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OrionTheWolf -> RE: Before you Vote for Billary? (2/11/2008 12:50:12 PM)
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Greetings Ellen,
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ORIGINAL: LadyEllen
Looking at this from the outside, I have to say I really dont understand the arguments against.
Outside the country, but actually your view is from within a socialized medical program. All views help in any situation though. First I would like to see some facts for the reasons for it. It seems many believe this is an all or nothing thing, when in fact that is incorrect. Many states have programs that adequately assist those that cannot afford insurance. A large portion of the uninsured, seem to be those that could afford it, if they cut out non-essentials, but as Americans we enjoy our past times and often consider them essentials.
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Even if the US adopted a system that was identical with ours in the UK, (and I strongly suspect you could come up with something better that we could then adopt!), with all the problems that our system has - you would still only have the same problems as you have now with the current system - except access would be wider, the "risk" (if one chooses to see it in terms of insurance) spread wider and the cost per contributor made lower, being spread over a larger number of people.
I believe "better" is very subjective in your statement. The questions I ask are based on your health care system, and will help to inform me better. If the government board turns someone down for a medical procedure, can they still opt to pay out of their pocket for it? Are there any penalties for going out of the country to have a medical procedure done? Are there any classification of people that are excluded from health care, and if so, can they pay for medical treatment on their own? How are Doctor paid? How do they can patients? How is their services reviewed? If a doctor is just medicore, does he get similar pay to one that is exceptional?
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Issues I can understand, from those who enjoy good insurance cover and health, include an aversion to paying for the unhealthy. But I have also heard that those who become unhealthy are just as subject to policy limitations as one would be in certain instances under a nationalised health system - just as our health service resources must be managed, insurers manage their revenue resources, limit some treatments, require patient contributions and exclude some conditions and treatments. And it seems that for those who become unhealthy thereafter they must pay more for insurance if indeed they can obtain it at all. This is all very well and good, but health is not guaranteed - by this time next month, any one of us could become very ill; it is an uncertain world and even refraining from smoking, drinking and drugs and doing our daily workout doesnt guarantee us invulnerabilty. It is easy to complain about paying for others' illnesses, when we are well - not such an attractive argument when we ourselves become sick.
If someone used $400 a month on non-essentials such as beer, video rentals, premium cable television, broadband, and games, shouldn't they drop those to pay for their own insurance? Just like the study that was done before Massachusetts instituted it's laws concerning medical covergae, many can afford it but do not get it so they can keep their non-essentials. This is what I have a problem with, not with the out of work Mother with three kids, that just had her husband leave her. This is also why I support health clinics, and medicaid at the State level.
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Then there is the argument that the government organising anything is wasteful of resources. This can be shown to be true enough of course - but then is the wastefulness of government any greater added cost to the whole than the oft complained about excesses of the current system of health insurance - which as I understand it seems to add hugely to premia costs to realise its profits?
This is a very valid point, but if the insurance schemes are addressed it help across the board, and allows for continued growth in the medical sector. If a toe is needed to be amputated, you do not replace the entire foot. This is my analogy of scraping health insurance in place of a nationalized program.
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There is the argument that government could become intrusive into personal lives and should not have influence, still less authority over our healthcare. But the insurance companies - private companies as I understand them to be, already have this intrusive quality and being private companies cannot be held to account in the same way that government can be. Why is it acceptable for a private company to have influence and authority over healthcare, but unacceptable for the government to have such?
Now here is one of the fundemental differences. It is a choice, albeit a small one, as to who has that information when you go to an insurance company. Not to mention you have civil action that insures the insurance company follows privacy laws. The government should have as little power as it needs to operate, and that is one of the founding ideas. Just look at how our government has been acting, and we should trust them with even more of our personal information?
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As I see it, what you need really is a national insurance company, government owned. This could be organised as a stand alone company, by way of of part nationalisation of existing insurers - the government taking a stake, compulsorarily if need be in every healthcare insurer. Everyone then pays in a basic contribution for state healthcare through taxation. This covers the more expensive end of the spectrum - long term conditions which require ongoing care, surgeries etc - the sort of thing which costs a lot and which seems to be what is refused most often and the cause of refusal of coverage for sufferers who need care most. It is made a condition of operating in the US as a health insurer that no one can be refused - and it is made a condition of acquiring and keeping a licence to practice medicine that treatment must be provided under this scheme. Health insurers get to keep their businesses and acquire more revenue (since all must contribute) - doctors and consultants receive a fixed sum per annum as guaranteed income for their services. At the lower end of the spectrum, visits to doctors for check ups, tests and the like are paid for at a reasonable, subsidised level - say $10-00. This pays for itself in terms of public health and also by detecting early the sort of illnesses and conditions which can be treated easily at the earlier stages but if delayed cost much more to treat. Those who wish to pay more, can still do so through their existing insurance - which will cost less of a premium since a basic contribution has already been made (the total cost should be +/- about the current cost) - to gain quicker treatment where this is thought needful. The insurance companies still make a profit, and the whole system is relatively undisrupted.
This is not a bad idea and one I have discussed with people before, but I would rather see State ones, and not a nationalized system. It could be run like an investment coop with all moneys earned going to the general fund. There would need to be caps on salaries, performance requirements for employees, and alot of fine tuning to prevent what occurs with a bueracracy. It could possible just be a non-profit entity that the State pays to handle everything. I still feel it should only be for those that cannot afford insurance though. If you make 100k a year, you should be paying for your own.
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But the biggest dragons to be slayed yet remain - the pharmaceutical industry and the medical hardware industry and the development costs they wish to recover from new treatments and equipment they have developed. It is the cost of new treatments and equipment, alongside demographic changes, which are putting the strain on our health service resources and leading to some treatments being assessed as not cost effective and therefore limited or not offered. I would suggest, through the machinations of insurance coverage policies that the same effect is being seen in the US - this will be why coverage costs rise above inflation, why policies are subject to increasing exclusions and limitations etc
This is also tricky areas to handle, as the incentive to big business to make more money, often comes through the money they put into research.
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We cannot deny these companies a return on their investment and a profit. To do so is counterproductive in that in the absence of payback they will not develop new treatments and equipment. But again, we could take national stakes in such companies, provide research investment funding and partake of the incomes and profits from their successes - to reduce the net cost in the health service of accessing new treatments and equipment. The development companies win, in that they get more funding - we win in that our costs are reduced and development is made easier through greater access to funding.
One thing that can be done is the corporate welfare for these companies to be completely cut off. Not sure why tax payers should pay for ludicrous research by a company that is making billions of dollars in profit.
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The way I see it, its not a matter of revolution here, but of evolution - changing what you have to meet the needs of everyone. And I think it important to realise that however self sufficient and independent we might feel ourselves to be right now - none of us knows what the future holds - when we will be in need and have to go without. Everyone has as much a stake in providing public healthcare as they do in providing for mutual defence against crime or war. As it says on our national lottery tickets "it could be you".
E
First a clear need must be present. Then any solution should be done at the State level. Things needs to change but it needs to change in sections, and slowly. A large system needs to have small changes placed, so the effects can be measured, and fine tuning can occur.
Live well,
Orion
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