5 freedoms you'd lose in health care reform

argatoga

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I think you're missing the point...

Even under a single payer system, you and I will bear the tax burden of feeding a VERY hungry monster.

A good chunk of our healthcare cost comes from the ridiculously overpriced prescriptions and related material. The government isn't the reason for this. Not that it will be cheap if that is taken care of, but health is a human right.
 
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Cobol74

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Same in the UK. National Insurance = about 10% of salary (Everyone pays and employes pay some more on top - not a lot but some) and you get a national health service everyone gets the same access. Drugs are capped at about 10 GBP a prescription; you used to get home visits - rare now. This also pays for your unemployment benefits between jobs (6 Months), sick benefits and disabilities too I think.
 
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he-he

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^Not quite the UK. Prescriptions are free in Scotland and Wales (not sure about NI). And while everyone gets the same access to the NHS, they don't always get the same, or correct, treatment. There really is a postcode lottery :(
 

Cobol74

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Not usually, they are mostly uniformly er good sort of (North Staffordshire excepted). You get sick, either see you GP and get referred, or need an ambulance immediately and you get taken to the local hospital. Some hospitals are specialist in some areas mostly London and other big cities.

Rates etc. ...

http://www.hmrc.gov.uk/ni/intro/basics.htm
 
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he-he

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Do you at least get to pick your GP (PCP in the US - primary care provider)? Say you get cancer, do you get the best possible treatment, no matter the cost?

You can pick your GP within a practice that's in the correct catchment area. There's one GP surgery that covers my postcode, but 10 GPs working there and while I'm allocated to one, I can choose to go to another if I want.

But in answer to your second question - no, sadly. You get referred to the nearest provider. You can ask to be referred elsewhere, but that requires knowledge, and a possible delay to treatment. As for cost, yes the NHS is free to the end user, but NHS England chooses where to allocate the money. So even if you end up being treated at one of the best hospitals (i.e. The Royal Marsden), you might not end up getting the best treatment.

http://www.mirror.co.uk/news/uk-news/nhs-crisis-cancer-specialists-hit-2906881
 

narf

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Do you at least get to pick your GP (PCP in the US - primary care provider)? Say you get cancer, do you get the best possible treatment, no matter the cost?

When I had some sinus issues I researched who did the best job at high-class nose picking and went straight there. All in I paid about 200? for about a dozen visits (pre- and post-op) plus three days in their private hospital wing - including food, meds, the lot. The largest part of that sum went towards CBCT imagery - regular xray images would have been covered, but I opted for higher quality imagery to reduce the risk of complications. Without that I'd probably have been at around 50?.

As for cancer, you may not get everything fully paid for like with my CBCT scans - only on a much more expensive level. However, that's probably true for every kind of insurance.
 

British_Rover

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Do you at least get to pick your GP (PCP in the US - primary care provider)? Say you get cancer, do you get the best possible treatment, no matter the cost?

The US spends more per capita then any other industrialized country, with the possible exception of Switzerland, for outcomes that are in most cases no better.

Overall life expectancy is lower in the US. This is partially because we have much higher murder rates so it is not all healthcare.

Infant mortality is also higher in the US and this is not because of higher murder rates. It is almost exclusively poor access to affordable prenatal care.

http://www.csmonitor.com/Photo-Gall...cialized-health-care-in-five-countries#759269


The only advantage to the US system is if you happen to have a truly rare/difficult to treat disorder or disease. In that case then you might be better off in the US assuming you had excellent insurance or were enormously wealthy. Prior to the ACA you might have thought you had good insurance but because companies could drop you at anytime you really did not.

I don't think a true Single Payer system like the UK and Canada have would really work here. Something more like Germany or Australia would work where the gov't provides most of the insurance and care but people can opt to spend more money on services if they want to.
 

LeVeL

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The US spends more per capita then any other industrialized country, with the possible exception of Switzerland, for outcomes that are in most cases no better.
Overall I don't think healthcare in the US is in any way inferior in terms of quality. That said, it's not exactly leaps and bounds ahead of everyone else so it shouldn't cost much more either.


The only advantage to the US system is if you happen to have a truly rare/difficult to treat disorder or disease. In that case then you might be better off in the US assuming you had excellent insurance or were enormously wealthy. Prior to the ACA you might have thought you had good insurance but because companies could drop you at anytime you really did not.
Again though, what level of care do you get under the ACA or under a single payer system? I'll keep using cancer as my example. Under these systems does everyone get the same mediocre level of treatment? How can you get a better level?

Seem, this is one of my big issues with such systems - it seems that everyone will be getting the same mediocre level of healthcare. Who gets the doctors that are truly best? What about the ones that are on the lower end of the scale? (note that I am not implying that a low-end doctor is necessarily a bad one)
 

British_Rover

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Overall I don't think healthcare in the US is in any way inferior in terms of quality. That said, it's not exactly leaps and bounds ahead of everyone else so it shouldn't cost much more either.

The difference in outcomes between the US and other countries is not substantial but it is there. Much of it can be explained away by outside factors, our higher murder rate because of easier access to firearms for one and poor food choices could be another leading to higher levels of obesity and diabetes, so if you control for those factors outcomes are pretty similar compared to other industrialized countries. Infant mortality is a tough one to control for and is in my opinion very much the cause of our poor access to prenatal care.

We both seem to agree on the above points so why does healthcare in the US cost two or three times more then other industrialized countries? Its all about the middleman. In the US those insurance companies gobble up profits and run up the bills for the rest of us. This is especially true for people on the individual and small group market which is specifically what the ACA is trying to fix.

Medicare and Medicaid have the lowest overhead costs for insurance providers. There is disagreement about exactly how much lower but it is lower for sure.

http://www.politifact.com/truth-o-m...a-boxer-says-medicare-overhead-far-lower-pri/

http://www.kaiserhealthnews.org/stories/2009/july/01/medicaid-true-or-false.aspx

Again though, what level of care do you get under the ACA or under a single payer system? I'll keep using cancer as my example. Under these systems does everyone get the same mediocre level of treatment? How can you get a better level?

Seem, this is one of my big issues with such systems - it seems that everyone will be getting the same mediocre level of healthcare. Who gets the doctors that are truly best? What about the ones that are on the lower end of the scale? (note that I am not implying that a low-end doctor is necessarily a bad one)

You are assuming that the treatment is mediocre. If you look out the overall health outcomes in countries that have some form of single payer, again only really Canada and UK have actual single payer where hospitals are run by the gov't and doctors are gov't employees, they are very, very good. In certain circumstances you might be better off in the US assuming you can afford the bill. If these circumstances were widespread we wouldn't see the roughly comparable level of positive outcomes int he US versus other countries.

In Germany the wealthy opt out of public health insurance and by more expensive private plans. Something similar happens in Australia.

Just to quote Narf he opted to pay more for some higher grade procedures. We can do that in the US with more substantial involvement of the gov't in healthcare. Not necessarily single payer but an expansion of medicare and medicaid.

When I had some sinus issues I researched who did the best job at high-class nose picking and went straight there. All in I paid about 200? for about a dozen visits (pre- and post-op) plus three days in their private hospital wing - including food, meds, the lot. The largest part of that sum went towards CBCT imagery - regular xray images would have been covered, but I opted for higher quality imagery to reduce the risk of complications. Without that I'd probably have been at around 50?.

As for cancer, you may not get everything fully paid for like with my CBCT scans - only on a much more expensive level. However, that's probably true for every kind of insurance.




The Medicare age should be dropped down over time and Medicaid should be expanded up the income scale.
 
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narf

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Overall I don't think healthcare in the US is in any way inferior in terms of quality. That said, it's not exactly leaps and bounds ahead of everyone else so it shouldn't cost much more either.

Really? Not inferior to anyone in any way? In other words, equal or better in every single way than everyone else?

I believe that's statistically impossible. Even if it were equal or better on average - even leaps and bounds ahead -, there must be ways were stuff is inferior to others - for any system by the way, ours isn't perfect in every way either.



In Germany the wealthy opt out of public health insurance and by more expensive private plans. Something similar happens in Australia.

Indeed. The public plans are paid for by you and your employer - you pay 8.2% of your monthly gross income, and the employer adds another 7.3% on top. That's capped at about 4000?/month, so the most coming out of your salary is 332?.
You can opt out and get fully private insurance if your gross income exceeds about 4500? per month, below that you can get private "add-ons", for example to get more fancy dental stuff covered (see below). Fully private plans don't have to be more expensive, but there's been quite some issues with them getting higher and higher the older you get... so they may seem attractive to get into when you're young, but madly expensive later.
As for total spending, in 2009 the public insurances have spent about 161b?, of that 5.5% administrative overhead... the private insurances have spent about 26b?, of that 14.3% administrative overhead. Based on that metric, public insurances run a much tighter ship.
In fact, my insurer runs such a tight ship he's paying back everyone insured 80? per year in dividends.... which now have to be income-taxed of course :mad:

Just to quote Narf he opted to pay more for some higher grade procedures. We can do that in the US with more substantial involvement of the gov't in healthcare. Not necessarily single payer but an expansion of medicare and medicaid.

Another common pay-to-upgrade case is dental. Lots of basic dental care is covered, such as annual checkups, everything for children, etc. - but more fancy stuff is not (fully) paid for. As an example, an additional hour with a dental hygienist will be about 90? out of your own pocket, most public insurers pitch in a certain amount annually.
 

SpitfireMK461

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I've been a fan of how the French have set their system up. As I understand it, everyone is covered a basic amount by a single payer system, but then there is a private market to get additional coverage. Is that correct?
 

British_Rover

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Really? Not inferior to anyone in any way? In other words, equal or better in every single way than everyone else?

I believe that's statistically impossible. Even if it were equal or better on average - even leaps and bounds ahead -, there must be ways were stuff is inferior to others - for any system by the way, ours isn't perfect in every way either.





Indeed. The public plans are paid for by you and your employer - you pay 8.2% of your monthly gross income, and the employer adds another 7.3% on top. That's capped at about 4000?/month, so the most coming out of your salary is 332?.
You can opt out and get fully private insurance if your gross income exceeds about 4500? per month, below that you can get private "add-ons", for example to get more fancy dental stuff covered (see below). Fully private plans don't have to be more expensive, but there's been quite some issues with them getting higher and higher the older you get... so they may seem attractive to get into when you're young, but madly expensive later.
As for total spending, in 2009 the public insurances have spent about 161b?, of that 5.5% administrative overhead... the private insurances have spent about 26b?, of that 14.3% administrative overhead. Based on that metric, public insurances run a much tighter ship.
In fact, my insurer runs such a tight ship he's paying back everyone insured 80? per year in dividends.... which now have to be income-taxed of course :mad:



Another common pay-to-upgrade case is dental. Lots of basic dental care is covered, such as annual checkups, everything for children, etc. - but more fancy stuff is not (fully) paid for. As an example, an additional hour with a dental hygienist will be about 90? out of your own pocket, most public insurers pitch in a certain amount annually.

Those overhead figures roughly line up with what we see in the US. I have some numbers quoted slightly lower for Medicaid and a little higher for private insurance but roughly the same. I am sure some private insurers hit that 14 to 15 percent mark pretty much dead on in the US while the others are struggling to get below the 20% cap that the ACA imposed.


http://www.acasignups.net/

Looks like the seven million CBO projection is going to be hit by the time this weekend surge of signups goes through.
 
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