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

[JazHaz]

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.

Yes it is annoying I agree. But not everyone who is working has to pay, for example if you have a long-term condition. My dad has diabetes and since diagnosis hasn't had to pay prescription charges for his insulin, syringes, blood tester kits etc.

[PhantorGorth]

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

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.

My point wasn't about those that would choose not to ( I agree it is unlikely) but that a capitalist system means that it wouldn't make any difference if everyone was motivated (the professed ideal). It is similar to the concept of giving everyone more money. That devalues the currency and you are back to were you started (other than possibly redistributing some of that wealth). The current edge motivated people have over those that are not would in that scenario lose that edge and wealth would then be dependent on other factors. Unfortunately wealth wouldn't equalise that much either as the system is free to use those other factors for people to be competitive with. All you would end up with is motivated poor.

Capitalism is a system that always reaches an equilibrium that has a wealth distribution such that a few people have the majority of the wealth. Though as I said before the extremes of that distribution can be reduced some what (taxes, etc). But, anyway, it always means that the poor are then unable to command many resources.

As Health Care is a mix of physical (equipment, drugs) and specialist human (doctors, etc) resources, most of which can not be reduced in cost in the same way say that modern consumer electronics has been over the last few decades (mainly for its specialist human resource requirement) means that Health Care is always expensive relative to what the poor can afford.

It then comes down to people's political ethics whether to make Health Care availability part of that wealth distribution (US until now) or via some system (usually centralised) to lift it to a social minimum (example UK's NHS).

[Chrisfs]

Site is still standing and no one is dead, that's great

If people are interested in the wonkish details
here's a decent article
http://www.csmonitor.com/USA/Politics/2 ... ans-to-you

[Selezen]

@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.

Again, that's the same story as the NHS vs Private care in the UK. The public health care system has its negatives, I'm not saying it doesn't. Publicly funded healthcare always has and (in my opinion) always will have resource issues which will drive up waiting times since the number of patients will always vastly outnumber the number of staff. At the moment in the UK a trip to the A&E department of a public hospital will mean a wait of 3 hours before being seen by a doctor and a total time spent in hospital (before being discharged or transferred) of at least 5 hours.

Getting an operation on the NHS is the same story. Once your GP has told you you need an operation or a scan or something, you have a wait of up to 18 weeks (that's the government target for maximum wait time before treatment) before you will receive or begin that treatment. With a private health firm (BUPA etc) you see the doctor and usually will get the scan or operation the same day or at your earliest convenience. That's what you pay your money for. Psychiatry and counselling are the same. NHS sponsored counselling has a wait time of at least a year. Private counselling is available as soon as your cheque clears...

I wasn't aware that this healthcare bill in the US was removing the whole medical insurance system! Is that really the case? Is the government funded "public" system replacing the insurance method? If that's the case then I accede: yes, you are losing the freedom of choice and will be stuck with a sub-standard service with no option for better service for those who can afford it. Which is bad.

[Commander McLane]

Actually I'm not so much interested in the wonkish details, because I am no US citizen, and this is an international forum. (So, in answer to the title of the page Chrisfs has linked to ("what the bill means to you"), I just can reply that to myself—as to the majority of members of this forum—this bill means nothing at all. It doesn't apply to us. And—truth fully be told—I find it somewhat annoying when americans think that their domestic issues are the most important thing for all the rest of the world.)

What I am more interested in is a debate about the general concepts of health care (well, it doesn't necessarily need to be health care, but it happens to be the issue at hand) which highlights our different world views and probably brings about some insights I didn't have before.

[snork]

In Germany we have a mandatory health care for about 130 years now—

Not really, it is only fully mandatory since, 2006 I think. Before that, there were ways to not be health insured - I myself have not been insured for about 5 years.
It was a risky decision, but I simply could not afford it, trying to study without any study-related income.
To be able to afford health insurance I would have had to work for money even more, and I was already at full schedule, working, studying, and household.

And just another usual misconception : prevention, regular checkups and early stage treatment do NOT reduce costs, when seen e.g. nation-wide.
It may reduce costs on a specific incident / person gone ill, but that means that person will contine to live longer and have more time to develop other cost-intensive illnesses. The older they get, the higher the chances for costly multi-ilnesses.
The way the economics think.

[LittleBear]

@Cmd. Cheyd

Aren't you just forgetting plain bad luck? People do work hard and then lose it all through no fault of their own. A lot of self-made people seem to overlook the fact that they were also lucky. It is popular to hate bankers at present, whist overlooking that bankers did in fact massively help the economy for years and funded numerous puplic services through taxation for many years until it All Went Horribly Wrong and ended up being bailed out.

I don't think your argument on compulsary health insurance being unconsitutional holds water. The Fedal Govenment has always done more than provide for the national defence. What about the FBI for a start? Your Govenment removes your freedom to take certain drugs and to boot charges you billions in taxation to prevent you doing so. What about the Fire Department? You don't have the freedom to chose whether to take out private fire insurance for your own private fireman to put out your house if it catches fire, the Fire Department protects your house whether you want them to or not? What about compulsary car insurance? You don't have the freedom not to insure yourself against third party risks and the govenment will fine / prosecute you if you fail to take out insurance for your car.

I can see your point that the way its been done is somthing of a fudge and could have been done better. But forcing citizens to take out insurance is hardly new. Try opening any buisness in either the US or Europe without the right public liability insurances in place and you'll soon run into a mountain of Fedral red tape!

All types of insurance are a socialist model, whether private insurance or national insurance. The whole insurance industry is built on the principle that the lucky majority pay for the unlucky minority.

The average American pays far more in Medical Insurance than us Brits pay in National Insurance and Private Healthcare combined, and don't have a particularly good health care system as a result. Mainly because if you take out private care insurance, you are not just insurancing against a risk but also paying towards someone's profit margin. Americans seem perfectly happy to pay for police forces, space exploration, defence, road building and a million other things collectively even though this removes the freedom of those who do not want roads, space shuttles etc. Why is healthcare so different in principle?

[Cmd. Cheyd]

@LittleBear
Actually, I'm not forgetting bad luck. PhantorGorth knows some of this story, but I'll relay a little more of it here. In 2002, I was working for Microsoft. My son, Feyd, was sick with a vague diagnosis of "Failure to thrive". To make a very long set of stories short- by the end of 2002, my son had died, I'd lost my job (and with it my entire self-identity), lost my home and was forced to live with my brother-in-law (who still worked, and still does, for MS), my car was repo'd, my father had a heart attack and quintuple bypass, my mother-in-law had a golf-ball sized brain tumor, and my wife had a botched lithotripsy that caused sepsis and left her in the ICU for 3-days with a blood pressure in the teens and 50/50 odds. When I finally found work (hard in the post-bubble-bust IT world), I was making $11/hr in a city with a very high cost-of-living. The road to recovery has been a hard one, but I did it without "social assistance". And I have no issue with the banks.

As for the constitutionality of the bill (a few hours still til it's law), is questionable because as I said, it doesn't provide equal protection which it must. It's why 28 State Attorney Generals are currently waiting for Obama's signature to launch lawsuits over it. Additionally, the Federal government (not State or Local) has never mandated purchase of anything such as this before. There are other grounds to argue constitutionality as well, but I won't go into them now. As for the Fire Department - That is a local government service, not a Federal. BIG distinction.

Compulsory car insurance is also different because it is not mandated to protect me, the buyer, from harm. Matter of fact, the mandated coverage EXPLICITLY doesn't protect me. I have complete freedom NOT to protect myself what-so-ever. It is there to protect the OTHER fellow. Health insurance is the opposite. It doesn't protect the other guy, it covers me. Again, a BIG distinction.

[LittleBear]

Really sorry to hear that, but isn't that exactly why a national health insurance system is a good idea? When times were good for you, you pay into the system and are entitled to take out when things are bad.

Take your point on the distinction between State and Federal expenditure, but in practice whether its state or federal taxes (the UK has a similar distinction between Council Tax which is a local tax and Income Tax which is national), it still amounts to 'The Man' in whatever guise taking your cash and spending it on things which benefit the public at large whether you want them as an individual or not. The UK once had a system of Fire Insurance where you had to take out private insurance and display a plaque on your house. If it caught fire, the fire service would only put it out if you had paid your insurance. I don't know if the US ever had a similar system, but it was abolished in the UK as it was pretty crazy for the fire service to stand there watching a house burn and only act when the fire moved on to the next house displaying its insurance plaque. Today, if my house caught fire it would be put out by the Fire Brigade, who are funded by my monthly Council Tax bill. My local council even sends me a bill with the amounts spent on police, fire, schools, roads etc marked on them. Isn't that a form of compulsary fire insurance? I can't refuse to pay for motorway saftey measures (if I don't drive they only benefit the other guy) nor can I decline to have the public fire insurance and chose private instead.

True, car insurance protects the other guy whereas health insurance protects the individual who takes it out but the collective payment of taxs for police forces, roads, armies, schools etc is somthing people of all societys do. Americans don't seem to have a big issue with the Govenment (whether national or local) providing these services out of compulsary taxation, so its a bit puzzeling (at least to a lot of us on this side of the pond) why healthcare being provided through compusary taxation (which compulsary insurance effectivetly is) should be such a hot potato. I don't have children, but I don't feel that my freedom is comprimised because I am forced to pay for education services which are only enjoyed by other citizens. I have only need the NHS once (touch wood) and the cost of my National Insurance I've paid over the years was much more than the cost of my treatment, but that is the nature of insurance. Although I have subsidised others who did need expensive treatment I could just have easily been unlucky and needed millions of pounds worth of treatment which I could not have afforded without a National Insurance system.

I can see your point about it not being fair for The Man to make you pay for things you may not want or need, but isn't that part of being a member of a society that there is an element of clubbing together to pay for vital services?

[Commander McLane]

As for the Fire Department - That is a local government service, not a Federal. BIG distinction.

Now, here's a point that interests me, because I—being not a US citizen—don't understand it.

Why? Why is there a big distinction? And what is this distinction?

Why is it that local and state government (and whatever may be between them) is basically seen as good, and federal government as bad? Is there any reason for this other than the completely arbitrary one that perhaps your town and state are currently run by your party, and the federal government by the other guys?

From an outside perspective it looks very much like many Americans entertain a certain fetish about their national government being the source of all evil. It is really difficult for me to understand this, because in principle I don't see any difference between national, state, regional, or local government, except for their respective areas of responsibility, of course. Why the national government should have a different (and seemingly inferior) quality than the more regionally limited governments is incomprehensible to me. And I mean it. I just don't understand it (except that I'm able to understand it as a form of fetishism, as mentioned above).

So if there is any actual, factual rhyme and reason to this distinction, I would be very glad to learn about it.

[Cmd. Cheyd]

Sorry, I was out of the office most of yesterday, so was AFK.

@Littlebear
I know it doesn't explain my National Health insurance is bad. I was just giving example as to why I'd not forgotten "plain bad luck". As for paying in during good time, pulling when bad - We have this already in Medicare and other similar programs.

I'll address the Fed / State / Local thing further down. But yes, we did have the Fire Insurance Plaque thing too... My paternal grandfather was a firefighter and had one of them as an antique on his mantle.

On the Car Insurance thing, Car insurance is NOT a mandatory purchase. Rather than buying insurance, you can place a given amount (varies by state) in a state-monitored bank account that ensures you have enough funds to cover the cost of an accident. And again, private passenger auto coverage is a State-mandate, not Federal. Lastly, you can choose public transport or other means to achieve mobility that don't require you to buy PPA. Driving is a priviledge (not a right) and one that you can choose to avail yourself of or not. If you choose to, then there are requirements such as PPA coverage, passing your exams, etc.

@McLane & Littlebear
Now, for the Federal vs. State/Local thing... The reason there is such a distinction drawn in many conservative American's mind is because of the early history of our government and the way it is SUPPOSED to be run (and did for over 150 years). Our constitution is laid out such that any power not EXPLICITLY given to the Federal government remains in the hands of the State. The idea being that those closest to the problem, area, or region are going to best understand the needs and concerns of their citizens. Our government was created to be a weak Federal government and a strong State government. If you look up Federalist / anti-Federalists in early American history, you can read about this debate. Add to this years of lies from the Federal side, and you have a natural distrust of the Federal government by many. Not to say the least of the MASSIVE incompetency seen in most Federally-run government programs, or the fraud, corruption, or abuse of those programs.

[Commander McLane]

Now, for the Federal vs. State/Local thing... The reason there is such a distinction drawn in many conservative American's mind is because of the early history of our government and the way it is SUPPOSED to be run (and did for over 150 years). Our constitution is laid out such that any power not EXPLICITLY given to the Federal government remains in the hands of the State. The idea being that those closest to the problem, area, or region are going to best understand the needs and concerns of their citizens.

Okay, so there is a historical reason, and nostalgia is indeed a considerable motivator for people's mindsets and actions. The question I have here is whether the circumstances haven't quite radically changed since 1776? Obviously a couple of colonies in the wilderness (which is a very simplifying description, I know) is something completely different to the world's only super power. I dare to say that the single states without a strong central government never would have evolved into a super power (historically, leading up to the 1860's, they actually evolved into two antagonistic regional powers). For comparison with a different region of the world: only through some sort of unification can the European states become real global players; as an assorted bunch of states they cannot. So I would even argue that a weak federal (= national) government of the US is neither possible nor even desirable.

I understand and support the idea of subsidiarism, that those closest to the problem should have the power of decision. However, I would like to raise two different points. (1) The nostalgical/ideological bias against the federal government aside, does it actually and factually hold true that the state governments are closer to the citizens than the federal government? Again, it's a real question. I'm asking myself, if I for instance take the most populated state of the union (which, if teleported to another part of the world, would perfectly qualify as a nation of its own): Are the guys in Sacramento really closer to the people in a small town in southern California than the guys in Washington? (The same question has of course to be asked for the other 49 state capitals.) Therefore, how much sense does the distinction between state government (good) and national government (bad) actually make? Especially, as (2) the matter in debate is of the same significance for all citizens in all states. As I said before, in my opinion health care as a system only makes sense for the whole society, not for fractions of it. Therefore it seems inherently a responsibility of the broadest government, which is the national government.

An example from another sector in another country: In the Federal Republic of Germany, where we have the federal government and state governments as well, education is traditionally defined as a responsibility of the states. The reasons are purely historic and completely obsolete, but a lot of education ministers and their staff in every single state would lose their influence and jobs if it became a federal responsibility, therefore it is not going to happen. So the situation is that formally each state independently legislates the educational institutions within its borders, but all of them have to do it more or less in the same way, because it would simply be crazy if somebody who went to school in Hamburg would not be accepted in a university in Munich because of different syllabuses or standards. People with children couldn't even move across a state border, if they weren't sure that their children can change from one school into the same grade of another school without problems. Therefore, a whole new bureaucracy with the sole purpose of coordinating the formally independent state bureaucracies for education was created and is thriving, giving even more jobs and influence to bureaucrats most of whom wouldn't be needed at all, if things were organized more efficiently in the first place. Needless to say that nothing of this is mentioned in the constitution.

Add to this years of lies from the Federal side, and you have a natural distrust of the Federal government by many. Not to say the least of the MASSIVE incompetency seen in most Federally-run government programs, or the fraud, corruption, or abuse of those programs.

I respect you clearly not being on "the Federal side", but I don't really have a clue which lies you are referring to. It would however strike me as odd if the federal government only ever utter lies, and the state governments only ever speak the truth. I don't think that's what you mean.

As far as incompetency, fraud, corruption and abuse are concerned, I just have my doubts. From Germany (and from Tanzania as well) I would say that the level of incompetency, fraud, corruption and abuse in organizations tends to be the same, regardless who is running them. I would say that is true for state organizations and bureaucracies, as well as for those owned by the churches and religious organizations, corporations, foundations, and NGOs. Overall I think the level is higher in Tanzania than in Germany, but that's about the whole difference. Is there evidence in the US that the level of incompetency, fraud, corruption and abuse is significantly higher in federally run organizations and programs than in organizations and programs run by the states, counties, municipalities and whatnot, or the private sector? That would be very interesting.

[ClymAngus]

Hang on, "the right to make your own choice" choices which are limited by your monetary worth. Also: "I could walk into any emergency room" that is assuming you are in any state to walk or are even conscious.

I can see where your going with this, one mans freedom is another mans slavery fine BUT (and this is a big but) this is ENTIRELY dependent on circumstance. I see this as a net for when choices are ALREADY being taken for you. If your K.O. you've already lost the most basic freedom of all: to be able to react.

No Selezen, you understand my use of the word "Freedom" perfectly. "Freedom" IS the right to make your own choice. Both in whether to have or not, and in from whom I do acquire it if I do. 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. With the passage of this bill, I explicitly LOSE the freedom of choice to carry insurance. It is mandated, enforced by entities that have the right to seize my income, take my home, and imprison me. This bill (as of tomorrow, it'll be law) also reduces my choices in where to acquire health insurance, although less explicitly in it's manner.

Prior to this bill, with or without insurance, I could walk into any emergency room with a broken arm and expect treatment but I wouldn't expect the government to pay my gas or public transport costs to get to the hospital. Exactly as you do.

[Sendraks]

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.

The thing I like about the UK system is that many prescribed drugs would cost a hell of a lot more than £7-£20 if the system wasn't run the way it is.

I'm not sure the legislation will solve all the problems in the US but trying to bring more of the Health spend under Government control is no bad thing. At present the US healthcare spend outstrips every country on the planet but in terms of outcomes, it is behind most western european nations, especially those with socialised systems. The UK spends much less on healthcare than the US, but we have better health outcomes. Ok, the social and public health differences of each nation make the solution more complex than just Government run healthcare, but the evidence of efficacy and efficency of well run socialised systems is there to be seen.

The reality is that effective/efficient healthcare isn't happening in the US at present, partly because of the way the private/insurance funded system exists to generate profit first and high quality health outcomes second and partly because the taxation funded/socialised parts are not well run. Hell, if you could just get the latter part of the US health system working properly you'd see huge gains in health outcomes.

I can understand why many Americans are opposed to this, some are rich and stand to lose (albeit trivially) through a socialised system, but a great many are poor and would benefit from a well run socialised model. Unfortunately the poor also tend to = the uneducated and don't realise they're protesting against something that might do them some good (which shouldn't be interpreted as protesting against socialised healthcare = uneducated). At the very least, the principle of having universally good healthcare for all citizens, is something no intelligent individual in their right mind would argue against. But this legislation isn't necessarily that principle enshrined in law.

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".

Another reason why Private Healthcare in the UK is so cheap is because the staff providing the private healthcare are, more often than not, NHS staff contracted out by the Trust. There are caps in place, at least on FTs, as to how much private practise they can do. The private sector healthcare is "better" than the NHS, isn't a universal truth in the UK, some of it is better than the NHS, but that's the really expensive stuff the average joe with "private health insurance" never gets to see as they can't afford it and the insurance company can't afford to contract that provider.

[Chrisfs]

I wasn't aware that this healthcare bill in the US was removing the whole medical insurance system! Is that really the case? Is the government funded "public" system replacing the insurance method? If that's the case then I accede: yes, you are losing the freedom of choice and will be stuck with a sub-standard service with no option for better service for those who can afford it. Which is bad.

Absolutely not. In fact there is no new public health system (currently there is Medicaid for very poor, and Medicare for retired people) . There was to be a public insurance plan intended to compete with private plans, but this got taken out some months back.
The bill regulates the existing private insurance industry.
Mandates that they must take all comers, and mandates that everyone must have insurance (with some exceptions). That can be individual insurance or through your employer. Provides govt subsides to mid and lower income for insurance. Sets up a govt run 'Exchange' for people seeking individual insurance that requires insurance companies to offer a few standard basic packages (and some bells and whistles) so that people can price compare apples to apples and are assured of getting a policy with no really big loopholes.
So there's regulations that will change the way private insurance companies can do business, but it's in no way replacing anything or a wholesale change. Health insurance will still be sold by private companies and most people will still get their insurance through their employers as has always been the case.