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The United States does not have universal health care or socialized medicine, although Medicare and Medicaid provide basic health insurance to elderly, disabled, and poorer residents. Most health insurance is provided as an employee benefit. For the self-employed or unemployed, they must pay out of pocket costs. In 2007, 45.7 million Americans had no health insurance. The recent increase in numbers arises from the economic downturn.
So the question is: are any of the universal health care models, such as those used in Canada and the UK, better for the US than the current system, with its large numbers of uninsured?
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The problem with the US (a benefit, some might say!) is that it is actually a hybrid system, not a "free-market" system. This makes comparison with European and Canadian models difficult. In 2007, Medicare provided health insurance to 43 million Americans, while another 50 million were served by Medicaid. 7 million Americans in each category have both Medicare and Medicaid.
Therefore, roughly 86 million Americans have universal healthcare already by my calculations. This would mean that the US already has state-covered (although not universal) health insurance for a good chunk of the population.
Which model is better? Well, any system that has over 40 million uninsured folks cannot be better than the systems in Canada or the UK, even with their very real flaws. I know of people who have died because they didn't have medical insurance. In a country that purports to be #1, that is just unconscionable!
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As much as many in the USA don't want to deal with it, some system for making health care treatment decisions should be considered. This idea that any treatments possible should be used should be discussed and perhaps we are at a stage where the collective wisdom needs to establish guidelines. Just because medically we can do it, doesn't mean we should do it. I'm not talking about rationing care, but making informed decisions about the level of care/treatment. In the USA, we developed standards about health care when the person is incapacitated after several famous cases. Health care is already rationed in the USA on the basis of price and ability to pay, shouldn't there be other considerations? Is the health care better per capita in those countries that do have national health care rationing not based on price and ability to pay?
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I'd like to cite the example of Massachusetts, which recently introduced health care insurance for the great majority of its residents. They did this by providing a low-cost alternative for the uninsured, and making it mandatory for all state residents to have insurance (actually tax-punishable for those who don't get it). Although they have had teething problems, it seems to have worked pretty well.
We do need change, that much is certain. Emergency rooms are now the costly alternative for the poor and uninsured and proves the adage of "a stitch in time saves nine". In the USA, we prefer 9 stitches i.e., treating the dying in emergency rooms vs. treating the slightly sick before the condition worsens. You wonder whether lunatics have taken charge of the asylum!!
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The United States has the best healthcare in the world - if you can afford it. Otherwise you can live in the US and be worse off healthcare wise than even many third-world countries. Something is desperately wrong.
Some of the answers lie with the priorities of the US government, and the corrupt relationship between the HMO's, the big pharmaceutical companies (and indeed most other big business) and congress. These special interest have congress so deep in their pockets that the welfare of the poor is the last thing on the minds of most influential senators and reps.
If the political will is there, the nation that sent men to the moon and spends billions on unnecessary wars can ensure that all its citizens have access to adequate healthcare and affordable drugs.
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The following from: Why the Current System Does not work for Women A Patchy System of Health Insurance The current health insurance framework leaves too many women uncovered. Twenty-one million women and girls went without health insurance in 2007, and another 14 million relied on coverage through the individual insurance market.3 Women are less likely to be employed full-time than men (52% versus 73%), making them less likely to be eligible for employer-based health benefits themselves. In fact, less than half of women have the option of obtaining employer-based coverage on their own.4 The following are excerpts from: http://www.healthreform....eports/women/index.html
"Roadblocks to Health Care Women are more vulnerable to high health care costs than men. Even when they work for an employee that offers coverage, one in six is not eligible to take it, often because they are part-time workers. They end up either covered through a spouse (41%), purchasing insurance directly through the individual market (5%), on public programs (10%), or uninsured (38%).5 And even among women with the option to get health coverage through their employer, they are twice as likely as men to go on their spouse’s plan (15% versus 7%).6 This dynamic has several effects. Single women are twice as likely to be uninsured than married women (24% versus 12%).7 Married women in the 55 to 64 age group are particularly vulnerable to a discontinuity of coverage as their spouses go on Medicare. Among this age group, there is a drop in dependent employer-sponsored coverage from 39% to 34%.8 When employer-based coverage is not an option, some women turn to the individual insurance market. In the 55 to 64 age group, the decline in employer-based coverage is coupled with a rise in the purchase of individual insurance from 5% to 8%. This trend is not seen with men.9 Sources: Sources Prepared by: Meena Seshamani, MD, PhD, Director of Policy Analysis, Office of Health Reform, Department of Health and Human Services Data analysis provided by the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services and the Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality. Report Production by the HHS Web Communications and New Media Division 1 National Center for Health Statistics. Health, United States, 2008. Hyattsville, MD: 2009. 2 National Center for Health Statistics. Health, United States, 2008. Hyattsville, MD: 2009. 3 US Census 2007. http://www.census.gov/hh...s/historic/hihistt1.xls
4 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006. 5 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006. 6 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006. 7 Current Population Survey, 2007. 8 Current Population Survey, 2007. 9 Current Population Survey, 2007.
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I guess the thing that irritates me the most about the US healthcare system is the fact that it is just plain inefficient. We spend the most per capita of any developed country and get some of the worst results. Instead of treating small medical problems of the uninsured, we wait until they are near death and go to emergency rooms where they must be treated, at a cost that is possibly thousands of times more expensive. Take care of a small skin cancer today at a few hundred dollars? No, instead wait until the person is at a Stage 4 cancer, staggers into the emergency room and we spend $1 or $2 million trying to save them with operations and chemotherapy. That is just as stupid as it gets.
Those on the right in particular, who rail about "socialized healthcare" forget that we do have government-run healthcare for almost 80 million in the form of Medicare and Medicaid. They also (conveniently) forget that the overhead for Medicare is much lower than for any HMO. I guess we've got to pay for executive jets and multi-million dollar salaries, or this wouldn't be the US.... The struggle over universal healthcare in the US is just another of those primal struggles between those who benefit from a crazy system and couldn't care less about the common good, and well.. the common good. A little bit like "clean coal", but don't get me started on that...
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I think United States should have universal insurance for all the legal citizens at least. So all those people that are not insured dont have to be worried to get sick and go to the hospital and after pay large amounts of the health care.
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For the life of me, I find it hard to differentiate between bags of cash in brown envelopes passed to corrupt officials in Third World countries and lobbying activities in the US Congress. The Healthcare industry is fighting tooth and nail to keep their inefficient and twisted system that keeps 46 million uninsured in the US and that enables them to sell drugs at sky-high prices. The Washington Post writes on 7/24/2009: "New disclosure reports that began arriving Monday in Congress showed familiar players at the top of the health-care influence heap, including $6.2 million in lobbying by the dominant Pharmaceutical Research and Manufacturers of America (PhRMA) and $4 million by the American Medical Association.
Many health companies and associations increased their first-quarter lobbying expenditures, sometimes dramatically. The Blue Cross and Blue Shield Association upped its lobbying expenditures by a full million, to 2.8 million dollars in the second quarter; GlaxoSmithKline's spending jumped from $1.8 million to $2.3 million; Novartis grew from $1.4 million to $1.8 million; and Metlife Group reported $1.7 million, up nearly 50 percent. Allstate, which spent less than $900,000 on lobbying through March, boosted its spending to more than $1.5 million from April to June." Wherever you see "lobbying", insert "bribery". I guess if you make bribery legal and change its name, it's all OK?
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Paul Krugman has written a great piece in the New York Times about how no successful free market healthcare system exists, although there are successful examples of healthcare systems that include the public option (what Repugs call 'socialized medicine). Will this incisive article change Republican minds? Not really, as they are impervious to both “theory and overwhelming evidence.” Ideology drives all in the “Party of Stupid”. Purely socialized medicine may not be the best option for the US, but whatever we choose, socialized medicine or the public option must play a big part, or you’ll end up with the same masses of uninsured. Obliquely, the problem with US health care is not so much healthcare, but the way the US makes legislation, that is, via a sophisticated bribery operation by corporations, sorry, via lobbyists. This just perverts the ability to formulate good policy.  Read Paul Krugman's full article here.
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It seems like the Healthcare Bill might finally be seeing some "light at the end of the tunnel" with the (apparent) rounding up of 60 votes. However, it has come at some cost to the original vision:
a. No 'Public Option" will exist, although a new government-overseen nonprofit will be allowed into the mix
b. No buy-in by younger people into Medicare - a late addition in the process
However, there will be an expansion of healthcare through various means and protections introduced for consumers.
What do you think of the Senate version of the Healthcare bill?
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bay001 wrote:It seems like the Healthcare Bill might finally be seeing some "light at the end of the tunnel" with the (apparent) rounding up of 60 votes. However, it has come at some cost to the original vision:
a. No 'Public Option" will exist, although a new government-overseen nonprofit will be allowed into the mix
b. No buy-in by younger people into Medicare - a late addition in the process
However, there will be an expansion of healthcare through various means and protections introduced for consumers.
What do you think of the Senate version of the Healthcare bill? From being a skeptic, I'm now quite enthusiastic about the Senate version of the Healthcare Bill for its protection of people with preconditions and for its protection from having your policy discontinued for no reason other than you've made too many claims for the insurance's company's comfort. I also like the fact that they will now have to spend 80 or 85% of policy payments on patient's care and limit the mighty salaries their execs take home. Last and most important, I think the new government-overseen nonprofit that those without insurance can buy into is a great thing for the uninsured and will hopefully be even better than the "public option". Sad to see all the shameless paid-off Republicans standing in the way of this Bill, which by the way, the CBO (Congressional Budget Office) says will reduce costs over a decade. I guess they are earning their bribes!!
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I'm not so sanguine about the Health Care Legislation emerging from the Senate. It was telling that the stocks of the healthcare companies rocketed up afterwards. Not surprising as the extension of Medicare availability to 55-64 year olds was removed and the public option was dropped.
Now they are licking their lips as they look forward to 31 million uninsured being forced to get policies. Of course, knowing legislators, they will leave just enough loopholes for the insurance companies to continue their greedy and exploitative ways....Aaahhhh!!!
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Well, it is done. The bills have been passed and the United States is on its way to near-universal healthcare. Who ever believed it would pass? But now it is here and ideologues on both sides are still steamed about the "great compromise" it resembles. Being a proponent of "single-payer" myself, I was really struck by this article in the New Yorker about how each industrialized country with universal healthcare (all but the US until now) found a different path to their version of universal care. Britain's system evolved out of world war 2, while France built on a payroll tax on workers. The Swiss on the other hand, built theirs on the foundation of private health care. Krugman's work on the "path-dependence" in Economics won him a Nobel Prize and it really does sound reasonable. Different cultures, traditions, societies, laws and economies will lead nations down different paths. As long as we realize that in rich nations, to throw overboard millions who do not have healthcare or force people to decide between bankruptcy and metastatic cancer is barbaric, then I guess whichever path we choose consistent with our societies is good enough. Do you agree?
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"Path dependence" makes a lot of sense to me - countries arriving at their versions of universal health care using their own routes. As long as they get to that destination, every country's idiosyncrasies will determine the shape of their policies. I am concerned that the US is too lax on cost controls for the new healthcare plan.
That must be tightened up as rosy assumptions seldom come to pass with government laws.
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