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

[Cmd. Cheyd]

It does not remove the current medical insurance system yet. But there is legislation that has been proposed to add it back onto the law.

The current law mandates that everyone is forced to buy insurance, and goes so far as to hire 16,000 additional tax agents solely to review people's insurance coverage and determine if it meets some arbitary minimum level. The goverment will provide subsidies for low and mid income families, but it also places the majority of the tax burden on that same group (figure I read was over 60% will be placed on families making within 300% of the poverty level - ie. $66K for a family of 4). The exceptions built in are for the President, Senate, Congress, and other high-ranking goverment officials.

The idea of the exchanges is by forcing more individuals to buy, you increase the risk pool thereby dropping the normallized cost. But there's a MASSIVE FAILURE in the way it's designed. If an individual does not sign up for insurance, they are fined $1500/yr payable as part of their annual income taxes; however, the annual cost of the insurance will be higher than that $1500. So what will happen is people will opt out of the insurance (reducing the risk pool and driving costs up) until they're sick. Then, because insurance can't refuse them, they'll sign up after they've become sick. They'll stay in just long enough to recieve treatment, then drop out again so they can save the money. So the insurance company is going to be stuck with limited-term, high-cost customers only. They'll be forced to raise rates. Except they won't be able to because their pricing is mandated by the Fed, so they'll go out of business. This means the government will be "forced" to become an insurance provider (after all, they already own the banks, the car companies, etc.). Presto-Chango - You have single-payor system.

On the business side, if a company doesn't offer a "good enough" insurance plan, they are subject to fines. If they offer too good of one, their employees must pay a "cadillac tax". But, if they just say "screw it" and don't offer any, they don't have to deal with being auditted, pay the same (and possibly more) in fines, and don't have their own out-of-pocket expenses for the insurance. Effectively, there is zero upside to the company offering their employees health care. Again, this will shift people to the government controlled "exchange". See the scenario above.

Add to all this the fact that NO social medical program run by the US government has EVER come in on budget (they average 5x-9x the original estimated price) and this program being scored as costing $940 BILLION dollars, and it that was scored BEFORE finding out it didn't cover children and needing to be amended. That's right - If a child has a pre-existing condition, they can STILL BE DENIED COVERAGE. They are having to put through another amendment to correct that, and that cost was not tallied into the original cost... The middle of a global recession, while the country is facing possibly losing its AAA bond rating, is NOT the time to go shifting 1/6th of our national economy under government control. And before someone blames Bush for the debt, at the height of the war we were running $102 billion a year in deficit spending. Since Obama has taken over, we're spending $90 billion. A MONTH.

There are a whole plethora of reasons to hate this law and it's forthcoming amendment. Depending on the poll you read, between 53% (most liberal) and 70% (most conservative) of the US populous was AGAINST it. I am not opposed to reducing health care costs, but there were MUCH better ways to do it. Tort reform (limiting the liability a doctor has in a lawsuit) would have been an EXCEPTIONAL move, it's doing wonders in Texas. It was offered up by the Republicans, but was only added last-minute by Obama / Reid / Pelosi for experimentation in a limited number of small districts as a way to try and get a Republican to vote for the bill so they could claim it was a bi-partisan bill. Why? Because the Democrats are strongly supported by the Trial Lawyers lobby. Removing the restriction on insurance companies to compete across state-lines would have driven down costs. Allowing "Catastrophic Healthcare Insurance" plans would have helped. Health Spending Accounts and Medical Saving Accounts... There were a LOT of other ways to go. Better ways.

[Frame]

uhmm, not trying to derail, however..

Denmark is the most taxed country in the world...
worktax: 8% tax of income, no
ordinary tax:39% after tax reductions..
extra tax for secondary work: 60%
tax on all consumer goods: 25%
tax on cars 180%

We got almost 100% free health care for everyone,
we have to pay the first $500 of prescription drugs, for which
our drug stores are legislated to sell us the cheapest one. and even then the drugs prices are cheaper than they would be without the government support..

and even those $500 if it is a life long condition like diabetes, is covered..
and even if I had no money, I could go to the citizen "shop" and say that i have no money, and get a note that says that I do not have to pay right now.. but I will be billed later, when i can afford it, or it will be covered by socialised benefits that Denmark also got..

and in regard to that free healthcare, and a well fare system is equal to socialism: rubbish... we have right now in Denmark a liberal government and have had that for the past 8 years..

now in regard to waiting lines in the E.R.

That has been stream lined so that you now have to call a number, that informs you where to go, and when approximately your injury can be treated, and make preparations to treat exactly that injury.

So, if I break my arm/hand, hurtful as it is, I can manage with pain killers, and then have someone take me to the E.R that has been alerted that I will arrive at a specific time. If my injury is severe, I'll be treated immediately, and people who has "only" broken an arm, will be put back in the line. believe me.. nobody is angry about the extra wait time, when they suddenly see 10 sickbeds rolling by, with people in real trouble after a mass traffic accident or something similar..

I do not have to explain to you how efficient this system is.

All this began back in the 50/60s, when US had Reagan release records with arguments about why free medical care was equal to communism. Notice that the Communist card was used as a reason not to introduce health care for all. That should ring an alarm bell for everyone today.. remember McCarthy ?.

But back to Denmark:

hell yeah it was expensive to start with for the government , but it has been stream lined ever since, the well fare system too was and is expensive.. but being on well fare is far from being a dance on flowers as it used to be back in the 70-80s. that said we do pay a sort of insurance to our unions "unemployed funding box" so that we will be supported for at least 4 years, should we strike out and not have a job for that long, after having worked for at least 1924 hours within 3 years.

There are more aspects of this. For example the bum on the street who is a bum here because he cannot live in a flat, because he cannot keep it clean, or pay his rent in time. He also gets treated by the system.. so we do not have people lying in the streets dying.. and for some reason we got nearly nobody who lives on the street, which is most likely due to our social well fare system. (but hey we are still a democracy ).

The things is, that health care for all, has so many spin off benefits that people who have not tried it cannot see them. We do not have to worry about a life long condition that for example my wife carries and therefore my future children could carry should limit them in any way. Who asked to be born.. Nobody, and especially not anybody with a medical condition.

if you give people the sense of security, they are less likely to go off and do violent crimes.. I have a bet that the U.S lack of social benefits is one of the main reasons that The United States that has 5 percent of the world's population has 25 percent of the world's incarcerated population. which is mind boggling. however I refuse to believe all of those people did it because they are evil.. I think that desperate people do desperate things. I have seen reality shows from the US, like the bounty hunters where they can get people to do anything for a little money.. thats is another alarm bell for me.. Desperation drives them to make choices they otherwise would have rejected..

I could write a long sad story with a happy ending that U.S. seem to be so in love with.. But I can ensure you, that, that happy ending did only come because there was a system in place, making that happy ending possible, and that ending would have been bad, if not for the system. A social benefit system, call it free medical care or whatever..

there is simply no value on life...

I bet that crime rates will fall as a direct result of this.. however that is very difficult to prove.

The thing is that I have feared that the US have been in an inward downward spiral towards a worse nation for some time now with bush at the rudder. slowly and surely becoming something else, and maybe even fall apart during this century.

So I welcome this change, and the U.S should really start to look north and learn and understand what Canada does, and maybe even start to relax & drink bear.. .

Cheers Frame

[Killer Wolf]

"if you give people the sense of security, they are less likely to go off and do violent crimes.. I have a bet that the U.S lack of social benefits is one of the main reasons that The United States that has 5 percent of the world's population has 25 percent of the world's incarcerated population."

not sure i see the connection between free prescriptions and muggings. no report i've ever seen in the papers said someone was mugged/beaten up outside a nightclub/stabbed/shot/whatever because the perp couldn't afford his cough medicine.

[Sendraks]

Just to build on what Frame said - not only does Denmark have an enviable system of universal coverage, they spend much less on healthcare than the US does and have better outcomes.

By comparison, Canada's system is much less cost efficient in terms of health outcomes. So if the US is going to look to any model of socialised medicine for ideas, especially on generating efficency savings, it'd be better looking at Denmark.

[Frame]

"if you give people the sense of security, they are less likely to go off and do violent crimes.. I have a bet that the U.S lack of social benefits is one of the main reasons that The United States that has 5 percent of the world's population has 25 percent of the world's incarcerated population."

not sure i see the connection between free prescriptions and muggings. no report i've ever seen in the papers said someone was mugged/beaten up outside a nightclub/stabbed/shot/whatever because the perp couldn't afford his cough medicine.

I'm obviously talking about robbers not people who for some reason or another decides to stab an adversary, because he got the girl or similar, that is totally different ballgame. Perps with no money are not likely to be found frequenting night clubs.. these acts you refer to are usually jealous related feelings acted out all wrong..

its a damn shame that people forget that every human breathing, walking is a little miracle, and only focus on the money, instead of sound economics...

Cheers Frame...

[lfnfan]

compulsory health insurance is just another way of being taxed by the state. you know that, right? you just have to suck it up and get on with it.

for me, the idea(l) of healthcare provision irrespective of ability to pay for it is laudible. And the healthcare professionals that i have come into contact with in the NHS have been wonderful, pretty much without exception.

of course, what annoys me is when an increasingly scarce resource - tax revenues - get pissed up the wall in the name of healthcare provision due to ill-thought out and badly implemented notions (like, which twisted mind thought it was a good idea to hire more managers than nurses, or to spend waste millions re-furbing the outside of the Royal Free Hospital and spending wasting £70k on a glass desk for the reception area?). Don't get me started on inability to detect and prevent abuses of the system such as health tourism, gaviscon, consultancy fees, etc. what are all these 'managers' actually managing to accomplish?

but then i tell myself i just have to suck it up and get on with it.

[DaddyHoggy]

compulsory health insurance is just another way of being taxed by the state. you know that, right? you just have to suck it up and get on with it.

for me, the idea(l) of healthcare provision irrespective of ability to pay for it is laudible. And the healthcare professionals that i have come into contact with in the NHS have been wonderful, pretty much without exception.

of course, what annoys me is when an increasingly scarce resource - tax revenues - get pissed up the wall in the name of healthcare provision due to ill-thought out and badly implemented notions (like, which twisted mind thought it was a good idea to hire more managers than nurses, or to spend waste millions re-furbing the outside of the Royal Free Hospital and spending wasting £70k on a glass desk for the reception area?). Don't get me started on inability to detect and prevent abuses of the system such as health tourism, gaviscon, consultancy fees, etc. what are all these 'managers' actually managing to accomplish?

but then i tell myself i just have to suck it up and get on with it.

Not all managers (in the NHS) abuse the system, but have much abuse heaped upon them. My wife has gone the route of Radiographer->Lecturer in Radiography->NHS Learning Environment Lead (a manager who makes sure that students (nurses etc) get placed in the right hospital to do the right training at the right time to be the best qualified practitioner when they graduate - she's responsible for over 1000 students). Post Budget - she has been told that her area is to become an "Efficiency Saving" at the end of the financial year and will no longer be funded. This is an infuriatingly clever stroke by the accountants because it will take 3 years before the new, badly trained, nurses etc start to appear in the system and probably a year or so longer after that, when the next lot arrive in situ, before anybody notices, by which time the accountants who made the decision will be long gone and if somebody decides to try and fix it, it will of course cost a lot more to put right because all the trainers and people who had the knowledge to place the right people in the right job will have gone.

[lfnfan]

the perfect short-term fix. and as you rightly say, when people start to suffer as a result of this dishonest decision, those responsible turn out to be entirely unaccountable.

I understand that the NHS is very big and complex, but all it needs is a small group of intelligent, knowledgeable, empowered, independent, and practical people to get their heads together and make logical, consistent, decisions. Then get them sense-checked. Then implement them.

Still, if it can't even be done successfully with the railways, what hope with the NHS?

sigh.

[Kaks]

Still, if it can't even be done successfully with the railways, what hope with the NHS?

<derail>

Meh, don't get me started on railways!

BR was costing the state a lot less than the 'privatised' rail companies we've got now.

I do find it slightly insane that the UK government is subsidising supposedly efficient, supposedly private companies to the tune of up to 3 times (adjusted for inflation!) what it was paying the supposedly inefficient, state-owned BR

PS: I'm not a chartered accountant so my previous statement could well be slightly shaky, but any Private Eye reader should be able to back be up...

</derail>

Isn't that refreshing to be able to talk about something else instead of healthcare?

[Sendraks]

I understand that the NHS is very big and complex, but all it needs is a small group of intelligent, knowledgeable, empowered, independent, and practical people to get their heads together and make logical, consistent, decisions. Then get them sense-checked. Then implement them.

The NHS is too big a system to have such a small group of people apply these decisions across the NHS. It won't work. It is too big. What should happen and IS happening, is at a local level small groups of intelligent, knowledgeable, empowered, independent, and practical people are getting their heads together and making the kind of decisions you're talking about.

The problem, in so far as the public and media perception of the NHS goes, is that this is happening at local level (at PCT/Hospital Trust level) and if you don't live in the particular areas where it is happening you won't see it. But it IS happening. The idea is to get this happening everywhere, but that is easier said than done.

As for their being more managers recruited that nurses, it baffles me as to why people think that is part of the problem. THe amount of clerical/administrative work needed to run the NHS is enormous and this is work you really don't want to have clinical staff doing. This doesn't mean that some areas have recruited more managerial staff than is necessary, but again it is wrong to assume that this is a systemic flaw in the NHS.

Besides, which do you think there are more of out there to recruit, Managers or Nurses? If one resource is smaller than another, this is going to manifest itself in the system and you can't get round it.

*edit*

For clarification - NHS workforce stats for 2009

Managers & Senior Managers Employed: 44,661
Nursing Staff Employed: 417,164

What exactly IS the problem?

[Chrisfs]

Meh, don't get me started on railways!

BR was costing the state a lot less than the 'privatised' rail companies we've got now.

I do find it slightly insane that the UK government is subsidising supposedly efficient, supposedly private companies to the tune of up to 3 times (adjusted for inflation!) what it was paying the supposedly inefficient, state-owned BR

How can that be??? I thought free market/profit motive magic made all private companies inherently cost efficient sleek machines and that there was no way government programs could compete. What kind of madness is this?

[Cmd. Cheyd]

Chrisfs- I am not familiar with the situation, but I'd place good odds you'll find that "free market" is heavily regulated, licensed, and otherwise still largely meddled-with by government oversights.

[Cmdr James]

Rail is a special case. There are serious problems trying to have competition in rail.

Either you allow multiple companies to use the same tracks, which can cause chaos with different trains needing different tickets, some are valid others not (we do have that here). Or you have a monopoly on a route with competition only for the franchise (we also have that) or you have each rail company build its own rails which would be even more chaotic.

If I want to my mother, I can either use South West Trains, or not use public transport. That isn't directly caused by government meddling, or anything else, its just where the tracks are and who runs on them. To avoid SWT I couldnt get within 100 miles, and thats pretty typical in the UK. Normally there is a choice of one rail company or driving. Sometimes there is a bus or coach alternative. In a few cases it is feasible to fly.

Without competition the free market does not work properly.

The rail market is of course regulated, licensed, and otherwise meddled with, but that is true of all business. Think alcohol, tobacco, banking, healthcare, media as examples.

[Disembodied]

Without competition the free market does not work properly.

Cmdr James cuts to the heart of the matter. This is why private enterprise is great at making consumer goods, but bloody awful at running essential services. If a manufacturer of toasters makes terrible toasters, it goes out of business and the supply of toasters, while it might take a dip, is quickly filled up by other, more efficient, toaster manufacturers. Hurrah for capitalism!

If you let private enterprise run anything so important it can't be allowed to fail, however, like power, or water, then all the benefits of private enterprise are lost – because the bad companies just keep on going: what are you going to do, get your water piped in from some other supplier? But you still have to keep shelling out for the company's profits. The whole affair is run not for the benefit of the consuming public but for the benefit of the shareholders. So the government has to plaster the industry with regulation, to protect the consumers.

So you end up with a situation where you have all the bad elements of the public sector (lumbering bureaucracy and inefficiency), with none of the good (public service ethos, recycling profit back into the sector to improve services, equality of service regardless of profitability), and all of the bad elements of the private sector (gouging the consumer, running down workers' pay and conditions and cutting corners on maintenance and safety) with none of the good (bad companies usually fail). But hey: a very small number of people who give donations to this or that political party end up controlling crucial services with no competition that will never, ever be allowed to go under. So it's not all bad. Oh, wait ...

The mantra that the private sector or the "free market" is inherently superior in all aspects is just as bogus, and just as much of a dogmatic ideology, as the idea that all industry should be controlled by the state. Whenever anyone says they have a one-size-fits-all solution to every conceivable problem, you know they're selling snakeoil. Let the private sector make the toasters: it's what they're good at. But giving anybody a monopoly of an essential service, and letting them run it for a profit, is just crazy. Or crooked.

[Sendraks]

To avoid SWT I couldnt get within 100 miles, and thats pretty typical in the UK.

The sad thing is about 50 years ago this wouldn't have been the case.