If Americans could genuinely be given the option of a NHS based along the lines of the U.K. Model what would be their major objections ?
It's a great question. I think the answer is that it would be dismissed as "Socialism," or at least traditionally it would be. There are numerous barriers to even discussing such a thing, largely the Health Insurance and Pharmaceutical lobbies (this is currently the largest barrier by far). But putting that and logistical issues to one side, I just think it's a lack of trust in the Government, even though it would result in lower costs and improved outcomes.
We have an NHS type system for people over 65, it's called Medicare. People on both sides are violently protective of it. And as well they should be. I really think it's a perception/lack of understanding problem, and it's part of a larger problem which is that we don't have intelligent conversations in this country about what Government should and should not be for.
If Americans could genuinely be given the option of a NHS based along the lines of the U.K. Model what would be their major objections ?
The media make the most of horror stories about how socialized medicine doesn't work in the U.K. or in Canada. We get stories about people dying while waiting for an appointment, or various screw-ups and how much people are really paying for it. So there's no real taste for it, personally I'd love to see a similar system here. One of the difficulties I see that such a system would face here, is the number of people using the system that wouldn't be paying into it.
The NHS costs around $1200 per tax payer and for that we get full health coverage. The US system currently costs $1800 per tax payer and for that you get nothing, as you still need insurance on top.
The NHS costs around $1200 per tax payer and for that we get full health coverage. The US system currently costs $1800 per tax payer and for that you get nothing, as you still need insurance on top.
It's somewhat oversimplified, but the numbers are clear, the amount we spend on healthcare versus what we get out is ridiculously skewed, and our quality of care is poor. This gets into something I've worked on some professionally, which is our lack of continuity of care, which is a problem I've worked on from a technology stand point. But because so much of care is dispersed, people get lost in the system. I've been a victim of this numerous times. It's awful.
To me an NHS style system, or "Single Payer" must be the goal. And from a technology standpoint, which can be so vital, were you to consolidate care into single payer, what you could do with technology--the ways you could improve care, are immense. But Limey is correct, between the media and right wing politicians backed by the vast insurance and pharma lobby, it's a long, long road ahead.
This is a genuine question. What happens to someone who is poor and has no private health insurance. Gets sick. Let's say has a stroke. Needs urgent and quite intensive medical intervention and subsequent physical and speech therapies ? A lot of support.
This is a genuine question. What happens to someone who is poor and has no private health insurance. Gets sick. Let's say has a stroke. Needs urgent and quite intensive medical intervention and subsequent physical and speech therapies ? A lot of support.
They get taken to hospital, get taken care of, and their bill is written off. There are many mechanisms in place for this scenario.
This is a genuine question. What happens to someone who is poor and has no private health insurance. Gets sick. Let's say has a stroke. Needs urgent and quite intensive medical intervention and subsequent physical and speech therapies ? A lot of support.
They get taken to hospital, get taken care of, and their bill is written off. There are many mechanisms in place for this scenario.
This is a genuine question. What happens to someone who is poor and has no private health insurance. Gets sick. Let's say has a stroke. Needs urgent and quite intensive medical intervention and subsequent physical and speech therapies ? A lot of support.
They get taken to hospital, get taken care of, and their bill is written off. There are many mechanisms in place for this scenario.
So where is the incentive to have insurance ?
If you have assets worth coming after, they will come after them.
This is a genuine question. What happens to someone who is poor and has no private health insurance. Gets sick. Let's say has a stroke. Needs urgent and quite intensive medical intervention and subsequent physical and speech therapies ? A lot of support.
They get taken to hospital, get taken care of, and their bill is written off. There are many mechanisms in place for this scenario.
So where is the incentive to have insurance ?
If you have assets worth coming after, they will come after them.
This last little conversation sums it up - Limey doesn't like the idea of people using a system that they are not paying into, but they are doing that today. They get sick, go to the emergency room, get treated and can't pay. Either it gets written off ( which really means those of us who have insurance pay through inflated prices ) , or a Govt. assistance program picks up the tab, which means we as taxpayers cover it. Either way those that can afford it cover those who can't.
So why is this any different than going single payer?
What I don't understand is why businesses are not lobbying for single payer. It would get them out of the healthcare provision market. Sure there would have to be some "per employee" tax to help cover this, but I'd be amazed if it wasn't cheaper than providing health benefits. I heard some time ago, that General Motors was effectively a health care provider that makes cars their costs were so high and they need to cover so many people.
The other argument rolled out is that people don't want the government deciding what treatment they get. Unless you're paying all your costs today, you're going through an Insurance company. Their mission is to make a profit. They are quite happy to disallow treatments if they don't think they are necessary. It's no different.
But I fear we have digressed from the Primaries to actual policies.
This is a genuine question. What happens to someone who is poor and has no private health insurance. Gets sick. Let's say has a stroke. Needs urgent and quite intensive medical intervention and subsequent physical and speech therapies ? A lot of support.
They get taken to hospital, get taken care of, and their bill is written off. There are many mechanisms in place for this scenario.
No, the bill is not written off, you are sent into debt, and debt in the States can have all sorts of punishments, from wage garnering to prison (in certain admittedly rare circumstances). As of 2011 (I believe), healthcare costs were the leading cause of bankruptcy in the States.
What happens, and this is something my dad works with in rural hospitals, is that you are taken to the emergency room if you fall ill, and if you don't have funds, the above happens, and the hospital ends up eating the costs. As you can imagine, in poor and rural areas, hospitals bear a far heavier cost than those, say, near to where I grew up in a middle class part of Los Angeles. So what is unfortunately common is that hospitals themselves go in to massive debt, and end up in bankruptcy, at which point all sorts of bad things can happen. My dad works as a court appointed overseer whose job it is to make sure that quality of care is maintained and patient records aren't breached. It's now mandatory in a handful of states, but far from a perfect system, and obviously the more perfect system is one where hospital bankruptcy isn't a common thing.
What the Affordable Care Act was intended to do was to subsidize those who cannot afford insurance, whereby the Government either purchases private insurance for people, or provides what is called Medicaid, which is essentially insurance for those who are poor/impoverished. This, in theory, would stop people without insurance from simply going to the ER (Emergency) if they didn't have insurance and couldn't get in to see a doctor. Going to the ER is far more expensive to everyone in the healthcare ecosystem than it would be to simply go to a doctor.
Stupidly, accepting the federal subsidies for the poor or those who cannot afford insurance was left up to the individual states. And in vicious anti-Government movement by Republicans, many of the poorest states (read, the south/south west and those largely Republican) rejected these subsidies because they didn't want big Government coming in and taking their guns. Or to keep the New World Order from taking over. or because Obama is the anti-Christ/Muslim/Kenyan born...moral of the story is the debate wasn't about healthcare but about perceived fascism, or something. Unfortunately, given that poorer states rejected the subsidies (though some have since changed their minds), those who need care the most didn't get it. And that is why I attack the Affordable Care Act from the left, because it's bad Capitalism, it's bad FDR New-Dealism (to coin a phrase), and it's awful socialism.
Although hospital debt finishes up on peoples credit reports, in cases where someone has otherwise good credit, it is ignored by lenders granting new credit as it's so common to have some kind of healthcare debt. Where people already have poor credit, or no credit, the provider knows that you can't get blood out of a turnip, so little attempt is made at collection. Obamacare would have been better supported across the board, had it been available for review or comment or revision before it was rammed through congress, "you've got to pass it in order to know what's in it", remember? Nobody has denied recently that healthcare reform wasn't urgently needed in this country, the way that Obamacare was rammed down our throats, how poorly thought out it was, and how impossible it was to sign up for it at the beginning made it impossible to support. Since then it's drag on economic recovery is obvious to anyone trying to run a business.
Even the basic premise of Obamacare was flawed, and so obviously. The theory was that healthy young people who were rarely sick would sign up in droves, thus supporting the healthcare costs of older people who needed services more often. Guess what? Young people didn't want to sign up because they thought they didn't need healthcare insurance. Consequently premiums and deductibles for everyones' insurance has gone up, now insurance is less affordable than ever. Fewer businesses are now offering insurance as part of the "package", and are keeping employee numbers as low as possible.
Because I'm doing independent consulting, I've been shopping around a bit. usually $300-400 gets you a somewhat decent plan, but that can mean you have a $5000 deductible, which means you pay the first $5k out of pocket (at the insurance companies' negotiated price, which is lower than just paying out of pocket), and then the insurance pays for anything over that.
One of the big problems is that when you pay for insurance coverage, you're not done paying, you're just paying for the privilege to pay less.
Also, depending on the plan, but commonly, for a married couple the deductible is 5000 each, so they get no coverage until they've spent 10K, which is like having no coverage at all.
In some disciplines, but they're not the only ones benefiting from this, it's really the insurance companies. The top 4-5 (they're quickly consolidating) health insurance companies are all Fortune 100 companies, which means they make a lot. Doctors and hospitals certainly profit in some cases disproportionately, but the money really sticks with the insurance companies and pharmaceuticals.
Depending on where they are, the hospitals can really take it in. All the major hospitals in Boston are teaching hospitals, and are non-profit.
As someone observed, the make an awful lot of non-profit. Much like our esteemed non-profit universities.
Yes, and it should be noted there are some world class teaching/research hospitals in that area. But yeah, even with non-profit institutions (like Kaiser Permanente, where my mom works and which is the closest thing to NHS in the private sector and a very good model) can have large, er, surpluses. That makes it sound like FIFA.
Genuinely just spent the last couple minutes pondering whether US healthcare or FIFA is more corrupt. US Healthcare. Final answer.
Was that Michael Moore documentary "sicko" accurate? I like his stuff, but don't trust it as its clearly biased. I work with pharma companies and it's really "interesting" the way they operate.
If Americans could genuinely be given the option of a NHS based along the lines of the U.K. Model what would be their major objections ?
The media make the most of horror stories about how socialized medicine doesn't work in the U.K. or in Canada. We get stories about people dying while waiting for an appointment, or various screw-ups and how much people are really paying for it. So there's no real taste for it, personally I'd love to see a similar system here. One of the difficulties I see that such a system would face here, is the number of people using the system that wouldn't be paying into it.
Don't believe all you see and hear in the media! The NHS works incredibly well and in my opinion it is the UK's greatest peacetime achievement. It's not perfect, of course, and errors and delays happen, and it could always do with more money - but when you are providing a service to a population of 60 million there are bound to be issues.
I agree that the system would not be popular in the US if people don't all pay their share. But I really don't get the I'm alright Jack - you go screw yourself mentality (I'm not saying that describes you by the way). This isn't Marks or Lenin - we're not talking about nobody should have two cars until everyone else has one - this is pretty fundamental - life or death. This is collective social responsibility - those who can, pay (and pay more) those who can't, don't. But their life, their health is of equal value.
What it comes down to is the American system of healthcare is far too profitable. Therefore changing it is "socialism" or some other scary world. No American's complain about their socialist police service, fire service, education, etc. But suggest single payer health care and you're a stinking commie, threatening the American way of life.
The amazing thing is the way American's of convinced to go against their own interests. A few years ago a survey was done and Texas came out with the highest percentage against health care reform. Texas has (or at least had) the lowest percentage of the population with sufficient health insurance coverage), so really is a case of the turkeys voting for Christmas.
I once has an argument with a guy in Philadelphia around the merits of NHS v the US system, he vehemently stated that he was proud that American's paid too much for drugs, that somehow the only reason anybody in the world got medicines was because American's were willing to bend over and take one for the team from the pharmaceutical companies.
If Americans could genuinely be given the option of a NHS based along the lines of the U.K. Model what would be their major objections ?
The media make the most of horror stories about how socialized medicine doesn't work in the U.K. or in Canada. We get stories about people dying while waiting for an appointment, or various screw-ups and how much people are really paying for it. So there's no real taste for it, personally I'd love to see a similar system here. One of the difficulties I see that such a system would face here, is the number of people using the system that wouldn't be paying into it.
Don't believe all you see and hear in the media! The NHS works incredibly well and in my opinion it is the UK's greatest peacetime achievement. It's not perfect, of course, and errors and delays happen, and it could always do with more money - but when you are providing a service to a population of 60 million there are bound to be issues.
I agree that the system would not be popular in the US if people don't all pay their share. But I really don't get the I'm alright Jack - you go screw yourself mentality (I'm not saying that describes you by the way). This isn't Marks or Lenin - we're not talking about nobody should have two cars until everyone else has one - this is pretty fundamental - life or death. This is collective social responsibility - those who can, pay (and pay more) those who can't, don't. But their life, their health is of equal value.
Off the track of the thread I know - sorry.
Preaching to the choir........
The latest, biggest objection is that people don't want "someone in Washington" deciding what treatment is appropriate for an individual, particularly as they get older. As an earlier poster indicated, insurance companies are already doing this.
Would it be possible for an individual state to introduce an NHS-style system without Federal backing? Leaving aside the "It would never happen" argument, if, for example, California, decided to introduce a tax specifically to pay for healthcare that was then free to any resident of CA, would that be allowed?
Massachusetts tried it under Governor Mitt Romney, and it failed for many reasons. Costs were far ahead of revenues, so new appropriations were necessary to keep it afloat. Poorly thought out initially, and I think would discourage other states from trying it.
Massachusetts tried it under Governor Mitt Romney, and it failed for many reasons. Costs were far ahead of revenues, so new appropriations were necessary to keep it afloat. Poorly thought out initially, and I think would discourage other states from trying it.
Not correct. The Massachusetts plan is almost exactly the same as the current national plan. You had to have insurance or pay a penalty. Subsidies were available for low income earners. The was no attempt to introduce an NHS style system.
Costs have been a problem, and will be for any system where the Govt(either state or national) has limited power to negotiate costs effectively. At the moment all they can do is try to limit premiums
Comments
We have an NHS type system for people over 65, it's called Medicare. People on both sides are violently protective of it. And as well they should be. I really think it's a perception/lack of understanding problem, and it's part of a larger problem which is that we don't have intelligent conversations in this country about what Government should and should not be for.
To me an NHS style system, or "Single Payer" must be the goal. And from a technology standpoint, which can be so vital, were you to consolidate care into single payer, what you could do with technology--the ways you could improve care, are immense. But Limey is correct, between the media and right wing politicians backed by the vast insurance and pharma lobby, it's a long, long road ahead.
So why is this any different than going single payer?
What I don't understand is why businesses are not lobbying for single payer. It would get them out of the healthcare provision market. Sure there would have to be some "per employee" tax to help cover this, but I'd be amazed if it wasn't cheaper than providing health benefits. I heard some time ago, that General Motors was effectively a health care provider that makes cars their costs were so high and they need to cover so many people.
The other argument rolled out is that people don't want the government deciding what treatment they get. Unless you're paying all your costs today, you're going through an Insurance company. Their mission is to make a profit. They are quite happy to disallow treatments if they don't think they are necessary. It's no different.
But I fear we have digressed from the Primaries to actual policies.
What happens, and this is something my dad works with in rural hospitals, is that you are taken to the emergency room if you fall ill, and if you don't have funds, the above happens, and the hospital ends up eating the costs. As you can imagine, in poor and rural areas, hospitals bear a far heavier cost than those, say, near to where I grew up in a middle class part of Los Angeles. So what is unfortunately common is that hospitals themselves go in to massive debt, and end up in bankruptcy, at which point all sorts of bad things can happen. My dad works as a court appointed overseer whose job it is to make sure that quality of care is maintained and patient records aren't breached. It's now mandatory in a handful of states, but far from a perfect system, and obviously the more perfect system is one where hospital bankruptcy isn't a common thing.
What the Affordable Care Act was intended to do was to subsidize those who cannot afford insurance, whereby the Government either purchases private insurance for people, or provides what is called Medicaid, which is essentially insurance for those who are poor/impoverished. This, in theory, would stop people without insurance from simply going to the ER (Emergency) if they didn't have insurance and couldn't get in to see a doctor. Going to the ER is far more expensive to everyone in the healthcare ecosystem than it would be to simply go to a doctor.
Stupidly, accepting the federal subsidies for the poor or those who cannot afford insurance was left up to the individual states. And in vicious anti-Government movement by Republicans, many of the poorest states (read, the south/south west and those largely Republican) rejected these subsidies because they didn't want big Government coming in and taking their guns. Or to keep the New World Order from taking over. or because Obama is the anti-Christ/Muslim/Kenyan born...moral of the story is the debate wasn't about healthcare but about perceived fascism, or something. Unfortunately, given that poorer states rejected the subsidies (though some have since changed their minds), those who need care the most didn't get it. And that is why I attack the Affordable Care Act from the left, because it's bad Capitalism, it's bad FDR New-Dealism (to coin a phrase), and it's awful socialism.
Obamacare would have been better supported across the board, had it been available for review or comment or revision before it was rammed through congress, "you've got to pass it in order to know what's in it", remember?
Nobody has denied recently that healthcare reform wasn't urgently needed in this country, the way that Obamacare was rammed down our throats, how poorly thought out it was, and how impossible it was to sign up for it at the beginning made it impossible to support. Since then it's drag on economic recovery is obvious to anyone trying to run a business.
Guess what? Young people didn't want to sign up because they thought they didn't need healthcare insurance. Consequently premiums and deductibles for everyones' insurance has gone up, now insurance is less affordable than ever. Fewer businesses are now offering insurance as part of the "package", and are keeping employee numbers as low as possible.
One of the big problems is that when you pay for insurance coverage, you're not done paying, you're just paying for the privilege to pay less.
I've read it all and I can see it as a criticism of her competence but it's Not quite the smoking gun I'd expected.
I think I've reconciled myself to it. Doubt I'd ever want to vote for her, she don't represent me. I'd vote for her over Trump tbh.
As someone observed, the make an awful lot of non-profit. Much like our esteemed non-profit universities.
Genuinely just spent the last couple minutes pondering whether US healthcare or FIFA is more corrupt. US Healthcare. Final answer.
I agree that the system would not be popular in the US if people don't all pay their share. But I really don't get the I'm alright Jack - you go screw yourself mentality (I'm not saying that describes you by the way). This isn't Marks or Lenin - we're not talking about nobody should have two cars until everyone else has one - this is pretty fundamental - life or death. This is collective social responsibility - those who can, pay (and pay more) those who can't, don't. But their life, their health is of equal value.
Off the track of the thread I know - sorry.
The amazing thing is the way American's of convinced to go against their own interests. A few years ago a survey was done and Texas came out with the highest percentage against health care reform. Texas has (or at least had) the lowest percentage of the population with sufficient health insurance coverage), so really is a case of the turkeys voting for Christmas.
I once has an argument with a guy in Philadelphia around the merits of NHS v the US system, he vehemently stated that he was proud that American's paid too much for drugs, that somehow the only reason anybody in the world got medicines was because American's were willing to bend over and take one for the team from the pharmaceutical companies.
The latest, biggest objection is that people don't want "someone in Washington" deciding what treatment is appropriate for an individual, particularly as they get older. As an earlier poster indicated, insurance companies are already doing this.
Costs have been a problem, and will be for any system where the Govt(either state or national) has limited power to negotiate costs effectively. At the moment all they can do is try to limit premiums