he has lengthy PDFs you don't want to bother to read. Either you've already made up your mind and are just rationalizing your opinion, or you don't really care enough about the topic to do your research.
At least you admit to having bias, but then I fail to see anything meaningful at all in what you wrote. At the very least, you should said that you don't have enough information to make a sound judgment on the topic, which is fine. Unfortunately, the norm is that people don't want to admit that, and would rather just make up some reasons for their opinions rather than admit they don't know.
You can lead a horse to water, but you can't make it dissolve.
Ah, sense. Such a rare and precious commodity.
What makes less sense is nationalized health care. People in America talk like it's a great thing. Have you BEEN to Canada? My grandfather got sick while on a trip to Canada. He went to the hospital and they told him, "Take the 1 1/2 hour trip back over the border and get treatment in New York. It's not worth the lesser healthcare that you'd receive here."
Unfortunately, the grass is always greener...
"According to the World Health Organization (WHO), the chance of a Cuban child dying at five years of age or younger is 7 per 1000 live births in Cuba, while it's 8 per 1000 in the US. WHO reports that Cuban males have a life expectancy at birth of 75 years and females 79 years. In comparison, the US life expectancy at birth is 75 and 80 years for males and females, respectively. Cuba's infant mortality rate is lower than the US with 5 deaths per thousand in Cuba versus 7 per thousand in the US. Cuba has nearly twice as many physicians as the U.S. -- 5.91 doctors per thousand people compared to 2.56 doctors per thousand, according to WHO."
--
The WHO ignores the distinctly more violent culture we have in the US, worse drug problems, Obesity (not a health care but a cultural problem) and other issues... Life expectancy is a terrible measurement of health care quality.
"Ahh! Arrogance and stupidity in the same package, how efficient of you!" --Londo Molari
We've got neither, despite price controls. What did we do wrong?
Seriously how often does this actually happen? I hear about it but have never known someone to have it happen. I know people who have recovered from breast cancer, a rare form of blood cancer and had a triple bypass surgery. They all had no problems with insurance. I seriously want to see one of these cases first hand so that I have all of the unspoken details from both sides.
I see the glass as full with a FoS of 2.
They are shit holes, in shambles, unsanitary. These are the ones normal Cubans get to visit as opposed to the nice hospital for the party elites and foreigners with cash that you saw in Sicko. Trying to sneak photos of them out of the country can get you arrested, but some have succeeded. I like the guy taking his sick father to the hospital in a wheelbarrow because there were no ambulances. If I go to a pharmacy here I have to pay, but I can get my drugs. There you will see a sign saying there are no prescriptions available.
You forget this is a communist totalitarian state we're talking about. They never tell the truth, just like the Soviet Union was broadcasting about record wheat harvests that'll feed everybody while we were sending them the millions of tons of grain they needed to actually do it.
Whatever happened to personal responsibility?
That's a foreign concept in the US these days.
"16MB (fuck off, MiB fascists)" - The Mighty Buzzard
Hrm, if only they had made a movie about that.
Oh, wait, they did. It's called Sicko.
but if you want to know someone who has 'problems' with insurance: I do. I cannot get any. They won't sell it to me.
If corporations are people, aren't stockholders guilty of slavery?
This topic is one close to my heart... in several ways. I have very personal experience with Socialized Medicine. You see, I'm Canadian, for those of you not familiar with your neighbours to the north, we have a Socialized Medicine system. I've lived under it's jack boots all my life. I have too many stories to cover in this one post. In Canada socialized medicine is an unmitigated disaster. Unless you live in a large population center or in one of the richer areas in Canada you won't get good care. Myself I live in a rural area in New Brunswick, and the 'health care' that Canada offers hear is unacceptable. I actually got a job in the US 'just' to get health insurance. Where I live the closet Canadian hospital is over an hour and fifteen minutes away, there is 1 medical center in my area, open 2 days a week. Only one of those days does a doctor actually operate out of the clinic. I'll give you my own most recent experiences with that system. I was rushed to the near by US Hospital (thank you US Health Insurance), with heart issues a while back. Treated and released for my condition (Aterial Fib as it's called) a day later. I was instructed to see a Cardiologist ASAP to figure out what causes the issue. I contacted Canadian medicare and was told that the closest appointment they could give me was EIGHT MONTHS away. It would be another SIX MONTHS after the consult to have any testing I needed done then another SIX MONTHS to see the doctor for my results. Realize at this point I had no idea what was wrong with me... I could've been dead the next day from it. I promptly hung up the phone and contacted the nearest Cardiologist in the US. This was a Thursday... I was scheduled for the following Monday @ 8:30. I was taken care of and all prudent testing was done over the span of that week, and the week following. My condition identified and treatment was rendered. I encourage people to debate me on Socialized Medicine, I'm all too well versed in it's use. Frankly I can see how on the surface Socialized Medicine would look appealing to people, but once you get underneath to the meat of the matter... it becomes a scary reality. The simple fact of the matter is in a socialist health care system you are at the mercy of the government in terms of your overall health care. I know too many friends and family that have been mistreated, and some killed by negligence on the part of the state in these matters. It is NOT a good system, in practice.
That's a pretty fair request. Though it's obvious typical politician speak to not give these details. The saddest part is, if they did, the majority of the voting population wouldn't be able to look at it objectively enough to understand. I for one think that the scope of health insurance has gone out of control. No other insurance that I know of pays for "routine maintenance". Insurance is for the tragic and unexpected. If your car is due for a transmission fluid flush, your auto insurance isn't going to drop a dime on it, though they might raise your premium if they find out that you are skipping the maintenance. Ultimately the cost of dealing with the insurance companies every day for routine checkups and care raises the prices. Insurance companies are cut a deal in exchange for being able to receive their patients while the uninsured has to pay the full un-discounted price. They can't lower prices for uninsured patients because that would be discrimination by extending different base prices to different patients for the same treatment. So prices have to go up to pay for the administration cost and to make sure that the average revenue stream (mostly from insurance companies) is able to pay the bills.
I see the glass as full with a FoS of 2.
I agree. I'm a doctor in Spain and the system works exactly that way. Here it's not the insurance companies, but the "benevolent health system" that press us into delaying or denying tests and treatments to people. The exact people that see a nice amount of their income substracted de facto by the health system.
Those that want (and can) go to the private system to get things done ASAP. They are paying double, though: to the public system which they can't renounce and to the private system.
Still, nothing can beat the fact the public system is obliged to receive and trat you as long as you're alive. But once inside it's not the money but the "I know someone inside" or "I'll file a complaint" that will get you the best bed, the shortest queue or the specialists you want.
> why in the world are medical tests on machines, like MRI's, increasing in price? It's not because these machines are more expensive now than they where 15 years ago.
Actually, they are. I work for a hospital and am directly involved with the DI (Radiology) department. When I started 5.5 years ago, they bought a new CT scanner, which was pretty decent at the time. Now we are looking at getting a new one and it's more expensive. Why? Because the resolution and speed have increased so dramatically. Back then it was a 6-slice scanner (each "slice" is a detector in the gantry, so it makes 6 images per rotation). Last year, a 256-slice scanner was announced. That means the tests run much faster and have higher resolution, allowing the radiologists to see more detail and give a better diagnosis.
It's a similar situation with MRIs. We have a 1.0 Tesla MRI at our disposal, but 3.0 ones are available now.
Then there are new back-end processes. These devices now create digital images, so there are software costs for the software to run the device. If a hospital/clinic gets one of these devices and doesn't already have a PACS (Picture Archival and Communication System) they almost have to buy one of those (they can get around it, but it's extremely inconvenient). Many PACS systems can run well over a million dollars by themselves, and then there is image storage... The images created by these machines get to be quite large, especially with high-slice scanners, and laws require you to store all of these images online for a long time. Here we have filled our 6TB NAS in about 2 years, and we are a very small hospital. So there are continuing storage costs. We're looking at adding another 12TB very soon, and still worry it's not enough.
Then there's the CIS, HIS, LIS, and all these other information systems that need to work together to keep track of patients' medical records. Those are horribly expensive as well, not to mention the ungodly amount of money good interface programmers demand to connect these systems together...
It's not just a single technology that gets cheaper over time, it has to adapt and get better, which increases the price.
I would have to agree. I work for a hospital coding the electronic forms for the insurance carriers. That's all I do, and I'm not the only person. The carriers change their requirements all the time, which causes claims to be denied. Then we have to change how we submit those claims and re-submit them and hope they aren't denied again. Sure we get paid, but it costs the hospital quite a bit to have all of us employed to get that money in the door. I can't say if the carriers purposefully change their requirements so that they don't have to pay, but sometimes it really feels like it. Why else would they ask for the same doctor's identification number in three different places on the same electronic file? They're excuse is "but we can't find that doctor" even though we're just copying the same number to a different place.
And the selfishness of "it is ALL my money I don't want to share it" attitude
You need to look a little closer. The attitude is "it is ALL my money I don't want to share it WITHOUT HAVING ANY CONTROL...why the hell did I work for it otherwise."
So I'm a Christian. A guy stops me outside a fast-food joint and ask for some money to get something to eat. I'll feed any hungry person. I'll give you half my peanut-butter sandwich. Just ask, and lets get you on a path so that you can stand tall and not ever have to ask anyone again.
I say, "C'mon. Sandwich, nuthin'. Let's get you a meal!"
"Uhm! I don't really like McDonald's. I'd prefer BurgerKing."
I pause, but not for long. "No problem. Fine. They have better burgers anyway. C'mon let's go get you somethin'."
"You won't just give me a dollar?"
"No, man. I'm not going to give you money."
"Fuck you. I don't want no hamburger. Asshole." And with that he walks away.
I've had similar experiences several times. Most people just hand over money. I'll help, but I know that cash does MUCH more harm than good. The liquor store was a block down the street in this case.
I have a brother that was fired from a decent paying job with the sanitation department. By his own words, he spent most of the day driving around hiding from the supervisors so that he could sleep. He was fired because he wouldn't get out of bed in the morning and was consistently late. Some people just cannot be helped.
When the people say they don't want to share, what they are saying is that they don't want a giveaway to parasites who want even try to do for themselves when someone is making an effort to help them.
Aah, change is good. -- Rafiki
Yeah, but it ain't easy. -- Simba
First, the workers do make similar wages, before taxes. It looks like their system transfers the burden of paying for health care from the auto company, to the individual, but in such a way that the individual doesn't really see it (taxes).
Per Wikipedia - Personal Income taxes:
Canada 31.6% 21.5%
United States 29.1% 11.9%
Plus, it looks like there is generally between 10% and 15% sales tax as there are both federal and provincial taxes.
Now, Canadians do pay less overall per capita for health care than Americans. But to be sure, the costs didn't simply vanish from the country, they simply shifted from the employers.
OK, the infant mortality rate is not comparable. The US does a much better job than the rest of the world at keeping premature babies alive. Different countries use a different method of reporting live births. Many countries do not count deaths of premature babies born before 25 weeks. The US counts it. This throws off the infant mortality comparisons. The US makes efforts to keep alive babies born very early, even with 2 lb birth waits. The chance of survival is very low. The death is counted. Cuba and others don't even try and the deaths are not part of their reported infant mortality rate. Here is one of many links. http://www.biggovhealth.org/resource/myths-facts/infant-mortality-and-premature-birth/
Here in Germany, the government is expressly forbidden to specify what a certain tax is going to be used for. Taxes are also expressly described as something that the payer cannot expect an individual benefit for.
Therefore the public health insurance system isn't funded by taxes (it would be impossible to do so legally). Hence it's possible to opt out of it under certain conditions (you're not- or self-employed, a government employee or make above a certain amount if you're employed).
Wikipedia: U.S. government programs accounted for over 45% of health care expenditures, making the U.S. government the largest insurer in the nation. Per capita spending on health care by the U.S. government placed it among the top ten highest spenders among United Nations member countries in 2004.[7] Core Health Indicators: Per capita government expenditure on health at average exchange rate World Health Organization, Accessed 2007-10-05.
The problem with this defense of insurance companies is the added expense and overhead they bring to the health care industry. Billers would not be necessary if insurance companies paid what they were supposed to when they were supposed to. And without billers, health care costs would go down (far less overhead for doctors).
A good friend of mine who is a doctor with a general practice had an experience where he documented every procedure (and these were common procedures for a general practice - strep tests, flu shots, etc), submitted everything correctly to the insurance companies, and paid a biller to collect from the insurance companies. Yet, he did not see a penny from insurance for over 6 months because someone in the billing company he used did a bad job.
So it's not fair to say "we need insurance companies so we'll have enough money to pay for health care" without mentioning that the towering costs of health care can be largely attributed to the state of health insurance.
By no means am I suggesting health insurance doesn't serve an important purpose - but right now they have far more influence over health care decisions and prices than they should.
If I remember correctly, anesthesiologists are never part of a PPO or HMO. They have no financial incentive to do so. Patients don't choose the anesthesiologist; it's usually assigned by the hospital (or more specifically, whoever does the scheduling in the operating room). I used to volunteer in an operating room, and we would change anesthesiologists for cases depending on their availability, or have them switch off in the middle of a long transplant.
Because I work in a downtown area of a city that has no effective public transportation... only a few city buses with routes that are just barely enough to claim they have a bus system at all. There is no residential infrastructure in our downtown area, except for a very limited number of luxury apartments, which one month's rent equals almost two months of my pay. All the grocery stores are on the opposite side of town from the downtown area. Yes, there are public trans bus routes to the shopping district, and I currently live very near those, but have you ever tried carrying several bags of heavy groceries onto a bus?
America is about individual effort toward success. The federal government's job is to act as the mortar that keeps the states together, and to handle international affairs. The government's job is not to be a charity. Charity is the job of the church and other non-profits. The federal government should do the minimum required, and the leave the rest to the state and local governments, and to private institutions.
Insurance rates are high because people who have the insurance don't use it properly. Why go to the clinic for the ear infection when you can just go to the nearest hospital emergency room and pay the same price? When the individual does not feel the price difference, that person does not make smart financial decisions.
Where is the incentive to go to college for eight years, internship, residency, fellowship, etc., when the prospective doctor knows that he will be told by a bureaucrat for the rest of his career what services he will perform for who, and how much money he will get for it. Where is the incentive to work hard and become the best surgeon alive, when he gets paid the same amount for the procedure as the next doctor? If you think HMOs are bad, just wait until you are dealing with the government!
How many here like going to the Department of Motor Vehicles (or equivalent name in your state)? Long lines, stupid people and rules, little individual attention? That's what your health care would be like, an assembly line. You get the same services as the next guy, unless you happen to know someone important.
For those that think we need a socialized public health care system, just look at the VHA. The federal government can't handle health care for veterans, how would it take care of every American?
I'd like to see a truthful example of this from a reputable insurance company. I had an over $100k back and spinal surgery done on a pre-existing motorcycle accident, (broken L2 and L3) from 4 years before I got insurance. I payed the $10 co-pay for the first visit and that was it. I have no problems getting insurance even though I survived.
Paying taxes to buy civilization is like paying a hooker to buy love.
Really, have you reviewed the budgets? http://www.fin.gc.ca/facts/fshc7_e.html