US joins rest of Industrial World in 20th (21st) Century

Chrisfs · Post by **Chrisfs** » Mon Mar 22, 2010 5:01 pm

Sigh, I said I wouldn't start it (beyond the first post)m but didn't say I wouldn't respond (poltitely). Sadly soonest time I'll get to make a comprehensive response is Tuesday night (US CA time) (leaving for work, plans tonight )

Briefly in response to Cheyd
Emergency Rooms: Yes you must be treated if you walk into an emergency room (not for free and not immediately, you may wait for hours)
Guarenteed treatment at the emergency room and govt picking up part if the tab you can't (and hospital picking up the rest as any stiffed service provider must do) is the most expensive and inefficient way to distribute health care.
It's not the answer to everything.
It doesn't cover immunizations or regular doctor visits or medication for chronic conditions.
So people who can't afford so see doctors or get immunizations/drugs, get to wait until they are really sick and what might have been relatively easy to fix earlier is much harder and more expensive. Instead of blood pressure meds, a person doesn't get help until they have a stroke.
The bipolar patient who can afford meds will get observation for 48 hrs when they try to injure themselves (assuming they don't succeed in killing themselves)
And once their savings are exhausted from that stroke or condition (if they had some to begin with), the govt will help out some. That's the current system. For the non-elderly, it kicks in at the most expensive time and private charity is nowhere near enough to cover everyone.

(and Now I'm late to work)

If you grant that emergency care covered by the govt is a good thing,
then govt help at an earlier, cheaper stage is better for both the people involved AND the taxpayer.

Post by **Disembodied** » Mon Mar 22, 2010 5:02 pm

Are there many people in the USA who can afford health insurance, but who choose not to have it? I travel to the USA regularly. I have the freedom to choose not to have health insurance – and yet, because I can afford it, I always buy it. If it became compulsory to have medical insurance before travelling to the USA, I wouldn't really feel like I'd lost any freedom because it wouldn't alter my circumstances one bit. As I understand it, prior to the passage of this bill, if I walked into a US emergency room with a broken arm, without insurance – and since I'm not destitute I'm not eligible for charitable care – I might get treatment but I'd also be presented with a bill for ... what? I've done a quick Google search and my totally unscientific estimate for the cost of a broken arm comes out at anywhere between $12,000 and $30,000. Good grief!

Now I'm doubly convinced that I'm never going to travel to the USA without health insurance. That's one freedom I'm not going to be exercising.

All nation states have a basic level of infrastructure. I can't choose not to be protected by the British Army, any more than I can choose not to pay for that protection. They'll defend me whether I like it or not, and if I don't pay my contribution towards that defence the State will seize my income, my assets, my home, and put me in jail. It's one of the costs, one of the responsibilities, of living in an organised state, I think.

NigelJK · Post by **NigelJK** » Mon Mar 22, 2010 5:06 pm

If you pay for insurance in the UK you are effectively subsidising the NHS for those who don't.

I've always found it odd that the 'left' thinking brigade find it easy to point the finger at those who are wealthy (usually through hard work) saying how 'unfair' it is that the not so wealthy can't have all of the tihings the wealthy have. Then just to really slap them in the face they tell them how 'fair' it is to tax them more than the not so Wealthy.

Just for the record my wife was very seriuosly ill a couple of years ago, fortunately she was covered by her employers health scheme (do they have these in the States?), the care she received was exceptional. Her oncologist does also work for the NHS, so the quality of medical care is the same. We had to Visit the Local NHS hospital as an emergency during this, and my Wife in extreem discomfort, had to wait 7 hours for a Docotor to see her (at 3am in the morning) only to be told he was going to do nothing, and to go back to the Private hospital for one of the nurses there to perform a simple procedure.

JazHaz · Post by **JazHaz** » Mon Mar 22, 2010 5:26 pm

Cmd. Cheyd wrote:
With the passage of this bill, I lose that freedom. Previously, I had the choice to carry insurance or not, and if so, the quality and quantity I chose to acquire.

Sorry but I disagree. Freedom of choice is an illusion.

If someone can't afford insurance, where is their choice? What about the choice between not paying the rent and having to live on the street or having to pay for their little child to receive cancer treatment?

Freedom to die if you can't afford healthcare?

This is why I would never want to live in the States. Freedom is one thing you don't have.

Cmd. Cheyd · Post by **Cmd. Cheyd** » Mon Mar 22, 2010 5:50 pm

@Chrisfs
Have you been inside a US-government run health care facility? I have - IHS Hospitals. Worked in them for around 7 years, and my wife for 3 years in VA Hospitals. Let me assure you, the wait in the emergency room will be longer. The two I worked for averaged a wait time of 62% longer than our corresponding private hospital complexes. I will agree, preventative care if FAR less expensive and more efficient than ER treatment. Problem is, people don't use it and not because of cost. I'll explain and knock down most/all of your arguements at once. How? Immunization. Children can recieve FREE IMMUNIZATIONS from both private charity and from the Department of Health in my communities. In spite of this, over 20% of enrolled students are missing some or all of their vacinations. The problem cannot be cost if cost <= $0. The problem is laziness and misinformation. This same problem exists with routine checkups and the Free Clinics offered in the metro area I work in. People don't come typically for routine exams or preventative care, they only show up with emergency cases or after they have become sick. Chronic conditions requiring routine medication can be covered by private charities and low / no cost programs offered by the drug companies themselves. If you want to expand private charity, reduce taxes so more individuals have more free income to donate. It has been proven to work. Just look at any of the financials for a major charity over the last 30 years. (BTW - Did I also mention I have done 15 years volunteer work. Kinda know that side of the fence too...)

I never granted emergency care covered by the government was a good thing. Offered by private charity is. And yes, healthcare at an earlier and cheaper stage IS good. But Americans are lazy.

@Disembodied
Yes, there is a fairly high percentage of people in the US that can afford but choose not to acquire health insurance. Mainly your sub-35 age ranges who prefer to pocket the money thinking they're immortal. Hey, I never said they were smart.

Figures I last heard were in the 30% range of that age bracket. The one of the problems with this health bill though is that it is EXTREMELY flawed in the way it tries to work. The idea of it is you're going to put all these people into a pool and force them to buy insurance through an exchange. The massive number of individuals will normallize the cost and thereby lower it. Failure to buy the mandated insurance will be punishable by a $1500/yr fine that should you choose not to pay, the IRS can just seize from your paycheck with no notification to you whatsoever. All they have to do is contact your employer and the employer is bound by law to seize your wages and deliver them to the IRS. Now, the annual cost of the insurance coverage - Guess what - It's more than $1500/year. So what will happen is this... Folks will forgoe the insurance in favor of paying the fine at a rate of $57.70 pulled out of their pay check every 2 weeks. Then, when they get sick, get cancer, or whatever - They'll sign up for the insurance, pay for a few weeks/months until they're better, then drop it. In the event of an emergency, such as the broken bone scenarios, they'll just show up in the hospital without insurance what-so-ever, and sign up ON THE SPOT. Why? Because the insurance companies can't refuse them.

And on your last point, at least in the US, our Constituion clearly lays out one of the responsibilities of the Federal Government is to "provide for the common defense" of the nation. Hence the US Military. Got no problems there. They are there to protect my Freedom. This bill does not protect my freedom, it removes it as I've laid out before.

@JazHaz
Freedom does not mean lack of risk. That is a common misconception of liberals within my country. Freedom means the freedom to succeed and the freedom to fail both. If you can't afford insurance, there ARE free and low cost alternatives. There are charities that help. They have the freedom to go out and earn more money at any point of their choosing. (And don't tell me they don't. I am living and breathing proof to the contrary.)

Post by **Disembodied** » Mon Mar 22, 2010 5:55 pm

NigelJK wrote:
I've always found it odd that the 'left' thinking brigade find it easy to point the finger at those who are wealthy (usually through hard work) saying how 'unfair' it is that the not so wealthy can't have all of the tihings the wealthy have. Then just to really slap them in the face they tell them how 'fair' it is to tax them more than the not so Wealthy.

There isn't any good, firm link between how hard you work and how wealthy you are. A nurse, for example, works a damn sight harder than I do, saving human lives here and there into the bargain, and gets paid a lot less. A binman puts in a hideous amount of extremely necessary hard work, and yet does not receive the kind of salary enjoyed by, say, an estate agent.

It makes sense for the wealthy to pay more tax than the not-so-wealthy. We've tried it the other way around, and all we got was the Middle Ages.

JazHaz · Post by **JazHaz** » Mon Mar 22, 2010 6:03 pm

Cmd. Cheyd wrote:
They have the freedom to go out and earn more money at any point of their choosing. (And don't tell me they don't. I am living and breathing proof to the contrary.)

Now that is just offensive.

Especially in a recession. There isn't the jobs in some communities.

I know, having not had a job for 14 months now. If I was living in the States, I'd probably be dead. I have had to get treatment from the NHS several times in the time that I've been out of work.

Cmd. Cheyd · Post by **Cmd. Cheyd** » Mon Mar 22, 2010 6:16 pm

JazHaz wrote:
Cmd. Cheyd wrote:
They have the freedom to go out and earn more money at any point of their choosing. (And don't tell me they don't. I am living and breathing proof to the contrary.)
Now that is just offensive.

Especially in a recession. There isn't the jobs in some communities.

I know, having not had a job for 14 months now.

My apologies then, Jaz. It was not intended as offensive, I was in your shoes during the Bubble-Bust back on 2002. If it would be of help any, let me know your career field and experience. If I know of anything (and you're willing to relocate), I'll gladly assist.

My point was more to the issue of general level of income, not to a specific short-term period (I do realize 14 months does not feel short-term whilst in the middle of it). I am a high school graduate with no college degree. In spite of this, I make a reasonably comfortable income (I'm about $3K a year short from being in the top 25% wage earners for the metro area I work in). My brother-in-law is in the top 10%, possibly top 5% for his metro area and is likewise educated as I. We have both gotten to our respective positions through hard work and personal advancement. The career field I'm in is not the one I started out aiming for. But I adapted. That was more of my point. Personal responsibility and motivation.

JensAyton · Post by **JensAyton** » Mon Mar 22, 2010 8:08 pm

JazHaz wrote:
Surely free access to healthcare should be a human right?

For reference:

Universal Declaration of Human Rights, Article 25 (not a treaty, but defines the concept of human rights as used in Chapter I of the United Nations Charter, as ratified by the United States)
International Covenant on Economic, SOcial and Cultural Rights, Article 12 (signed but not ratified by the US)
UN Convention on the Rights of the Child, Article 24 (signed but not ratified by the US)
American Declaration of the Rights and Duties of Man, Article XI, ratified by the United States (but vague); not formally a treaty but considered a binding obligation

Over here in Rightpondia, we now also have the Charter of Fundamental Rights of the European Union, Article 35. (The European Convention on Human Rights doesn’t address healthcare.)

Loxley · Post by **Loxley** » Mon Mar 22, 2010 10:21 pm

Swore I wasn't going to get involved in this thread, but, well...<rant mode on>

I've paid my National Insurance my entire working life and never yet been seriously ill. Does this put me in the position of being a creditor as far as the NHS is concerned? Well, yes it does. Does this bother me? No, no it doesn't.

Should I become ill or injured I can be assured of treatment "free at the point of delivery" regardless of my current financial status. Should I choose, I have the freedom to take out private health insurance in addition to this. This might allow me to jump a queue or two or maybe have a nicer room in the hospital. There is nothing a socialized medical scheme can do that can prevent that.

I'm aware that socialism is practically a swear word on the other side of the pond, but really the point of having a nation, a society, is to be stronger as a whole than we are alone. No one wants to stop people being a success, it's just a question of giving a helping hand to those currently down on their luck. <rant mode off>

Can we go back to being the "Friendliest Board this side of Riedquat" now?

Website · Post by **DaddyHoggy** » Mon Mar 22, 2010 11:04 pm

Loxley wrote:
Swore I wasn't going to get involved in this thread, but, well...<rant mode on>

I've paid my National Insurance my entire working life and never yet been seriously ill. Does this put me in the position of being a creditor as far as the NHS is concerned? Well, yes it does. Does this bother me? No, no it doesn't.

Should I become ill or injured I can be assured of treatment "free at the point of delivery" regardless of my current financial status. Should I choose, I have the freedom to take out private health insurance in addition to this. This might allow me to jump a queue or two or maybe have a nicer room in the hospital. There is nothing a socialized medical scheme can do that can prevent that.

I'm aware that socialism is practically a swear word on the other side of the pond, but really the point of having a nation, a society, is to be stronger as a whole than we are alone. No one wants to stop people being a success, it's just a question of giving a helping hand to those currently down on their luck. <rant mode off>

Can we go back to being the "Friendliest Board this side of Riedquat" now?

I think this debate is actually doing rather well - nobody has called anybody else a Nazi yet, so I think we're in no danger of it going wrong just yet.

One thing to note about NHS v Private Health Care.

1) Private Health Care in the UK is relatively cheap because Private Health Care companies pay slightly more than the NHS but it doesn't fund any University places for nurses or doctors or dentists, the NHS does that, the private sector steals them after they're trained - I know this because my wife has worked in both as "staff" and "manager".

2) - If you're involved in an RTA they don't pat you down for your BUPA card and send you to a BUPA hospital to have your leg sown back on, that first contact treatment will always be done by an A&E dept at an NHS hospital.

3) Even if you have private health cover in the UK, for very complicated operations, you may be looked after by BUPA pre-op, have the op either in an NHS hospital or by an NHS team drafted in to the private hospital, and then the BUPA hotel will look after you post-op.

Without the NHS Private Health Insurance in the UK would be prohibitively expensive in the UK too.

and that's my 0.02Cr worth in this debate.

(And when I lived and worked in the US I was insured up to the hilt just in case!)

Commander McLane · Post by **Commander McLane** » Mon Mar 22, 2010 11:10 pm

Loxley wrote:
Can we go back to being the "Friendliest Board this side of Riedquat" now?

To be fair, we are.

The exchange of arguments so far is way more civilized than in most (all) of the other internet fora I use to glance at.

I'd like to say a word about "freedom". In Germany we have a mandatory health care for about 130 years now—it is far from perfect, and there have been far more "health reforms" in my lifetime than I ever would be able to count—together with a couple of other mandatory care systems (unemployment, pension, etc., what we call social security) for which the workers fought against the government. And if you would tell anyone here that this system takes away his "freedom", they wouldn't even understand what you're talking about. As far as we germans are concerned, this system enhances or freedom, it doesn't take it away. And yes, here we have a fundamental difference between american and continental mentality.

Health care is good for me. Education is good for me, too. That's why schooling is mandatory as well in our countries. Tax paying is mandatory, too. And I cannot help but thinking that all three of them are good ideas in a society that has organized itself.

Personally I am a big fan of solidarity. Everybody pays according to their ability, and the needy get what they need. Hey, if a become needy, I will get what I need. I think that's a great thing. And if I don't become needy, I will be happy that I'm healthy, and glad that through my payments I could help a lot of people who were less lucky than I am. Sounds like a classic win-win situation for me.

PhantorGorth · Post by **PhantorGorth** » Tue Mar 23, 2010 12:00 am

Cmd. Cheyd wrote:
They have the freedom to go out and earn more money at any point of their choosing.

I agree this is a possibility for a lot of people but it is impossible for all. By saying this I don't mean that there are people unable to do this (though this is certainly true for whatever reason good or bad). What I mean is that in any capitalist economy, even if everyone was fully motivated, there are will always be winners and losers. If everyone was motivated that motivation would lose all it's economic advantage. A capitalist economy always reaches an equilibrium where there are rich and poor and the poor will end up priced out of most things. Mathematical modeling shows that the only real thing that changes the ratio of rich to poor is taxation. Low taxation = greater inequality, High taxation = less inequality (but inequality would still exists).

Free health care at point of delivery is therefore a good thing as there will always be people who can not afford to pay for themselves. Right wing philosophies about self-reliant do not hold water when you apply them globally.

Even as a centre-left socialist I have some doubts over the quality of this health care reform bill but at least it is a step in the right direction and a crack in the fundamentalistic right wing memes that, in my personal opinion, erroneously pervade mainstream US thought.

Cmd. Cheyd · Post by **Cmd. Cheyd** » Tue Mar 23, 2010 4:16 am

I don't have time tonight to comment much more, but will leave one short one...

PhantorGorth wrote:
I agree this is a possibility for a lot of people but it is impossible for all.

It is not impossible, so much as unlikely. Anyone is capable and all have the freedom here. The only barrier is personal motivation, not some systematic mechanism. There will always be someone who chooses laziness or procrastination.

Killer Wolf · Post by **Killer Wolf** » Tue Mar 23, 2010 8:13 am

some very interesting points on all sides here.

the thing i hate about the UK system is that i have paid contributions my entire working life, and when i went to the docs i still have to pay £7-20 per prescription. yet someone unemployed gets it for free. yes, i get access to free docs and the NHS hospitals etc, but it seems like people who aren't contributing get even MORE benefits.