Europeans are usually shocked that 47 million citizens of the world’s richest country have no health insurance and so could, at least in theory, die because they cannot afford medical care. Whether America’s traditional insistence that citizens should take responsibility for their own healthcare is proud self-reliance or shameful inhumanity is a matter of political perspective. But increasing ideological polarisation has prevented a consensus forming on whether medicine should be viewed as a “public service” or be treated simply as a form of private consumption no different from food, clothes or housing.
But such theoretical and moral issues are no longer the driving force behind US healthcare reform. Whether or not voters have undergone a moral conversion, America has suddenly become aware that its present healthcare system is unaffordable. As Mr Obama pointed out to the American Medical Association, the doctors’ trade union largely responsible for thwarting President Clinton’s health reforms, carrying on with the status quo is no longer an option. The mind-boggling cost of healthcare, not bank bailouts or property foreclosures, threatens the US Government with bankruptcy and the whole economy with stagnation.
[blockquote]Europeans are usually shocked that 47 million citizens of the world’s richest country have no health insurance and so could, at least in theory, die because they cannot afford medical care.[/blockquote]
But that’s just the thing…many, if not most, of those 47 million aren’t citizens, but illegal aliens. Another large chunk of that figure is people who could buy health insurance, but somewhat rationally choose not to because they are young, single and healthy or simply prefer to spend their money elsewhere. Lastly, no one in America goes without healthcare, as the article falsely states, because (s)he doesn’t have insurance.
What will bankrupt America is expanding state payment of medical bills, as it is alreaady bankrupting the federal government.
It is invidious trying to compare different healthcare systems and the manner in which they are funded for usually they are apples and oranges. Each has grown and developed against the background of differing circumstances; during the last several years we have been enrolled in both the US and the UK version of coverage, and have drawn on each.
Without doubt the British version lacks the frills that I get with my American coverage, but it is serviceable and meets needs most of the time. Yes, there is strict rationing of resources here in the UK, but the payback on the other side is that doctor bills are not something that anyone in this country has to worry about. You may have to wait to get a CT Scan or an MRI, but most of the time there is little danger in that, and there ARE procedures covered by the National Health Service that would be fearfully expensive, and about which private providers in the USA will fight tooth and nail not to cover.
As a pastor, I have spent many hours in the USA sitting with people whose whole hospitalization is being spent worrying about the inadequacy of their insurance — or the virtual lack of it. My wife, a college professor, has had students in her classes who really are quite ill, but cannot afford to go to the doctor. This just doesn’t happen here, although the other side of that might well be the determination of the medical profession to put themselves above contradiction at times (and my daughter is a doctor who has worked on both sides of the Atlantic).
Medical care is so costly these days that the American approach, wonderful as it is for those who can afford it through insurance or personal means, is rapidly pricing itself almost out of existence. When sitting on the diocesan council in my US diocese I cannot think how many hours we spent agonizing over health care.
There are a lot of approaches to health care funding, but with a growing and aging population the USA is going to have to find one that works and does not totally bankrupt an already damaged economy.
I’ll be happy to relay the good news to those in my parish who cannot afford their medications, pay for minimal dental care, and because they work at low-level jobs, make just enough money to disqualify them for any assistance. I will assure them that their sacrifices to enhance corporate profits (especially those of medical insurance companies) and provide bonuses for their woefully underpaid executives are deeply appreciated. And I will, as a true patriot, encourage them to make even more sacrifices to keep their overlords and corporate masters even happier.
The system of arrangements has made sick people a source of profit. The incentives encourage doctors to see patients as revenue enhancers. But the fact is that people are woefully underinsured, and people do delay health care because of their lack of insurance.
What we do have is a system that rewards corporate bureaucrats who make money by denying people health care.
As Obama has stated, people can go to private companies if they want. A public option will put some pressure for the incentives to shift, so that we begin to see that health, not revenue, is the criteria for success. Apparently Gawande’s article in the New Yorker is required reading for everyone in the white house, and is orienting the thinking of the president.
Why did we not get health care a long time ago? One reason: the risk of integrated hospitals.
As racism declines, the desire of most Americans – universal coverage – will become a reality. Unless we can find another scapegoat – like undocumented workers – to delay a coherent change in the current system of arrangements, that exploits healthy people to deny coverage to sick people.
[blockquote]What we do have is a system that rewards corporate bureaucrats who make money by denying people health care.[/blockquote]
While I have seen lots of complaints about the possibility of health-care-related decisions being made by a “government bureaucrat”, the complainers neither (a) acknowledge that those decisions are now made by an insurance-company bureaucrat nor (b) present a logical argument why we would prefer the decisions of the bureaucrat who works for the insurance company to those of one who works for the government.
[blockquote]While I have seen lots of complaints about the possibility of health-care-related decisions being made by a “government bureaucratâ€, the complainers neither (a) acknowledge that those decisions are now made by an insurance-company bureaucrat nor (b) present a logical argument why we would prefer the decisions of the bureaucrat who works for the insurance company to those of one who works for the government. [/blockquote]
If that’s the case, what’s your complaint against private insurers? And what do government bureaucrats have that private insurers do not (hint: left-liberals usually hate them with a passion).
If that’s the case, JW, why doesn’t the federal government make a demonstration project out of Medicare first? Let’s see them control costs and rationalize treatment with that enormous program, then extend it. Unless that is somehow “racist.”
What many folks forget is what we have done to medical insurance. Insurance is a risk mitigation device to protect against catastrophic events. But in medicine, we use it for sniffles, routine physical exams, teeth cleaning, I even had a relative who went to the doctor for a prescription for extra-strength advil, because “my doctor visits are free”.
Put routine medicine on the same basis as auto repair. You comparison shop, you pay for what you need, and you keep an insurance policy for catastrophic events.
Also, a lot of people say they can’t afford health care: that is, after their cell phones, their dvds, ipods, cable tv, hi speed internet, new car note, hi house mortgage. What that means is that you are paying for all their toys. Think about it.
Capt. Deacon Warren is spot-on. What we call health “insurance” today has largely become a pre-payment plan for medical products and services. The prices of covered products and services has skyrocketed, while those of OTC and other non-covered items has remained stable. The reasons for this are obvious.
#9 and #8
Don’t your observations cry out for some form of government insurance along with the availability of private insurance for those who do not like the government plan. Even if you are completely correct, that all of the uninsured people in this country could have insurance if they would simply sell there home and rent an apartment, buy cheap cars, turn off their cable, stop going on vacations, give their kids fruit and candy for Christmas, pull their children out of college, and do without cell phones and computers; will they?
And if they don’t what do we do? Should we adopt the grasshopper and ant theory and simply let them die if they have no coverage? Because if we are unwilling to do that, the free market system will not work.
Also, your high deductible plan would kill preventative care. If people have to pay large sums every time they go to the doctor for a check up, they will not go until the are forced to go by illness. This will increase the cost of care.
If we had government sponsored health care, and gave those who wanted private coverage a tax credit up to the cost of the government plan to help pay for their private coverage, would not that more accurately reflect what we are already doing; as well as give us more control over what emergency rooms charge?
[blockquote]Don’t your observations cry out for some form of government insurance along with the availability of private insurance for those who do not like the government plan. Even if you are completely correct, that all of the uninsured people in this country could have insurance if they would simply sell there home and rent an apartment, buy cheap cars, turn off their cable, stop going on vacations, give their kids fruit and candy for Christmas, pull their children out of college, and do without cell phones and computers; will they?
And if they don’t what do we do? Should we adopt the grasshopper and ant theory and simply let them die if they have no coverage? Because if we are unwilling to do that, the free market system will not work.[/blockquote]
I’d say it’s up to them. Every product or service I buy has an opportunity cost to it, why should others be exempt? I much prefer that to imposing a system on everyone that will become a political football and bankrupt the nation (not that Medicare isn’t doing a good job of that already). Along with this freedom should come responsibility for one’s refusal to buy insurance, though. I’d repeal any law requiring providers to give treatment as a flip-side…we did away with slavery more than a century ago and I see no clause exempting healthcare professionals from that abolition.
[blockquote]Also, your high deductible plan would kill preventative care. If people have to pay large sums every time they go to the doctor for a check up, they will not go until the are forced to go by illness. This will increase the cost of care.[/blockquote]
People who aren’t interested in purchasing health insurance aren’t likely to be diligent about annual checkups. And what does an uninsured checkup cost, anyway…$200? Are you saying people who shun $10,000 annual insurance premiums for other goods aren’t willing to shell out two Benjamins a year for a checkup? This does not sound like a money problem to me.
[blockquote]If we had government sponsored health care, and gave those who wanted private coverage a tax credit up to the cost of the government plan to help pay for their private coverage, would not that more accurately reflect what we are already doing; as well as give us more control over what emergency rooms charge? [/blockquote]
A good idea! Unhappily, we’re headed in the other direction…
Health care in Britian may be affordable and with out frills, that is why 47% of British women die of breast cancer as apposed to 27% in the US. If you want an example of a government subsidized organization look at Amtrack (good article on T19 today). How can a private health insurance company compete against a government subsidized one? The other thing that is coming is the government is going to start tracking treatments to see which ones are cost effective and work. The problem will be who designs and runs the studies and collects the stats. You can make a study tell you any thing you want. Look at the 2nd hand smoke studies. The researchers designed and modified the statistical evaluations until they got the results they wanted! This is going to be a hugh mess. Look at the stimulus package for an idea of large scale complexity with out proper controls. I have read that 5 to 6 billion dollars of waste and fraud have occured and we have spent just 6 % of the 700 billion dollars>
#11 you say “I’d say it’s up to them. Every product or service I buy has an opportunity cost to it, why should others be exempt?”
Why do Libertarians say it this way? Why can’t you just come out and say, I believe if you can’t afford health care you should be allowed to die?
#12 You are correct you can make many statistics say what you want them to say, and if you search for one illness you can make any point you want. For example, the death rate from all types of cancer is lower in the UK than in the US. What is quantifiable is the life expectancy of the average person in the UK, Western Europe, Canada and Australia significantly exceeds the life expectancy of the average American; and if you use life expectancy at birth, the citizens of 46 nations have longer life expectancies than citizens of the US. All 46 of those nations have some form of government sponsored health care.
[blockquote]Why do Libertarians say it this way? Why can’t you just come out and say, I believe if you can’t afford health care you should be allowed to die? [/blockquote]
Because that would be inaccurate. If hospitals, doctors, nurses, pharma companies, etc. want to donate their time and products to help the poor, you’ll hear nothing but praises from me. Tell me, Mitch: Why will you allow these people to die?
[blockquote]and if you use life expectancy at birth, the citizens of 46 nations have longer life expectancies than citizens of the US. All 46 of those nations have some form of government sponsored health care. [/blockquote]
Don’t we have “some form of government sponsored health care” here? What is Medicare? Medicaid? SCHIP? The VA? Various and sundry state and local health programs? Overall, government purchases about half of all medical products and services in the nation. Why isn’t your jeremiad an indictment of government healthcare?
# 13 Yes you can make statistics prove what ever you want and you are doing a good job! The countries that have a higher life expectancy rate are about live about 1 to 2 years longer than the average person in the US and correlation does not prove cause. The more Eopiscopal Churches you hve the higher the incidence of sexually tranmitted diseases! Related to population not Churches! The problem with breast cancer is directly related to rationing of health care. Delay in diagnosis and treatment! Diagnosis and treatment of prostate cancer in Augusta Georgia among blacks is directly related to social aversion to diagnosis and treatment because of the rectal exam not the availablity of screening. PSA’s are done free of charge at screening clinics etc. Follow up and compliance with treatment are not always good when prostate CA is expected. So it isn’t always lack of care as other issues that compound diagnosis and treatments.
Is healthcare a right? Is a house a right? Is a car a right? Is a cellphone a right? Is high speed internet a right? Is Cable tv or dish a right?
Those who cannot take care of themselves will be taken care of by a compassionate society. If you measure compassion by dollars, America has to rank at the top. We have poured dollars into care for the truly poor and others who cannot care for themselves. In fact, we have done it with such abandon, that it has lead to an entitlement mentality.
Who has worked in pastoral care, in a soup kitchen, or elsewhere and watched the “poor” drive up in better cars than you own and have their heads glued to a cellphone while you try to “minister” to them?
Healthcare for most is a choice. Healthy living for most is a choice. When you ask me to pay for all your toys and your health care, I am going to ask a whole bunch of inconvenient questions. And I am going to keep on asking until some rational answers appear. Politicians be forewarned!
Mitchell, many drug companies do have programs to supply drugs to those that cannot afford them. Get on line and look!
Dave B:
[blockquote]Health care in Britian may be affordable and with out frills, that is why 47% of British women die of breast cancer as apposed to 27% in the US. [/blockquote]
I am going to call your bluff: state your source. According to [url=http://info.cancerresearchuk.org/cancerstats/mortality/]Cancer UK statistics for 2007[/url], breast cancer accounts for 8% of deaths. While these are both men and women, I would submit that this figure is completely out of step with the 47% you provide, and much more in line with my experience here.
The NHS isn’t perfect, but it isn’t bad at all. Please conduct a rational discussion based on solid figures.
[blockquote]I am going to call your bluff: state your source. According to Cancer UK statistics for 2007, breast cancer accounts for 8% of deaths. While these are both men and women, I would submit that this figure is completely out of step with the 47% you provide, and much more in line with my experience here.[/blockquote]
Yeah, that can’t be right. From all I’ve heard, “only” about 10% of all women will contract breast cancer, much less die of it. Perhaps the wording is the culprit here and he meant to say that 47% of all women in the UK who contract the disease perish from it, whereas in the US only 27% do.
Had [url]http://publications.cancerresearchuk.org/WebRoot/crukstoredb/CRUK_PDFs/mortality/IncidenceMortalitySummaryRates.pdf]a quick deeper dig[/url], just in case you were referring to the mortality rate among women who had breast cancer. Incidence was 122.5 per 100,000; mortality was 27.7, so that suggests that 23% of women with breast cancer die of it; I would submit that this compares favourably with the 27% you quote for the US (if, indeed, this is what the figure means). Anyway, quote your source, so we can discuss it sensibly. For the moment, it looks dodgy to me.
Grr, pressed Submit rather than Preview. [url=http://publications.cancerresearchuk.org/WebRoot/crukstoredb/CRUK_PDFs/mortality/IncidenceMortalitySummaryRates.pdf]This[/url] is the link.
The NHS in Britain is the product of the era in which it was introduced and I doubt whether anyone attempting to provide basic medical coverage for everyone in a country would go about doing it the same way again. However, here’s the overwhelming statistic: at least everyone is covered (and taxed accordingly). I will leave the hunting for statistics to others, because unmeasurables like worry and anxiety are significantly reduced for everybody in such a system.
Does that make the delivery of medical care as polished as the USA? Most of the time the answer has to be no, although would be a little unfair to compare it to Amtrak! But if you want to pay and get some of that polish and speed of delivery, there is private medicine in Britain that will give you the opportunity to bypass the system if you want or need to — and can afford it or have private insurance.
I am fully committed to the free markets wherever free markets work best, but we have to ask ourselves if the US system delivers as much for the buck as other systems might deliver for the pound, euro, dollar, or whatever currency. Anatole Karetsky is a very shrewd economist and he is asking a question that all Americans have to answer and that is can we continue to afford our present medical system?
I apologize for the way I worded what I wrote, I meant that mortality rates for those diagnosed with breast cancer 27% US 47% UK, I’ll get back with a source!
gatewaypundit.blogspot.com/…/nationalized-health-care-and-breast.html This has the statistics I was quoting, it also turns out that European countries with nationalized health care have higher mortality from cancer than the US. Correlaiton does not prove cause! Sorry I took so long, I was busy at work today…
The 47 million number has been debunked many times over. The actual number is closer to 9 million. And while high, 9 is a far cry from 47.
I’m with Jeffersonian on this. And I’ve worked in healthcare on both sides of the pond, too. Everytime Obama says you can keep your healthplan if you like it, he knows he’s lying. Because once a gov’t option is in place that anyone who needs to can sign up for, employers are going to drop health insurance plans as an employee benefit in droves. They would be crazy not to. Why should an employer put forth the time/paperwork/expense to offer healthcare plans, when they can tell their employees, “Look, you don’t need this benefit anymore! You can all simply sign up for the gov’t option!” Bye-bye insurance.
For an example of how an American State fared with governmental supplied health care, look at Hawai’i:
They had a plan to make sure all children in the state were covered by health insurance, so they offered a plan to anyone without insurance. So what happened? People dropped their children from their employer health care plans to sign their children up for the state plan, and it almost caused Hawai’i to go bankrupt! Less than a year into it, the plan was repealed.
#27 libraryjim, so what lesson did you learn?
1) children should not be insured by the governement
2) people are dissatisfied with employer health care plans
3) they feel robbed by their insurance companies
4) they don’t tell the difference between government or corporate bureaucrats
5) insurance is expensive
6) people are generally freeloaders when they can be
#7 – Jefferson, that’s probably the way they should do it: expand medicare, and create some incentive system that rewards doctors who offer successful payment.
Although you do mention $200 as the number for a physical, I think you miss the point about “insurance.” Social insurance is not an investment. It creates a pool of wealth so that when life happens, people have support. The larger the pool, the more we can help people who are down on their luck.
I do imagine that you live your life quite perfectly. You’ve never smoked, you only have on or two glasses a day, and can trust you’ll be in perfect health. When life happens to people, its probably their own fault, and should pay the consequences.
And although I love the idea of doctors volunteering their services, human sin would seem to instruct us that we never offer enough. Which is the beauty of capitalism: offering money for services actually insures that work gets done. Doctors should get paid for their work, including the poor.
Is health care a right? Well, unless we start turning the poor away from emergency rooms we are treating it like so. Perhaps we should just say it isn’t, except for the lucky and rich. It would be far more honest.
#26 you may be correct, but that is going to happen any way. I own a small business. I employee 5 people. I provide health insurance for all of them. I pay more than $25,000 per year to do so, and the cost continues to go up annually at an alarming rate. I can not continue to sustain that benefit. Very soon I will have to drop the benefit or fire an employee. The system we have cannot be sustained by small business. We must have an alternative other than employer plans, and I personally do not believe going to a private plan ownership can possibly work as too many people are uninsurable outside of employer group plans, or cannot afford the insurance.