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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?
One of the better arguments I've seen for fixing the current health care crisis can be seen here
Of course, the insurance companies (who have very powerful lobbies) will attempt to shoot this plan down as they stand to lose. Though it really can be forcefully argued that insurance companies really do bring nothing to the table in terms of health care. Fundamentally, the idea is a good one when constrained. However, insurance companies have become too powerful and they now function as parasites on the system, making it less efficient and more expensive for the end user. Ask yourself: "what product do insurance companies offer in terms of health care?" What do they create? How do they contribute to health care? When it comes down to it, health insurance companies are not in business to provide health care or help you pay for health care. They are in business to provide insurance, collect money, minimize any payout and answer to their shareholders who expect the system to turn a healthy profit. Any reduction in what they have to pay out is money earned for them.
Which candidate will be better positioned to answer the problem? It will be the one who is able to make some hard decisions and stand up to powerful lobbyists. It will be the candidate who is able to apply creative thought and novel solutions to problems that we've been creating for ourselves for decades now. it will be the candidate who is able to rationally apply logic and recruit, retain and manage in their administration, unbiased and reasoned people who are willing to work hard on solutions that will benefit Americans and the wider global population.
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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.
With an obesity epidemic... which candidate has the best answers?
That isn't something that the government should be dealing with, or even give a damn about. If people (and this includes me, I'm a big guy, so I'm not just picking on others here) are too damn stupid or lazy to manage their weight properly, that's their own fault. Our government has WAY more important issues to deal with than trying to coax some fat Americans into improving themselves.
"16MB (fuck off, MiB fascists)" - The Mighty Buzzard
All I can really say is the obvious: That people don't believe that government is there mostly to just protect rights anymore (if that ever was really the case), so socialized healthcare will be a reality whether we (or I) like it or not,
and that once you get government in healthcare, the incentives to cut costs in places that aren't immediately visible and to pass laws that limit what we can do (and eat, and so forth) are even more likely to go into effect to keep costs low. Expect more restrictions on things like fast food if this goes into effect. People, apparently, cannot take care of themselves, so we need "Democracy" and mass opinion to do it for us. Some people might get the shaft and lose things they love, but in a democracy you sometimes gotta break a few eggs to make an omlette, right?
Which seems to distill to "We can't risk helping people in case we accidentally help some people we don't like."
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.
In 2006, BBC flagship news programme Newsnight featured Cuba's Healthcare system as part of a series identifying "the world's best public services". The report noted that "Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority" The report stated that life expectancy and infant mortality rates are pretty much the same as the USA's. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power.
"Kill 'em all and let Root sort 'em out"
If we take a look at the costs of manufacturing in the US, there is one expense that manufacturers (such as the auto makers) pay here that they don't pay pretty much anywhere else - health insurance. For every new American-built car sold, a staggering portion of the price of the car goes to cover health insurance.
Yet our country spends more per capita on health care than just about any other country on the planet, thanks at least in part to our for-profit system. In other industrialized countries, the workers are still paying for health care, but it comes out of their paychecks in the same way taxes come out. And in the end those other countries can make similar products at a lower final manufacturing cost (even after paying to export to the US).
If people are so certain that the US system is great, then please answer one question. How can we make American manufacturing competitive on the world market again while paying the highest health care costs in the world?
If you look at our top trading partner (that would be Canada), you'll see that their workers make comparable wages for equivalent jobs to those in the US. Yet numerous auto manufacturing facilities have been moved to Canada to save money. Where is the savings if the workers make similar wages? It is in health care and pensions, both managed by the state.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
There seems to be something of a misconception amongst most Americans that I speak to, that your only options are the current system or some kind of filthy commie healthcare system where government employees carry out open heart surgery with rusty cutlery.
The current system in the UK, for example, offers both private and state healthcare, with the NHS free for all and private healthcare available if you want to pay a bit of money for a TV in your hospital room and a shorter wait for your elective surgery.
If you don't want or can't afford private healthcare then you can use the NHS, which is perfectly adequate for most people and certainly doesn't have huge waiting lists for essential treatment as some people seem to believe. Yes, there are the fringe cases, but for the mostpart the NHS is no worse than any of the private medical services when it comes to patient care.
As a result of this system, the private healthcare providers have to charge reasonable rates, because they know that people will simply abandon them for the NHS if they don't appear to be offering good value for money any more.
Americans seem to be terrfied of any kind of government provided or subsidised healthcare at any level, almost as if they see it as a "gateway drug" to communism - as comical as that appears to the rest of the world.
Disclaimer: I currently contract for the NHS, making me far more cynical about it then I might otherwise be.
Huh? Since when it it a Constitutionally delegated power of the Executive branch to "make sure" that Americans are "able to stay healthy," while also meddling in their finances?
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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.
Walk into any Emergency Room lobby and you'll see a sign saying "you will be treated regardless of your ability to pay"
Which encourages a mentality of waiting for health problems to become emergencies and discourages any sort of preventive measures to maintain health.
Sorry, health care is not a right, keep the government out of it.
Just to make a discussion of it, why not apply the same to fire fighters? Why should the government care if your house is burning down? There's a hose over there.
Here in Aus we have both nationalised AND privatised healthcare. Yes we are the country of moderation, never going to one extreme or the other.
I've made use of our public hospitals in my life for:
1. A severely broken leg (emergency).
2. A radio frequency ablation (serious but not urgent) in and out in a day, by one of the leading heart specialists in the world.
3. My sons birth...single room for the Mrs, very quiet, great midwives and a nice experience. Funnily my other half is from the UK and MUCH prefers our system and hospitals. Though more stuff is covered over there apparently.
All of these cost me nothing up front, service in all cases was great.
That includes the midwives, the bulk billed GP visits, etc.
Now the cost. I pay ~$600 a year on the 'medicare levy', that's how much it costs me in taxes. That's full cover (except dental, public doesn't cover most of that) for $600 a year for top notch service. There's more than that, but as a tax paying citizen, I'm happy for a portion of my taxes to be alloted to public healthcare.
My mate pays a little more than that for private health insurance. He fell off his ladder a few years ago and totally mangled his wrist, nasty business, many breaks. After years of putting into his private insurance...he ends up in the public system anyway. There was nobody available to operate on him in the private hospital we took him to. Total waste of money.
My father had his ankle fused in the private system, his treatment was no better than the public system. Except he got to pay a $3000 premium for the effort.
I'm happy to pay ~600 a year to the government for 'health insurance', it's money well spent.
I hear of Americans paying in the thousands a year for cover, I have to ask...why? Surely your hospitals can't be that inefficient, or are you all just very sick?
I like our system, it works well. You can have the best of both worlds if you find the right balance point, going to one extreme or the other with total nationalisation or total privatisation seems silly.
"My personal health is my responsibility. If I want to smoke, drink, and eat fatty foods until I die of a massive heart attack, that's my business. Nobody else should be concerned with it. If it can't afford to pay for the health problems I've brought on myself, nobody else should be required to pay one red cent to cover me."
I agree. But what if the heart condition is hereditary and you can't afford to pay? Then you have a serious problem.
Look, I hate the thought I my money going to people who don't want to work, who don't want to take care of themselves, etc. There will always be people gaming the system because they're deadbeats and lazy and scammers, etc.
The the reality is, if I were to become homeless, I would want food, shelter, treatment until I got back on my feet. If I were unemployed, I would want food, shelter, medical treatment until I found a job. If I got some disease and couldn't afford it, I would want treatment. Just because some people refuse to find a job, or pick themselves up by the bootstraps doesn't mean the system is completely out of the question.
That costs money. At some point, you have to suck up the fact that some people game the system and will get my something for their nothing. That's life. That's taxes. That's school levys. That's fire/police. That's Social Security. In the end, YOU will need those things.
This country, including myself, needs to change it's me me me me me me me me attitude, or we're not going to make it long term. I'm a firm believer that karma is one hateful mistress when you ignore her.
I'm a health care provider. I've been in the field in various capacities since 1981 and as a licensed professional since 1990.
When we talk about the "health care system" in America we have to be very clear about what we are talking about. There are two halves to this system- health care providers and health care finance. The main problems in the US health care system are in health care finance, since this is what determines access to health care.
National health care insurance is an inevitability and IMHO will be driven from the Right not the Left. The driving force will be lobbying from large businesses (GM, for example) that will be rendered noncompetitive by health care costs; they will either go bust or leave the US for countries with a national health care plan. IIRC nearly $1500 of a GM auto's sticker price is health care costs for current and pensioned employees. The creation of a national health system would allow GM and other large companies to offload much of the cost of health care insurance for current employees but also for retirees. This would be a major gain in the bottom line for companies struggling under these costs and other market forces, and would put them on a more-equal footing with most European and some Asian competitors. It would also be a major gain for small businesses (like my Dad's, like the company I work for, etc.) as it would reduce payroll costs. The losers, of course, would be private insurance companies and their CEOs, employees and shareholders.
For the individual, national health care coverage would mean greater freedom to move between jobs to improve one's lot in life and greater flexibility in managing care for children or dependent adults (e.g., aging parents).
The creation of a national health care finance plan would be able to leverage economies of scale unavailable to private insurance companies. The removal of the profit motive would reduce overhead from an industry average of 10-30% to closer to Medicare's 2%- a savings of hundreds of billions of dollars per year right there. With universal coverage, every person in the US could obtain preventive, clinic based care (which is the least expensive way to receive care) rather than letting problem go unaddressed and eventually seeking care in an emergency room (the most expensive way to receive medical care). With universal coverage, health care providers would not face defaults on payments for services which would allow a reduction in the cost of care. Rationing of health care would be reduced through the elimination of provider networks and access restrictions imposed by insurance companies. And finally, authorizations for services would not be influenced by the need to protect the profit margin.
From the provider side, it costs money to get paid. Someone has to prepare a bill and send it out. For many of my patients, payment comes from two to four sources and I have to send a bill to each in turn according to an order of precedence. Each bill costs $3-5 to send, and then there are the costs of tracking reimbursement to collate all the payments, figuring out who gets money back if the bill gets overpaid (which happens frequently because the insurance companies don't understand their own systems very well). Being able to do single payer billing would save an average of $10 per patient in my clinic, which means either more profit or the ability to lower costs for services. Imagine the cumulative savings if the cost of every health care service in America could be reduced by an average of $10.
That all sounds like a panacea and of course no such thing exists. Every health care finance system would have problems. People worry about where the money would come from and the only possible answer is taxes, since that is the only source of government revenue. However, we already pay that tax and then some. Like most people, I get my insurance through my employer. I chose the cheapest plan, which is a high-deductible plan. It costs $512 per month, 50% out of my po
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.
Until very recently health care costs were growing at several times the rate of inflation (inflation has increased a lot) and the US is spending much, much more per capita on health care than other western countries while covering a smaller portion of its population. The uninsured still receive care but they get emergency care and that is a very expensive way to treat most conditions. The cost of that is ultimately passed on to the insured and/or taxpayers so we're currently paying for insuring the rest of the country but at an inflated price and getting poor results now.
There are serious problems with care for the insured. Contracts and billing between hospitals and payors are a terrible mess and administrative costs are a big part of hospital bills with private insurance. Medicare and the medicaids cost a lot less to administer so more of the public health care dollar goes to care than the private counterparts.
I don't think the Canadian or British models would fit America very well but the German system with multiple non-profit payors or the Australian system with national health care and an option for a private premium insurance is something I think we should explore as they tend to keep choice in the equation.
Obama's plan seems like it would be expensive but we're already paying for everyone to get health care now in some form so for the most part this is just shifting money around in an effort to provide better care. I think a lot of the savings with this plan from increased efficiency of care and cutting some of the cost of caring for the uninsured that is currently passed on to the insured is going to be eaten up by the hospital and insurance companies. It doesn't fix problems with private insurance but that's too big of a problem to tackle now.
McCain's plan will cause some employers to drop insurance and make modest increases in cash wages for their workers because it will cost more to insure them and they can just let their employees buy insurance with a tax credit paid by other employers who provide insurance to their workers and some of their fake raise. It creates a competitive disadvantage to offer insurance because you'll be paying more to insure your employees and your competitors while they are probably paying a bit less than they were before. The insurance they'll be able to buy probably won't have group risk built into it so you'll see a lot more medical underwriting so healthy people can get good insurance cheaply and sick people will still have problems getting insurance.
If you didn't come to party don't bother knocking on my door. Prince '1999'
Parent should be modded up. Many are screaming that any kind of progressive change to the health care system would be socialistic. Yet they all refuse to recognize that nearly the entire system we have is already heavily regulated and in no way represents any kind of free market. I assert that excessive regulation and the insurance companies are a huge part of the problem. Unless a new adminstration is willing and able to tackle these issues nothing will change.
One of my job responsibilities is to support a Home Health Care system's application and I have a lot of experience with supporting them. The percentage of effort and expense put into keeping up with constantly changing regulatory mandates is truly staggering. I personally don't understand why people continue to get in the business anymore because they are constantly squeezed between increasing costs, and shrinking revenues. A major portion of the cost increases are due to administrative overhead a substantial portion of which is dedicated to ensuring regulatory compliance. I'm not generally a proponent of deregulation, but in the case of health care the government and industry both have made a huge complicated mess of the entire system.
The problems with our current 'private' insurance system have already been well articulated in other posts here. There's also the topic of legal liability which I won't even start in on. Bottom line is that we all need to be willing to start rebuilding the system from the ground up if we truly want change.
What if the Hokey Pokey really is what it's all about?