So to you FReepers, I ask for a rebuttal to his argument, if there is any. Please try and present logical reasons as to why.
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Okay, it's not that it's too long, but it's just that he, like Coulter Fhtagn and her degenerate ilk, is incapable of saying anything intelligent that isn't laced with venomous comments about various Democrats who I've never heard of, with words like "bottom-feeders" and "Stalinists" sprinkled about willy-nilly. Basically his entire argument is based around not wanting to indirectly subsidize medical care for people who aren't him.
The United States is the only industrialized nation that does not cover the cost of health care for all its citizens. The US spends more than twice as much per capita on health care than any other nation in the world -- over $4,000 per year for every man, woman, and child. Still, more than 50 million Americans have no health insurance. People without health insurance experience more illnesses and do not live as long as those who are covered.
In the United States two different government agencies, the Congressional Budget Office and the General Accounting Office, conducted comprehensive studies on the cost of providing health care to all. Both concluded that the conversion of the current patchwork of private and public health insurance programs to a universal health care system would save $100 billion on paperwork alone. There would be additional savings depending on how the plan is structured. The GAO concluded that the savings created by switching to a national health system would make it possible to provide comprehensive care for all Americans.
About a quarter of health care expense in the United States essentially comes from paperwork —- having to comply with the requirements of a multitude of different insurance companies for documentation, eligibility determinations, billing of patients, and collections. Because of this complicated payment system, trying to sort out who will pay for the care of a patient means hospitals need large administrative staffs to deal with the procedures of a variety of insurers. Further complicating matters, the present system offers a limited, expensive, and ineffective form of universal coverage by requiring hospitals to provide emergency care to the uninsured. Emergency care is the most expensive form of health care.
Physicians in the United States presently average about an hour a day completing paperwork for different insurance companies in order to get paid for services they have provided. Patients often experience long delays in receiving care because paperwork is being processed. Under many plans, insured patients must make the initial payment for medical care, then submit a request to their insurance provider to get reimbursed.
When everyone is covered under the same plan, the need to keep track of who has insurance no longer exists. A patient in a doctor’s office or hospital doesn't need to provide insurance information before receiving care. Everyone simply carries a card that guarantees access to the care needed.
A single-payer system of health-care financing frees physicians and their patients to keep their focus on health care and the best way to deliver it. The term single-payer describes a government-sponsored form of health-care financing in which a single insurer, the government, pays all of the bills. Hospitals in a single-payer system are paid on the basis of the costs they incur in serving a population, not by each individual patient admitted. The hospital does not need to submit a bill for each aspirin or bandage that is given to each patient. The amount each hospital receives from the government is based on its costs from the previous year plus the cost of inflation. This aspect of the single-payer system is called global budgeting.
The concept of global budgeting for hospitals allows communities and government agencies to make plans to improve the health of the population and prevent illness. By focusing on preventive medicine, universal health care invests in measures such as immunizations to prevent diseases, campaigns against smoking, and mammograms to detect breast cancer in its early stages. A forward-looking health policy carries benefits for public health and government budgeting.
An increased focus on preventive medicine will improve general health conditions and help avoid many costly medical procedures in the future. The use of expensive resources for individual patients can also be reduced as care is shifted to other venues such as outpatient clinics and community care. The outpatient setting allows healthcare professionals to focus on preventive care. Outpatient clinics and community health centers have been shown to reduce the incidence of pregnancy complications and to improve the treatment of chronic illnesses such as diabetes and asthma, resulting in tremendous savings on health costs.
The Canada Health Act of 1984 includes five basic principles that determine how care is to be provided. The act requires that care be publicly administered to avoid the profiteering and increased costs of for-profit health care; comprehensive, so all medically necessary care is covered; universal, so everyone will be covered; portable, so people can move from job to job or city to city without losing coverage; and accessible, so people do not have to go too far to receive health care. This simple act provides one successful example of how the principles of the single-payer system can be put into use.
In the United States, by contrast, the government provides health insurance only for the poor, citizens over the age of 65, and people with disabilities under the Medicaid and Medicare programs. These programs account for less than half of all Americans. The majority of the uninsured are working people and their families. Many employers do not provide health care as a benefit to their employees, or they make the employees pay for such a large portion of the premium that employees cannot afford it.
The single-payer system of health care is not the only possible way to provide universal health care, but it would probably cause the least disruption. In another alternative, known as a national health service, all physicians and nurses are employees of the government and are paid flat salaries. A national health service provides inexpensive and comprehensive care, but reduces the independence of health-care professionals. The single-payer system is more compatible with the way health care is now provided in the United States.
If the United States adopts a single-payer system, the cost of care will be included in taxes instead of the payroll deduction most people pay to cover their health insurance premium at work. Working people who are presently covered through their employment would not experience an increase in taxes. Instead, the money now deducted from their paycheck to pay their health insurance provider would go to the government to help cover the cost of universal health insurance.
Some critics contend that greater government involvement in health care will result in inefficiency and declining quality. In a single-payer system it is not necessary for hospitals to be owned by the government, or for physicians and nurses to be government employees. Government involvement in actual medical care can be minimal. Single-payer is only a method to finance universal health insurance. The government’s primary role is simply to collect money and pay bills, a role that the government can carry out effectively and efficiently.
The single-payer system allows people to decide where they would receive their health care. For many people in the present system, especially those covered by HMOs that restrict choice, the single-payer system would provide far more choices about who they could see for their care and what kind of care they could receive. The current system often does not allow people to have long-standing relationships with a physician because coverage plans change so often that patients never really get to know their doctor.
Some people worry that if the United States adopts a single-payer form of health-care financing, problems with waiting lists might begin here. Indeed patients in some countries where everyone is guaranteed health care, such as Britain and Canada, must wait for certain types of elective care. In these countries, patients with urgent problems receive care immediately. Where waiting lists do exist, such as in Canada, governments are working on managing the systems better. More importantly, in these systems care is given based on medical need instead of the ability to pay. Those who need care the most get the best care first. It is important to note that in any system insufficient financing creates bottlenecks when people try to get access to limited resources. The problem of waiting lists arises from insufficient funding, not from any fundamental problem with guaranteed care.
An important difference between the United States and other industrialized nations is the amount of money the United States spends on health care -— over twice as much per capita on health care as the next closest nation. The United States spends nearly 14 percent of its GDP on health care, whereas most nations spend only 6 to 9 percent of their GDP on health care.
The United States is certainly spending enough money. However, in addition to the amount spent on paperwork, much of this money is diverted into profits for insurance companies and large for-profit managed care organizations. In the US system, care is also rationed, but it is distributed according to the ability to pay rather than according to need.
In most industries free-market competition tends to increase the quality and decrease the cost of goods and services, but this tendency does not apply to health care. Numerous studies show that for-profit HMOs and hospitals tend to have lower quality as measured by complication rates. Increased costs and reduced quality of the US system are evidenced by rising health-care premiums and decreasing patient satisfaction. At the same time more than 125 studies have demonstrated that people who lack health insurance suffer more illnesses and die earlier because they fail to obtain preventive care and receive health care only when their conditions are more advanced.
People in the United States have always had a great deal of pride in the technology and innovation available through the health-care system in their country. Some people worry that changes in the way health care is financed might diminish the incentive to create new innovations. Although many innovations in health care have originated in the United States, countries with universal health care and single-payer financing have also been on the cutting edge of medicine. The first heart-lung transplant was performed in Toronto. The first laparoscopic cholecystectomy was performed in Newfoundland. Surgeons at Saint Paul's Hospital in Vancouver recently pioneered an efficient new way of replacing heart valves. The incentive to create and innovate in medicine comes from physicians’ ambition to help patients and from the prestige and compensation that follow. Single-payer financing does not negate these rewards.
The single-payer form of health-care financing does not necessarily change the way in which physicians are compensated for the care they provide. Physicians still have incentives to provide care under a single-payer system because patients can choose their providers based on their satisfaction with the health-care provider. For example, a physician who sees patients in a private office gives the government a slip imprinted from each patient’s health security card. The government then pays the physician according to a predetermined fee schedule. Income is determined by how many patients a physician sees. As in any system, of course, there can and should be limits on how many patients a physician may see in a given time, to ensure that each patient receives optimal care.
Universal health care with a single-payer form of financing would make the United States a more productive society and allow citizens to feel good about taking care of each other. The current system is broken and harmful. Studies have shown people stay in unwanted jobs to keep their health insurance. There is a growing dissatisfaction with the way in which health care is provided in the United States. This is especially true with the for-profit HMOs. Dissatisfaction with the health-care industry in general is increasingly driving bright, innovative people away from careers in health care.
The biggest question about universal health care is not whether it works, but whether sufficient political will exists in the United States to make such a dramatic change in the way health care is provided. This is the challenge that lies before the United States in the new century. The public acknowledges the need to guarantee the education of all children and the obligation to provide police and fire protection for everyone. Do US citizens feel it is the responsibility of society to provide health care for everyone? If not, who does not deserve to have health care?
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A good debater, that he is. Any help on this matter would be appreciated.
All you need to know about government provided (mandatory participation) "health care" is that in Canada, your dog can get an MRI 8x faster than you can get an Xray. No BS.
Private health care system in Canada is technically illegal under the law, and yet the "single-payer" system is so overburdened -- with demand for services that far exceeds the available capacity -- that provincial governments are now contracting with private clinics to reduce the burden on the public system. Just think about that for a moment . . . you've got governments entering formal contractual relationships with businesses that aren't even permitted to exist under the law!
(As a side note, this is one thing that makes Canada such a great country, despite its clear leftist leanings. The place is so large and sparsely populated that it is basically ungovernable, which means that any law is effectively unenforceable as long as even a small portion of the population -- maybe no more than 10% -- make up their minds to ignore it. This is how gun owners can freely ignore the "mandatory" national gun registry law, why Canada is utterly incapable of projecting military force anywhere around the world, and why British Columbia is now one of the top producers of certain narcotics for drug users all over North America.)
In addition to this specific point, I would add some general arguments about the basic flaws in the delivery and payment processes for any service that involves payment through an insurance-based system. See all of my posts on this thread, particularly the detailed points in Post #34:
It is interesting that the comparisons are always made to the worst of the public health care systems, which are undoubtedly in Canada and England.
Canada has effectively communized its doctors, refusing to permit any of them to truly practice privately. Britain does allow private practice, but costs are prohibitive.
When Mrs. Clinton decided to try and nationalize American health care, her model was essentially the German model of insurance pools.
But I am going to talk about none of those models, nor Cuba nor Tadjikistan. I'm going to compare the US with the best system of public health care: France.
FReepers love to hate France, which is fine.
But let us be objective.
How can one objectively measure and compare health care systems? I would say that two numbers give a good, though not perfect, feel: life expectancy and infant mortality.
Neither of these things are perfect, of course. The Japanese diet is very heavy in fish, as is the Swedish, and they live longer. Is this because Japanese and Swedish health care are superior, or because they eat a lot of fish?
But Canada, America, France, Britain and Germany: these are comparable countries. The heaviest drinkers in that group are the French; the heaviest smokers, I believe, are the English, although the French are much heavier smokers than the Americans. The dietary practices of all of these countries are generally poor. Americans and Canadians eat fast food. The Germans eat tons of sausage. The French butter their cheese. And the English eat, well, garbage.
So, we are comparing relatively comparable groups, with no stellar dietary practices among any. And the French are heavier smokers and much heavier drinkers than the Americans. But they live longer than any of the countries mentioned. They also have the lowest infant mortality rates. Those things are attributable to health care.
The thread already discusses the bad things about the British, Canadian and German health care systems, the heavy hand of government, rationing, etc.
What is the French system?
It is not "government health care", really.
The French system is the American health care system: doctors are independent and free. There are public and private hospitals. Entry into the medical profession is unrestricted and available to any students who want to study it and get good grade. And anyone can go to any doctor or facility he chooses. There is all of the liberty of the American system in the French system, and none of the heavy-handed restrictions.
So, what is the DIFFERENCE then?
The difference is that primary health insurance - NOT provision of health care, but insurance to pay for health care - is provided by the national health insurance, called "Social Security" - the Secu.
You go to the doctor, you pay, yourself. And then you send the bill off to the Secu. The Secu reimburses you the portion of that which is covered according to the schedules. The schedules are relatively generous, but there is a co-pay element for most things of 10-20%. The fact that you have to pay for the care first, out of pocket, and then be reimbursed is itself a deterrent to abuse. The 10-20% co-pay is also a deterrent to abuse.
Everyone is covered. Everyone pays taxes, of course.
Now, if you think about it, America already has this system. It's called "Medicare" and it covers all retirees. In France, Medicare covers everyone from prenatal care through death. That's the difference. So, in France there is nobody who is not covered. That is one advantage of the system.
A second advantage of the system is that everyone is in the pool. Pooled insurance is always cheaper per capita than individual or small group insurance, and the bigger the pool, the more the cost is spread.
What are the disadvantages of the French system?
Three:
(1) People who do not have the means to initially pay for the care have to scramble a bit. Of course the truly indigent get state assistance, but it is true that you pay out of pocket first, and get reimbursed later. This is intentional. It's a deterrent to abuse and hypochondria. Not a huge deterrent but a deterrent. The advantage of doing it this way is that the doctor is paid at once. Medical practitioners do not have to battle with the insurance company the way American doctors do. The individual submits his or her claim to the Secu.
(2) The co-pay. 20% of health care expenses can be quite high for expensive conditions like cancer. Once again, the truly indigent are covered, but everyone else isn't. The solution, of course, is found in the free market. There is a robust private health insurance industry in France, which aims exclusively at the "Gap". Of course, the same is true in the United States with Medicare "Gap" coverage.
(3) The French system is expensive. Let's not kid ourselves here. The French have the best health care system in Europe, and are about the only ones to have a thriving pharmaceutical and medical research industry (because the doctors are free and therefore, like Americans and unlike English and Canadians, have an incentive to research and advance new techniques), but it costs a lot more per capita than the English, Canadian or German system. The French pay a lot more in taxes for their Secu than the Germans or English do. But it's still cheaper than the American system, and it produces better results.
Now, when I saw that Mme Clinton was studying health systems and going to propose something for the United States, I was surprised that, having studied different systems, she opted for a quasi-German system instead of the French system. Clearly she was not aiming at the highest quality of care - or she would have chosen the French public insurance system. She was looking for something much cheaper. The trouble with that is that it just isn't as good, and Americans will never accept that.
Americans, like the French, want the highest quality medical care in existence. And they are willing to pay a premium for it. The French system delivers as high, or higher, standard of care as the US, at a very high price compared to the rest of Europe, but at a moderate (though not low) price compared to America.
Part of this is the effect of economies of scale. Having one pooled insurer cuts down on costs, as the article says.
There are other structural differences with the USA, though, which do come into account. In America, licensing is by state. This is nonsensical. The human body does not change jurisdiction by jurisdiction. But the American Medical Association has a monopoly on access to the profession, and uses licensing requirements and rigidities to maintain a sort of protected guild system. This, of course, inflates the cost of care for Americans and reduces the mobility of doctors. But this is only a small thing.
The key difference between the French and American system which accounts for a substantial portion of the difference in costs is not medical at all. It is the incomprehensibly bad - if not outright insane - American legal system, in which a spilt cup of hot coffee results in a $2 million fee, and normal bad luck in medicine is invariably sued for millions. American malpractice insurance is tens of thousands of dollars a year, and this of course drives the cost of medicine sky high. Also, American doctors practice extremely defensive medicine, undertaking unneccessary tests that have no medical value, but which protect against lawsuits. Doctors get sued in France too, but things are limited by a naturally conservative legal system that does not like to be used like a slot machine and which does not award significant punitive or speculative damages.
Strip those elements away, and French health care is only a bit less expensive than American, and a LOT more expensive than the other European alternatives. But everyone is covered, and it produces better average results than the American.
It's a good system.
Of course, therefore, Mme. Clinton did not even consider it.
I scratched my head and pondered WHY at the time, and why NOW, whenever national health systems or insurance is discussed in America, the bad models are always cited to, but never the good French model, which really allows the market to ration the care, and relies upon taxes and private insurance to pay for it...and still ends up cheaper per capita than the US system...
It took me some time to figure out WHY the French system is ignored in the US. On the right, of course, ANY sort of "public" system is met with hostility, and anything French MUST be bad. But that is only what we should expect to hear.
But why does the American LEFT ignore France's model and focus on the Canadian and British models? Many Americans of the Left know France. They are not wholly ignorant.
I pondered this long, and then it hit me.
The American Left ignores the French model because it is too free. The doctors are left free to do as they please. And the private insurance companies still have a substantial and lucrative 20% niche. Patients are not herded through gatekeepers and HMOs. French medicine is as free to its participants as American. The only difference is the public insurance pools and universal insurance coverage (and, of course, a sane legal system).
The American Left does not like this model, because there is no control. The doctors are not controlled. The patients are not controlled. The insurance companies are free to compete in their niche. American leftists do not JUST want universal coverage. They want universal coverage WITH PATRONAGE, POWER and POLITICAL CONTROL.
And that is emphatically NOT the French system.
The French system still has a large research sector, and is quite expensive by European standards precisely because it is NOT centrally controlled. The professional bodies of doctors oversee the medical profession itself. Not the funding bureaucrats.
This is too free.
Americans always talk about Canada and Britian and their not-very-good health systems because that's all the American LEFT ever proposes to them. The American left, like the left everywhere, above all desires not quality care but COMMAND.
If America is driven by politics and needs to adopt a national health system, the Americans will be fools to not consider and adopt the French system. It is the only one that has the requisite degree of freedom, which Americans hold almost as dear as the French. The Americans have flirted with the German-style HMO system. It is better than the British system, to be sure, but it is still heavy handed, and the doctors command the patients and the patients cannot choose their care or go to specialists without permission.
This is absurd.
If America is going to have national health care, it should be INSURANCE that is national, and not health SERVICES. There should be co-pays, and private insurance for the gaps. And the doctors must be left free. And there must be tort reform. The French system is the only ones the American people would ever be able to stomach. Which is why the Americans have adopted it...for everyone over 63, in Medicare.
Perhaps it will make it more palatable if Americans pretend that it is not French?
Put us on a single payer system and whose border do we then cross to seek care when the system bogs down? The Canucks get to come down here. Do we go to Mexico?
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1. MONEY PIT
Cost inflation is primarily a result of third-party payer and government subsidies. "Universal health care" would maximize this problem and compound it by banning competition. Economically, a worse approach cannot be imagined. Add to this the following...
2. MONOLITHIC
One organization managing every person in the country would require a beaurocracy of gargantuan proportions. This would be wasteful and slow to adapt to the explosion of new innovations.
3. NEEDS OF THE MANY OUTWAY THE NEEDS OF THE FEW
WHEN (not if) the program becomes too expensive for the government to fund, everyone's health care becomes a political decision. That means decisions are made democratically. So, expensive treatments for diseases affecting small numbers of people will be first to be banned. Without a legal market, it will not be available to you in that country no matter how much you are willing to spend.
4. BERLIN WALL
People who can afford it will want to escape such an undesirable system. Since this creates a two-tiered system which is counter to the egalitarian principles that spawned universal coverage, the government will be tempted to ban all private commercial medical transactions (as in Canada). Punishing peaceful mutually benefitial voluntary transactions between its citizens is the essence of tyranny.
5. LIMITED LEGAL RECOURSE
If the government doesn't treat you right, good luck taking them to court.
These problems are observed facts of socialized medicine where it is practiced.