Universal Health Coverage

[dude1394]

Politicians trying to fix problems by making them worse.
http://www.latimes.com/news/opinion/...nion-rightrail

Universal healthcare's dirty little secrets
Patients in countries that provide government insurance often experience hurdles to care such as extremely long waitlists.
By Michael Tanner and Michael Cannon, MICHAEL TANNER is director of health and welfare studies and MICHAEL CANNON is director of health policy studies at the Cato Institute.
April 5, 2007

AS THEY TACK left and right state by state, the Democratic presidential contenders can't agree on much. But one cause they all support — along with Republicans such as former Massachusetts Gov. Mitt Romney and California's own Gov. Arnold Schwarzenegger — is universal health coverage. And all of them are wrong.

What these politicians and many other Americans fail to understand is that there's a big difference between universal coverage and actual access to medical care.

Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to healthcare."

Supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.

You may think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care. And yet, in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health. Believe it or not, there is "no evidence," Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health. Similarly, a study published in the New England Journal of Medicine last year found that, although far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."

Another common concern is that the young and healthy will go without insurance, leaving a risk pool of older and sicker people. This results in higher insurance premiums for those who are insured. But that's only true if the law forbids insurers from charging their customers according to the cost of covering them. If companies can charge more to cover people who are likely to need more care — smokers, the elderly, etc. — then it won't make any difference who does or doesn't buy insurance.

Finally, some suggest that when people without health insurance receive treatment, the cost of their care is passed along to the rest of us. This is undeniably true. Yet, it is a manageable problem. According to Jack Hadley and John Holahan of the left-leaning Urban Institute, uncompensated care for the uninsured amounts to less than 3% of total healthcare spending — a real cost, no doubt, but hardly a crisis.

Everyone agrees that far too many Americans lack health insurance. But covering the uninsured comes about as a byproduct of getting other things right. The real danger is that our national obsession with universal coverage will lead us to neglect reforms — such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets — that could truly expand coverage, improve quality and make care more affordable

As H. L. Mencken said: "For every problem, there is a solution that is simple, elegant, and wrong." Universal healthcare is a textbook case.

[Mavdog]

The author is avoiding one of the main rationales for universal health coverage, which is preventive care. not having access to the UofChicago study which according to this author cannot establish a "casual relationship" between being insured and having better health, it is hard to see what they are truly saying and how that conclusion is based.

it is difficult to see how anyone could argue that an uninsured person would be proactive with any preventive healthcare, if they are unwilling to pay the premiums for insurance coverage, why would they be willing to pay the several hundred dollars for a physical? consequently there is every reason to believe that if all our citizens had basic health coverage they would be more proactive with preventive actions such as having a yearly physical, and therefore would be able to identify potential problems early on.

health savings accounts can continue to be available with universal coverage, they are not mutually exclusive of each other.

as far as "deregulating insurance markets", the recent news of several insurance providors overcharging texas consumers for their insurance is a strong reminder that this industry SHOULD be regulated.

[mcsluggo]

THere are basic market failures that run rampant through healthcare, and all of the fixes are "second-best" alternatives that have some pluses and some minuses. However, as is usually the case, parrots on both sides attempt to blow up the minuses of the other side's argument without ever aknowledging any minuses on their own side.

This, of course, makes the search for "second best" solutions imposible, because the optimum solution will ALWAYS be a comprimse position, trying to minimize the minuses from all the possible fixes for the market imperfections, by occupying some grey area somewhere in the middle. All of the posturing on both the left (pretending that there are no harmful effects on both supply and demmand incentives from having "universal coverage") and the right (pretending that the problem is actually government interferance, and a free market could solve THIS problem, even though a stanard market CAN'T really exist and there are such extreme externalities in health care that even if a straight market COULD exist, it would vastly under-supply compared to the socially optimal (and economically efficient) level of coverage).

I find conversations in this area tiresome because EVERYONE is wrong to some degree, and they SHOULD know it (and be looking to minimize the "wrongness") but instead everyone is just happy to be standing there half naked screaming about the emperor's new clothes on the OTHER guy. Tiresome.

[dude1394]

I would pretty much get behind the guvment providing a stipend or tax-cut or whatever to get some more market forces into health care.

Right now it's quite ridiculous. No one asks how much anything costs, they just go get it. Companies cover the costs so no one even looks at what they are paying for. Folks WITH coverage pay jacked up costs to cover folks who have no coverage, or for the legal-lottery.
I'd much rather see some way for me to cover my own insurance or health-care so I would actually not have to pay a negotiated rate for an office visit or at least shop around.

Universal health-care to me looks just like what this author is promoting, rationing of care. Sure you can get it, in a year or whatever or until the guvment decides you can't. Not to mention the constituency it's going to build to keep from making any change.

The system is pretty wacked out, but if the choice is having the guvment run it, I'll stick with the system we have, that's for sure.

[alexamenos]

Originally Posted by dude1394

Right now it's quite ridiculous. No one asks how much anything costs, they just go get it. Companies cover the costs so no one even looks at what they are paying for. Folks WITH coverage pay jacked up costs to cover folks who have no coverage, or for the legal-lottery.

true story....

so my wife's getting set to have an operation....and i'm trying to haggle with hospital over some costs. I'm just saying, "look, I realize she has to have the surgery, I just want to find out how much this other doc will charge for all this stuff." They look at me like I'm insane, like I'm the craziest person they've ever seen. I maintain I was being prudent and responsible, but apparently we're not to question costs when it comes to anything medical.

there's just a rule -- thou shalt not haggle over medical costs. somebody else is picking up the tab, and the costs just are whatever the doc sez they are.

[Mavdog]

one misconception that seems to be linked to the call for universal health coverage is when the universal coverage is provided that everyone will have the same coverage, ala the british or canadian models.

that is not a quid pro quo, or in other words there can continue to be the opportunity for the traditional health insurance coverage that many of us have today and also the health insurance for those who cannot get covered.

there is an opportunity to continue with the american model and to also extend coverage to those citizens who don't/can't get coverage.

so no dude, there won't be any "rationing" of healthcare if this is done correctly. there won't be any changes to those who have health coverage, they can continue with their ppo or hmo as they have today.

and as for the haggling with the hospital...heck, the insurance cos. do it all the time. my teen was recently given a script for antibiotics, and when we got to the pharmacy we were told the co-pay for the pills was (get this) $175, or about $6 a pill. the pills cost almost $40 each! so we said thanks but no thanks, we'll take the old ones that seemed to work on thew acne and are only a co-pay of $10 for the whole script. when we called the dr for the new script for the old drug, we were told to call the manufacturer and guess what? the drug co provided secondary coverage for these outrageous pills that paid all but a co-pay of $25.

so yes, haggling does work.

[dude1394]

If a sensible compromise is reached I can see there being no rationing, but I'm not buying it, there is too much history of dems not wanting anything less than complete guvment control for that to work imo.

[FishForLunch]

If Universal Heath care gets implemented by the democratic senators hoping to be President ,will they promise that health care will not deteriorate like the Walter Reed mess. We all know those senators will not wait in line for anything, they have enough in the Banks to treat themselves without insurance.

[dude1394]

Interesting question fish. Since they exempted themselves from social security will they do the same with "universal health care".

[wmbwinn]

Originally Posted by dude1394

Politicians trying to fix problems by making them worse.
http://www.latimes.com/news/opinion/...nion-rightrail

Good article that is 100% accurate in every single word.

More information missing from the article that should be included:

all Americans can present to a county hospital and/or medical school based hospital and can receive all healthcare that they need without rejection for their insurance status.

Next important fact: Congress protects you against the crushing blow of healthcare bills. All you have to do to prevent a negative credit report is pay 5-10 dollars per month to your medical bill. If you do that, it is illegal to report you as "bad debt" or "delinquent" or any other negative report.

You will get harassed by bill collectors and collection agencies but they can't touch you if you pay 5-10 bucks per month. They will tell you otherwise and will harass you. But, they are just doing their job and trying to squeeze you for more money sooner. They can't touch you. You are protected by Federal law.

So, we don't have a problem with access to healthcare.

And, the county/medical school based systems are among the best centers of healthcare in the world. So, you may wait in line a bit, but you are receiving top notch care. And, it is available despite your pocketbook status.

Educated people who understand the facts vote against "universal healthcare plans" that mirror the failures of Europe and Canada or our own VA Medical system.

Are you dumb enough to vote for a universal VA system for all Americans?????

[wmbwinn]

Originally Posted by Mavdog

The author is avoiding one of the main rationales for universal health coverage, which is preventive care. not having access to the UofChicago study which according to this author cannot establish a "casual relationship" between being insured and having better health, it is hard to see what they are truly saying and how that conclusion is based.

it is difficult to see how anyone could argue that an uninsured person would be proactive with any preventive healthcare, if they are unwilling to pay the premiums for insurance coverage, why would they be willing to pay the several hundred dollars for a physical? consequently there is every reason to believe that if all our citizens had basic health coverage they would be more proactive with preventive actions such as having a yearly physical, and therefore would be able to identify potential problems early on.

health savings accounts can continue to be available with universal coverage, they are not mutually exclusive of each other.

as far as "deregulating insurance markets", the recent news of several insurance providors overcharging texas consumers for their insurance is a strong reminder that this industry SHOULD be regulated.

No one's insurance covers much in the way of "preventive healthcare" other than immunizations, mammograms, digital rectal exams (prostate cancer screening), PAP smears, and colonoscopies.

And, even those with insurance usually refuse to undergo the above list of preventive care measures in full. Most comply with immunizations but many don't. Men don't enjoy DRE's. Women don't enjoy mammograms. No one enjoys colonoscopies.

So, the fact is that:
1)preventive healthcare is minimally financed by anyone's insurance
2)even the insured don't take advantage of it at an acceptable percentage
3)Everyone can have access to healthcare in this nation regardless of their finances or insurance status by reporting to medical school health systems or the County hospital systems. Everyone can have immunizations, mammograms, DRE's, and colonoscopies and PAP smears.
4)Immunizations are available at the Public Health facilities free of charge in most situations.

The insured don't use their insurance for preventive care. The uninsured can obtain preventive healthcare at the medical school or county hospital system. No one's insurance covers true prevention care such as health club memberships and paying for weight loss programs.

[wmbwinn]

Originally Posted by mcsluggo

THere are basic market failures that run rampant through healthcare, and all of the fixes are "second-best" alternatives that have some pluses and some minuses. However, as is usually the case, parrots on both sides attempt to blow up the minuses of the other side's argument without ever aknowledging any minuses on their own side.

This, of course, makes the search for "second best" solutions imposible, because the optimum solution will ALWAYS be a comprimse position, trying to minimize the minuses from all the possible fixes for the market imperfections, by occupying some grey area somewhere in the middle. All of the posturing on both the left (pretending that there are no harmful effects on both supply and demmand incentives from having "universal coverage") and the right (pretending that the problem is actually government interferance, and a free market could solve THIS problem, even though a stanard market CAN'T really exist and there are such extreme externalities in health care that even if a straight market COULD exist, it would vastly under-supply compared to the socially optimal (and economically efficient) level of coverage).

I find conversations in this area tiresome because EVERYONE is wrong to some degree, and they SHOULD know it (and be looking to minimize the "wrongness") but instead everyone is just happy to be standing there half naked screaming about the emperor's new clothes on the OTHER guy. Tiresome.

We already have the world's best compromise system health delivery program.

[wmbwinn]

Originally Posted by dude1394

I would pretty much get behind the guvment providing a stipend or tax-cut or whatever to get some more market forces into health care.

Right now it's quite ridiculous. No one asks how much anything costs, they just go get it. Companies cover the costs so no one even looks at what they are paying for. Folks WITH coverage pay jacked up costs to cover folks who have no coverage, or for the legal-lottery.
I'd much rather see some way for me to cover my own insurance or health-care so I would actually not have to pay a negotiated rate for an office visit or at least shop around.

Universal health-care to me looks just like what this author is promoting, rationing of care. Sure you can get it, in a year or whatever or until the guvment decides you can't. Not to mention the constituency it's going to build to keep from making any change.

The system is pretty wacked out, but if the choice is having the guvment run it, I'll stick with the system we have, that's for sure.

Private sector solutions are always better than government system solutions. That is always true in every area except the military.

[wmbwinn]

Originally Posted by alexamenos

true story....

so my wife's getting set to have an operation....and i'm trying to haggle with hospital over some costs. I'm just saying, "look, I realize she has to have the surgery, I just want to find out how much this other doc will charge for all this stuff." They look at me like I'm insane, like I'm the craziest person they've ever seen. I maintain I was being prudent and responsible, but apparently we're not to question costs when it comes to anything medical.

there's just a rule -- thou shalt not haggle over medical costs. somebody else is picking up the tab, and the costs just are whatever the doc sez they are.

Medical care costs are determined by the Medicare system in an indirect fashion. The problems that you see when you look at an itemized statement of your medical bills are the way they are because that is how the hospitals survive the idiocy of Medicare.

For example, you should realize that under Medicare, Doctors who perform procedures get paid very well. Doctors who don't (such as psychiatrists) get paid very poorly. Medicare pays 15 dollars for an office visit to your primary care doctor or your psychiatrist if it is a simple follow up visit. If your doctor sticks a needle in your arm, now he is going to paid 200 dollars or so.

So, what is your doctor going to do? He is going to give you a shot or find some other procedure he can do to make a living. Sad but true. Why do you think "tender point injections are so popular and used so much? They don't do anything of any benefit for more than a few hours. Wonder why your doctor wants to give you a vitamin B12 shot? 90 bucks.

The Hospitals do the same thing. The MRI scanner, CT scanner, surgery suite, interventional cardiology suite, outpatient surgery suite, Obstetric surgery suites, interventional pain clinics, and other similar hospital functions are where the hospitals make money. The psychiatry department, family medicine clinic, internal medicine clinic, and other similar clinics are where they lose money.

So, hospitals are investing in cardiology suites, MRI/CT scanner operations, surgical care, interventional pain centers, etc.

What does a single item cost on your medical bill? It costs whatever makes sense financially to the hospital when they review Medicare policy. Can the hospital charge 3 times more for a drug than what it costs them to obtain the drug. Yes.

Can the hospital charge a facility fee for the MRI machine the hospital owns. Yes. The facility fee is very high.

How much does it cost for a neurologist to tap your knees and ankles and elbows and tell you that by examination, that you have a "pinched nerve" (radiculopathy)? About 30-60 dollars by Medicare reimbursement. How much does it cost for the neurologist to "prove"you have a radiculopathy?
A four extremity EMG/NCS (electromyogram/nerve conduction study) is about 3 thousand dollars. The MRI of the cervical spine is 1000 bucks and the MRI of the lumbar spine is 1000 bucks.
How much does it cost to prescribe a medicine like Neurontin for your pain? The office visit is 30 bucks and the prescription is about 200 bucks per month. How much does it cost to go see the interventional pain man for injections for your back? About 1500 dollars.
After the injections fail, what does it cost to move to next more aggressive step of radiofrequency ablation? 3-5 thousand dollars. How much does it cost to go to the next step of surgery? 20K at least considering the hospitalization.

So, you get the idea. How is a hospital going to manage your back pain?
EMG/NCS combined with MRI for diagnosis.
Medications
Referral to interventional pain specialist.
Referral to a surgeon.

Other options include physical therapy, weight loss, exercise, medications, adaptations to your life, stretching exercises, etc. But, those don't make hospitals much money under Medicare.

So, in summary, do you want to "fix" the healthcare system?

Overhaul Medicare and make it make sense and support preventive care (true preventive care) and make it support doctors who use their mind to think to arrive at diagnosis and treatment instead of pushing doctors hospitals into diagnostic and treatment plans that are financially derived.

EMG/NCS, MRI, interventional pain, and surgery are all necessary and useful. It is not necessary for everyone to have those services for their back pain. But, the hospital system wants everyone to utilize those services.

[wmbwinn]

Originally Posted by Mavdog

one misconception that seems to be linked to the call for universal health coverage is when the universal coverage is provided that everyone will have the same coverage, ala the british or canadian models.

that is not a quid pro quo, or in other words there can continue to be the opportunity for the traditional health insurance coverage that many of us have today and also the health insurance for those who cannot get covered.

there is an opportunity to continue with the american model and to also extend coverage to those citizens who don't/can't get coverage.

so no dude, there won't be any "rationing" of healthcare if this is done correctly. there won't be any changes to those who have health coverage, they can continue with their ppo or hmo as they have today.

and as for the haggling with the hospital...heck, the insurance cos. do it all the time. my teen was recently given a script for antibiotics, and when we got to the pharmacy we were told the co-pay for the pills was (get this) $175, or about $6 a pill. the pills cost almost $40 each! so we said thanks but no thanks, we'll take the old ones that seemed to work on thew acne and are only a co-pay of $10 for the whole script. when we called the dr for the new script for the old drug, we were told to call the manufacturer and guess what? the drug co provided secondary coverage for these outrageous pills that paid all but a co-pay of $25.

so yes, haggling does work.

Private healthcare plans exist only because universal healthcare doesn't exist. Companies need their employees to be happy in their employment and healthcare benefits are part of that equation. If you provide universal healtcare, you will kill private healthcare. Ford and GMC aren't going to pay for private healthcare plans if Uncle Sam is giving it away and charging Ford and GMC to pay for the government plan...

There has been debate about establishing universal healthcare in a system where Federal law would REQUIRE companies larger than some arbitrary measure to provide private healthcare plans. Those debates have not produced anything.

[wmbwinn]

Originally Posted by FishForLunch

If Universal Heath care gets implemented by the democratic senators hoping to be President ,will they promise that health care will not deteriorate like the Walter Reed mess. We all know those senators will not wait in line for anything, they have enough in the Banks to treat themselves without insurance.

The closest thing we have to government controlled healthcare is Medicare and the VA hospital system. The worst thing we can do is expand those ideas...

In Canada, you have some working citizens employed by companies based in the US who offer these Canadiens healthcare plans. Those Canadians cross the border and go into the States for their healthcare. 90% plus of all Canadians live within 200 miles of the US border (it's too cold further north for non Eskimos/native Americans). All Canadians who can cross the border for their healtcare in the States.

Who uses the "free" Canadian healthcare system? The unemployed welfare line.

I lived in Canada for a while.

[dude1394]

How do the canadians who go to the US for health care pay for it? Is it full cost out of their pocket? Hope so since we are subsidizing their medicine.

[wmbwinn]

Originally Posted by dude1394

How do the canadians who go to the US for health care pay for it? Is it full cost out of their pocket? Hope so since we are subsidizing their medicine.

Many of them have private US based healthcare insurance because they work for companies that are US based and they have access to the same benefits. So, the same private healthcare plan you have, they have.

Many will pay out of pocket for their healthcare. Again, consider the legal obligation they have? Can a private hospital in Washington state lever much force against a Canadian national for repayment of a medical bill?

Send 5-10 bucks per month...

[Mavdog]

Originally Posted by wmbwinn

No one's insurance covers much in the way of "preventive healthcare" other than immunizations, mammograms, digital rectal exams (prostate cancer screening), PAP smears, and colonoscopies.

uh oh, my providor paid for all but a $10 co-pay for a physical. complete blood work, x rays, cardio, etc.

And, even those with insurance usually refuse to undergo the above list of preventive care measures in full. Most comply with immunizations but many don't. Men don't enjoy DRE's. Women don't enjoy mammograms. No one enjoys colonoscopies.

So, the fact is that:
1)preventive healthcare is minimally financed by anyone's insurance
2)even the insured don't take advantage of it at an acceptable percentage
3)Everyone can have access to healthcare in this nation regardless of their finances or insurance status by reporting to medical school health systems or the County hospital systems. Everyone can have immunizations, mammograms, DRE's, and colonoscopies and PAP smears.
4)Immunizations are available at the Public Health facilities free of charge in most situations.

The insured don't use their insurance for preventive care. The uninsured can obtain preventive healthcare at the medical school or county hospital system. No one's insurance covers true prevention care such as health club memberships and paying for weight loss programs.

you are suggesting that people who go to parkland without a specific condition will get in to see a dr? I wonder what the wait is to get a mammogram, and more importantly I wonder how much is devoted to educating those who have no idea what a mammogram is?

the ones who go WITH a problem and are w/o insurance have to wait for hours. we caan be proud that as society if a needy person seeks healthcare they can find it. there's is a continued problem with the current public health system for uninsured btw, for instance dallas county handles the bulk of public health needs for the entire north tx area yet the financial burden is borne not by the other counties, just dallas.

immunizations have been successful due to its linkage to school. it's a requirement for enrollment.

if only 'true prevention" was as simple a health club memberships and weight loss programs..

[Pirate]

The theoretical concept of "better more affordable health care for all" with the same degree of service, but less cost, is the Holy Grail of American politicos. The ultimate promise, and a popular one every time you have to pay a medical bill.

It looks good on paper, but it would likely be a boondoggle of the worst sort - huge tax burden, less access to medical services, longer waits, more bureaucracy, and something that could not be unraveled once it was instituted .

I want the Free Lunch that the promise of "universal health care" offers, but I am averse to putting my neck in that noose.

And once the government owns your medical coverage, its costs, and access to it, I think they own YOU - lock, stock, and barrel. They can justify imposing any action or proscription on you, in the name of "keeping down future health care claims." I dont like that concept at all.

No doubt many will be willing to hand over their freedom in exchange for a PROMISE of a free lunch (a "free" lunch that you and I will end up overpaying for, by the way). But this is not going to be a good deal if it ever gets enacted.

[wmbwinn]

Originally Posted by Mavdog

uh oh, my providor paid for all but a $10 co-pay for a physical. complete blood work, x rays, cardio, etc.



you are suggesting that people who go to parkland without a specific condition will get in to see a dr? I wonder what the wait is to get a mammogram, and more importantly I wonder how much is devoted to educating those who have no idea what a mammogram is?

the ones who go WITH a problem and are w/o insurance have to wait for hours. we caan be proud that as society if a needy person seeks healthcare they can find it. there's is a continued problem with the current public health system for uninsured btw, for instance dallas county handles the bulk of public health needs for the entire north tx area yet the financial burden is borne not by the other counties, just dallas.



immunizations have been successful due to its linkage to school. it's a requirement for enrollment.

if only 'true prevention" was as simple a health club memberships and weight loss programs..

"a physical. complete blood work, x rays, cardio, etc." is not preventative care. That is routine workup or routine annual examination. It does not prevent anything other than diagnosing something otherwise missed in order to address that problem. Most insurance policies will pay for annual exams.

"you are suggesting that people who go to parkland without a specific condition will get in to see a dr? I wonder what the wait is to get a mammogram"

The wait is a lot less than the wait in England or Canada. In England, if you have a need for a hip replacement due to severe arthritis, the wait is one to two years...

I badly sprained an ankle in Canada in 1991 and waited 14 hours in an Emergency Dept. just to get an x-ray. It was not as if it was a busy ER with a lot waiting people. I sat there with the same 10 people all day. Government managed care for universal coverage means that the reimbursement for healthcare will go way down and the hospitals will hire fewer nurses and support staff. The Doctor gets paid the same if he sees one person or a dozen people. We don't want that system here. Working, insured Canadians cross the border to use the US healthcare system. Canadians don't want the US to adopt the Canadian healthcare system.

"and more importantly I wonder how much is devoted to educating those who have no idea what a mammogram is?"

I don't know what more can be done that what has already been done to educate people. Women don't get mammograms because they hurt. Men don't get prostrate exams because of the nature of the exam. A large percentage of people avoid colonoscopies.


"the ones who go WITH a problem and are w/o insurance have to wait for hours. we caan be proud that as society if a needy person seeks healthcare they can find it. there's is a continued problem with the current public health system for uninsured btw, for instance dallas county handles the bulk of public health needs for the entire north tx area yet the financial burden is borne not by the other counties, just dallas."

Waiting for hours is better than waiting for years. People in Canada and England wait for years. People should not complain about waiting for a few hours for free healthcare provided by the best facilities in the world. Parkland is one of the world's leaders in most areas of healthcare. Perhaps you would rather wait 3 times longer in a Canada ER or wait for months to years for "elective" treatment of conditions like severe hip or knee arthritis. Perhaps you would really prefer the Canadian or England failure to our system?

As to Dallas county handling the bulk of the Public Health fees, that is typical. The larger system as organized by the state and federal congresses produces that pattern. It makes logistical sense to centrally organize such services for provision and cost savings.

The county hospital systems that are also major medical facilities with major medical schools receive a lot of extra money under Medicare. That is how the federal government has organized to provide healthcare to those without insurance. The rate of reimbursement for Medicare is higher at Parkland that it is at a neighboring private hospital in the same city and county. Parkland receives Medicare money per medical resident to pay for that resident's salary and education. The system is organized on purpose to produce the inequalities of burden to provide healthcare for the uninsured. Parkland is an excellent example of how the system works.

Don't complain about Parkland until you visit England and Canada and the US VA system. Then you will be very grateful for how well Parkland works...

[wmbwinn]

Originally Posted by Pirate

The theoretical concept of "better more affordable health care for all" with the same degree of service, but less cost, is the Holy Grail of American politicos. The ultimate promise, and a popular one every time you have to pay a medical bill.

It looks good on paper, but it would likely be a boondoggle of the worst sort - huge tax burden, less access to medical services, longer waits, more bureaucracy, and something that could not be unraveled once it was instituted .

I want the Free Lunch that the promise of "universal health care" offers, but I am averse to putting my neck in that noose.

And once the government owns your medical coverage, its costs, and access to it, I think they own YOU - lock, stock, and barrel. They can justify imposing any action or proscription on you, in the name of "keeping down future health care claims." I dont like that concept at all.

No doubt many will be willing to hand over their freedom in exchange for a PROMISE of a free lunch (a "free" lunch that you and I will end up overpaying for, by the way). But this is not going to be a good deal if it ever gets enacted.

Spoken like a true Reagan era conservative. Wish one of you were running for president...

[dude1394]

More on the "advantages" in health coverage for europeans.
From http://www.captainsquartersblog.com/...ves/009946.php

US Health Care Saves More Lives Than Socialized Medicine

A new study by the Karolinska Institute in Sweden shows that the American health care system outperforms the socialized systems in Europe in getting new medicines to cancer patients. The difference saves lives, and the existing Western European systems force people to die at higher rates from the same cancers, although the Telegraph buries that lede (via QandO):

The researchers studied Australia, Canada, New Zealand, Japan, South Africa and the US, as well as 19 European countries, with a total population of 984 million, and looked at access to 67 newer cancer drugs.

They found that the proportions of female cancer patients surviving five years beyond diagnosis in France, Spain, Germany, Italy were 71 per cent, 64 per cent, 63 per cent and 63 per cent respectively. In the UK it was 53 per cent.

Among men the proportions still alive at five years in the same countries were 53 per cent, 50 per cent, 53 per cent and 48 per cent. Again in the UK it was lower at 43 per cent.

The Telegraph rightly focuses on the British system and its deficiencies. However, when one looks further into the article, the point about the American system finally surfaces:

Dr Nils Wilking, a clinical oncologist at the Karolinska Institute in Stockholm, said: "Our report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival. Where you live can determine whether you receive the best available treatment or not.

"To some extent this is determined by economic factors, but much of the variation between countries remains unexplained. In the US we have found that the survival of cancer patients is significantly related to the introduction of new oncology drugs." ...

The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average.

It's funny how the supposedly equalized treatment of people under Western socialized-medicine models holds people back from new therapies and new medicines, while the American model of market-based medicine (with significant regulation) outperforms in this regard by a factor of 10. That response allows patients to start treating their cancers earlier, but what this report misses is that the American model also allows for earlier detection, thanks to the long waits for procedures like CAT scans and the like in Britain and other socialized systems.

And yet, the Democrats this year have already begun discussing how they will bring the American system closer to nationalization. Perhaps their presidential candidates should read this report first. Certainly American voters should familiarize themselves with it.

[mcsluggo]

dude, I don't think you'll find too many people that are very surprised by that. It is clear tht the US system has well defined strengths and weaknesses (vis other countries' systems):

The US system is extremely expensive, and it fails to cover a relatively larger proportion of the population. On the other hand, it is better at promoting innovation and R&D, and for those that DO have full coverage, it offers excellent care. I think these are fairly well agreed upon.... the issues come from WEIGHING these relative strengths and weaknesses.

So what is most important? (and can the system either be tweaked or overhauled to reduce some of the weaknesses while retaining the strengths?)

[MavsX]

oh god.