US Adverts on National Healthcare

Apologies in advance.  I am typing on a netbook so I could listen to Paul's link.  I really hate the keyboard on this thing, and I might botch up spellings more than normal.

A report highlighting how those average waiting times and met targets on average times can be misleading:
http://news.bbc.co.uk/1/hi/health/7686275.stm

I am well aware of how the targetting doesn't always represent realities and how people try to artificially show targets being met.  You've still yet to show where you've come up with the justification for the implication that people over 65 wait 2-3 years in the UK or Canada. 

And even if they didn't realize, what difference does it make?   If their criticisms of the NHS are valid, they don't become any less valid when presented to an American audience instead of a British audience.   

If you want to argue that somebody has taken something you said out of context to make it sound as though you were claiming something you never intended, then that's fair enough, but whether it's done in the U.S. or the U.K. is irrelevant.

Context is exactly the problem.  If this were being presented in the context of improving the NHS, whether shown in the US or UK there wouldn't be an issue at all.  Presenting it in the framework of "it's a failed program" is where the problem lies.

Just the relevant clip:

"Now I turn to the National Health Service.  We're seeking here not merely to provide services for those who are sick, but to make a healthy nation.  The aim is to ensure that the provision of proper care and treatment shall not depend on financial resources, and that when you are sick you'll be free from the money worries which so often accompany illness. 

"The scheme gives a complete cover for health, by pooling the nation's resources, and paying the bill collectively.  It's not dependent on insurance; everyone is eligible.  It covers all kinds of care - doctor, dentist,  midwife, health visitor, occulist and optician, and surgeon.  It provides for treatment in hospitals and sanitoriums, and for the services of specialists of all kinds.  Help in the home when people are sick will be given wherever possible.  Spectacles, dentures, appliances, and artificial limbs will be available."

I don't see how it is out of line with what the NHS provides.  I am glad I fired up the netbook because Attlee definitely described it as a process.  Maybe inititally it was seen as a process to get through austerity, but even in an ideal world, the NHS would have to change with the times.  It arguably has made improvements, and most people in this country feel that there is still room for improvments.  Yet, most people would also say that it is a worthwhile system.

But nothing like it is coming to the US anytime in our lifetimes, and I think most people who are involved in campaigning either for or against healthcare reform know that.

Just the point I was making.  And that it why I called this statement double-speak:


1948: "Pay into our scheme (and you have no choice, by the way) and we'll cover you for X, Y, and Z when you need them."

2009: "You need Z?  Oh no, we only cover X and Y now.  If you want Z you'll have to pay for it yourself."

What do you call that then?

More like it's been like the second example all along.  Any healthcare system has a finite amount of resources.  All healthcare systems make some members wait or go elsewhere for certain treatments.  The NHS tries to be fair about it.

It's the National Health Service, not the National Miracle Service.

So, let's begin this process and keep the personal stuff out of it OK?

You painted yourself into a rhetorical corner.  The only way to refute your argument was to point out that there was no answer for it.  

What do you feel has merit in the current bill being proposed and what do you think needs improvement? I'll start by saying I think that the current bill on the table isn't clear enough in how it will be administered, and I'm not in favor of the government controlling healthcare. I also don't feel that it will be sustainable, as it's not cost effective.

It depends on what you mean by "administered" and "controlling".  I assume you mean "I don't want the government deciding what treatment I get," and the coverage that I've seen points out that there's language in the bill that precludes the government from making "clinical guidelines for payment, coverage, or treatment."  Just seeing how the right has stirred up controversy by suggesting some government agency will make treatment decisions (i.e. "I don't want some bureaucrat between me and my doctor."), I'm pretty sure we don't have to worry about this becoming an actual problem.

Anyway, currently insurance companies control health care, and it costs more than anyplace else on Earth.  Do you think they're doing a good job, or are you just concerned that the government will be worse?

As for cost effectiveness, I haven't seen any good ideas about how it's going to be paid for, and estimates indicate it'll add to the deficit if it's enacted the way it is.  I honestly don't know how I feel about this.  If we wind up with a good program, I might be ok with some deficit spending, as long as it's not a ridiculous amount.  I know that's vague; I don't have enough information yet with regard to the cost of the program, so I'm reserving judgement for now.

What do you feel has merit...?

I think the idea that everyone should have a basic level of health care coverage has merit.  I think the idea that losing your job doesn't mean you're out of luck if you get sick or get injured in an accident has merit.  

I think the idea that America is a country that takes care of all of its citizens, where doctors do not have to check with an insurance company before deciding what treatment to offer patients, where people do not have to make decisions about their health care based on how much money they have in the bank, where no one falls through the cracks because of a decision made by an insurance company, I believe those ideas have merit.

I don't see how it is out of line with what the NHS provides.

Spectacles/opticians: Stated in 1948 to be covered under the NHS for all.  Now many people have to pay separately.

Dentistry/dentures: Stated in 1948 be covered under the NHS for all.  Now people pay for dental care separately, even if they can find an NHS dentist willing to take them on.

Sanitoriums:  Stated in 1948 to be covered under the NHS for all.  Now we have elderly people being told they have to sell their homes to get long-term care.

And so on.   

I'm not saying that the NHS never provides good care.  In fact I had first-hand experience of excellent care under the NHS when I had to undergo some pretty major surgery in 1984, and it was very quick too.  But that doesn't alter the fact that it doesn't always deliver what it's supposed to deliver, 25 years ago or today.

And of course no bill anywhere is even remotely proposing anything that suggests a government takeover of the actual provision of health services a la NHS.

An effective takeover can happen without ownership of the facilities providing the services transferring to the government though.  All that needs to happen is for there to be so much restrictive legislation that the government is, for all practical purposes, running the show anyway.

You can see examples of that in Britain with telecommunications and the railways.  While the former nationalized monopolies are now nominally private, there is so much restrictive legislation that in many ways they are under even stricter government control now than they were as nationalized industries.

And do you want communists like Dr. Ezekiel Emanuel getting his way in any sort of government helathcare program?

http://www.nypost.com/seven/07242009/postopinion/opedcolumnists/deadly_doctors_180941.htm?&page=0

And do you want communists like Dr. Ezekiel Emanuel getting his way in any sort of government helathcare program?

http://www.nypost.com/seven/07242009/postopinion/opedcolumnists/deadly_doctors_180941.htm?&page=0

Do you want to get you "news" from Murdoch's New York Post?

Spectacles/opticians: Stated in 1948 to be covered under the NHS for all.  Now many people have to pay separately.

Dentistry/dentures: Stated in 1948 be covered under the NHS for all.  Now people pay for dental care separately, even if they can find an NHS dentist willing to take them on.

Sanitoriums:  Stated in 1948 to be covered under the NHS for all.  Now we have elderly people being told they have to sell their homes to get long-term care.

And so on.  

See, I interpreted the recording slightly differently.  It's a vision and an explanation. Is this the thing you claim riles the ire of so many people about the NHS failing to live up its promise or is there more? I still don't find it that far off from what we've got.

Plus, it still has nothing to do with the American proposals.

An effective takeover can happen without ownership of the facilities providing the services transferring to the government though.  All that needs to happen is for there to be so much restrictive legislation that the government is, for all practical purposes, running the show anyway.

You can see examples of that in Britain with telecommunications and the railways.  While the former nationalized monopolies are now nominally private, there is so much restrictive legislation that in many ways they are under even stricter government control now than they were as nationalized industries.

Let's stick with healthcare.  Utilities by nature have a tendency to be monopolies and there are other reasons that make them different than healthcare. Let's compare apples to apples and keep the oranges out of it.

With so many countries providing public insurance, why hasn't a monopoly that wasn't a legislated happened elsewhere? 

It depends on what you mean by "administered" and "controlling".  I assume you mean "I don't want the government deciding what treatment I get,"

No, I mean government having the power to regulate healthcare, as most anything managed by the government is done inefficiently.

Anyway, currently insurance companies control health care, and it costs more than anyplace else on Earth.  Do you think they're doing a good job, or are you just concerned that the government will be worse?

I think it will be much worse under government control, and I think that the quality of healthcare in the US (which is generally very good) will decline.

As for cost effectiveness, I haven't seen any good ideas about how it's going to be paid for, and estimates indicate it'll add to the deficit if it's enacted the way it is.  

Which is a huge concern of mine and why I'm not convinved that this should be passed.

I think the idea that America is a country that takes care of all of its citizens, where doctors do not have to check with an insurance company before deciding what treatment to offer patients, where people do not have to make decisions about their health care based on how much money they have in the bank, where no one falls through the cracks because of a decision made by an insurance company, I believe those ideas have merit.

While I agree with this, I believe we will only be replacing the words 'insurance company' with 'government' if this bill passes.

I think the idea that everyone should have a basic level of health care coverage has merit.  I think the idea that losing your job doesn't mean you're out of luck if you get sick or get injured in an accident has merit.  

I agree with this 100%-I know, unbelievable .  I do think these goals can be reached without the government option though.


I think this site does a good job of breaking down the healthcare issue and I like this international comparison guide:

http://www.npr.org/templates/story/story.php?storyId=110997469

http://www.npr.org/templates/story/story.php?storyId=106180134

And do you want communists like Dr. Ezekiel Emanuel getting his way in any sort of government helathcare program?

Communists?  Seriously, were you frozen in the 1950s?  We beat the communists in 1989.

...most anything managed by the government is done inefficiently.

No, it's not.  As I said before, the US military, the Post Office, and the Centers for Disease Control are three examples of government agencies that do a good job.  Now you can go find me however many examples you want of inefficient government agencies, but you can do that with insurance companies, auto manufacturers, telecommunications companies, or any other large bureaucracy.  

There are good large organizations and bad ones in government and in the private sector.

{The cost} is a huge concern of mine and why I'm not convinved that this should be passed.

Should not be passed in its current incarnation or at all?  I'm ok with saying "I need more information on costs" or "They need to pay for it without deficit spending" or something like that, but if you're saying "It's too expensive, so we shouldn't do it" then I disagree.

While I agree with this, I believe we will only be replacing the words 'insurance company' with 'government' if this bill passes.

With the government you have some form of redress if you disagree with a decision.  At the very least you have members of congress you can contact, and you can let your feelings be known with your vote.  You probably think that's not much power, but it's more power than you have when dealing with an insurance company.  They're not obligated to you; they're obligated to their shareholders.

I want the system to be obligated to me rather than somebody who bought shares in a company.

I agree with this 100%-I know, unbelievable .  I do think these goals can be reached without the government option though.

I'd be in favor of reform that provides a basic level of care for everyone without government involvement, as long as there's some meaningful mechanism in place to keep hospitals/insurance companies from weaseling out of providing care for people.  As things stand now, though, I don't think the industry is going to reform itself, and since the issues have been evident for some time, I'm ok with the government taking the lead.

I agree with this 100%-I know, unbelievable .

Not unbelieveable.  I'm sure you're in favor of people getting good health care, I just think the conditions under which you'd be comfortable with it happening are unlikely.  From what I can tell you're looking for a conservative Republican leader to persuade the various components of the health care industry to voluntarily reform themselves in an effort to provide quality health care to every American.  I don't think that's ever going to happen.

No, I mean government having the power to regulate healthcare, as most anything managed by the government is done inefficiently.

I can't speak for services run by the US government, but I would say that my UK government-run doctor's surgery in the UK is pretty efficient (i.e. it can be done) .

As an example: I returned home from my holiday late last Sunday night and realised that I needed to go to the doctor for a repeat prescription as my current one was about to run out. I called the NHS surgery at 9 o'clock on Monday morning and within a couple of minutes I had booked an appointment for the next day at 10 a.m (I'd actually requested an appointment for Wednesday - my day off - but they had one available on Tuesday instead). The next morning I arrived at the surgery at 9.55 and when I went to take a seat, there was only one other patient in the waiting room. I was seen by the doctor 5 minutes later and at 10.10 a.m. I walked out of the surgery with 2 prescriptions in my hand. I had them filled at work later that day (I work in a Pharmacy) and I only paid £7.20 for both (one was free and I had to pay for the other).

My mum also needed to get a doctor's appointment when we got home from the holiday and she called the doctor at 8 o'clock that same Monday morning (an hour before I did) - she was able to get an appointment for 30 minutes later (8.30) and was back at home with her prescription before 9 o'clock - if that's not efficient, I don't know what is .

http://www.npr.org/templates/story/story.php?storyId=110997469

I've clicked on the link and yes, it gives a comparison of the different healthcare systems, but what are you trying to get across by linking to it? i.e. What are your opinions of the comparisons? How would you weigh the different aspects of the US system against the other systems being compared? What you do like/not like about the US system and what parts of other systems would you like to see implemented in the US? If you could live in one of the other countries, which healthcare system would you like to be covered by?

Personally, I quite like the system I use at the moment (NHS), although I do feel that it needs improvement and I support what people like Kate Spall etc. are campaigning for. However, looking at the healthcare comparisons, I also think that French system is pretty good, and that Germany and the Netherlands have good systems too. Of all the healthcare systems listed in the link, I would probably go with France or the UK first and Japan and the US last, with the others somewhere in the middle.

All your posts are saying at the moment is that you think that reform is needed, but that it won't be efficient if the government do it and that it can be done even if the government is not involved, but you are not giving any evidence other than linking to sites that have lots of information but no definitive point or opinion and you are not saying how you would like to see things change.

So if it were up to you, what would you do? How would you restructure the US healthcare system if you were in charge?

(P.S. I am not in any way trying to attack your post, I'm just curious as to how you want to see a reform happening in the US and what that reform would entail in terms of insurance companies/coverage etc. to make it work effectively).

Which is a huge concern of mine and why I'm not convinced that this should be passed.

Just for clarification here (as I did RTFM--err RTFB), the cost for the public option is through a single $2B loan from the government to the (unnamed public option). This loan is for startup and initial coverage and is required to be paid back in 10 years. All other funding will come from premiums. There is tax revenue from individuals without qualified insurance (2.5% of AGI), large corporations who do not provide qualified plans (smaller businesses are prorated the value with the segment of under 50 employees being exempt from the charges), and individuals with high income (starts at $350K but if they make too much money, it'll increase to $500K). However, that revenue goes into the Treasury as a trust fund for backup funds for the entirety of the Health Insurance Exchange (e.g. to offset the high-risk loads of insurance plan).

Just the point I was making.  And that it why I called this statement double-speak:


1948: "Pay into our scheme (and you have no choice, by the way) and we'll cover you for X, Y, and Z when you need them."

2009: "You need Z?  Oh no, we only cover X and Y now.  If you want Z you'll have to pay for it yourself."

What do you call that then?

Geez.....60 years on! And X, Y and Z - you are just making things up as you go along. As I said - if you choose to go private that is your choice, nobody is making you pay again, you are making that choice.

I think the idea that everyone should have a basic level of health care coverage has merit.  I think the idea that losing your job doesn't mean you're out of luck if you get sick or get injured in an accident has merit.  

Basic healthcare should be a right, but so should not so basic healthcare that includes care for more expensive or catastrophic things.  When people say basic healthcare, maybe I am wrong in assuming that it means just check-ups and basic injuries.

I think what keeps most people (at least in my experience) who are uninsured or under-insured from going to the GP isn't the cost of the GP, but the cost of any follow up care and scripts.  What's the sense in being told you have an ulcur if you can't afford to get rid of it?  

I might be totally off in this and people actually mean coverage for most things (like pretty much every industrialised nation except the US gives their citizens).

#I think it will be much worse under government control, and I think that the quality of healthcare in the US (which is generally very good) will decline.
[...]

While I agree with this, I believe we will only be replacing the words 'insurance company' with 'government' if this bill passes.

Right now we have a system in the States which answers a lot to profit rather than to morals.  I think that medical ethics is one of the things that has kept it from totally devolving into a worse system than it is.

The pharmaceutical companies focus on making illnesses chronic, treatable conditions rather than really coming up with cures.  Insurance companies really don't want to pay for your expensive state of the art treatment if they can get away with it.  Maybe you haven't had problems with your insurance company (yet), had to pay for COBRA (yet), had to try to qualify for Medicaid only to find that the income limits are extremely low (yet), be told which doctors you can or can't see by your insurance company (yet, but I find that really hard to believe).  Any of these things happen to you, and you will see how quickly your healthcare declines.

But it would all be worth it because it would be for the cause of keeping things private.

You keep saying you are in favour of reform.  What sort of reform do you want to see, and how would any change to the system not change things (a con to reform you bring up a lot)?

Personally, I quite like the system I use at the moment (NHS), although I do feel that it needs improvement and I support what people like Kate Spall etc. are campaigning for. However, looking at the healthcare comparisons, I also think that French system is pretty good, and that Germany and the Netherlands have good systems too. Of all the healthcare systems listed in the link, I would probably go with France or the UK first and Japan and the US last, with the others somewhere in the middle.

I don't know why the French system isn't brought up more. Or some of the Scandinavian systems, or so many others.

It would seem to me the French system would be ideal for those who want to ensure that private insurance survives.  Of course, it would mean that people would definitely have to change their healthcare plan.

Geez.....60 years on! And X, Y and Z - you are just making things up as you go along. As I said - if you choose to go private that is your choice, nobody is making you pay again, you are making that choice.

In fairness I asked him where he got the idea that everything but frivolous cosmetic surgery was covered.  I don't think that was much of an answer though.  Especially the stretching of the definition of sanatorium, which isn't an old folks home, but a place where infectious diseases are treated.  Not to mention I was expecting something like an actual promise and not an outline of a vision.

ETA: http://en.wikipedia.org/wiki/Sanatorium

Communists?  Seriously, were you frozen in the 1950s?  We beat the communists in 1989.

I guess nobody told these people then:

http://www.cpusa.org/
http://www.communist-party.org.uk/

Geez.....60 years on! And X, Y and Z - you are just making things up as you go along. As I said - if you choose to go private that is your choice, nobody is making you pay again, you are making that choice.

It has nothing to do with choosing to go private.  If you have been paying into a government scheme on the understanding that certain things will be covered, now when you need those things they are not, then you are being forced to pay again.

See, I interpreted the recording slightly differently.  It's a vision and an explanation. Is this the thing you claim riles the ire of so many people about the NHS failing to live up its promise or is there more?

It's certainly a complaint you'll hear from many people who have paid into the NHS most or all of their working lives.  My mother fell into this trap 10 to 15 years ago, and I know a lot of people complain about it today.  They were told that by paying N.I. "contributions" they would receive "free" this and "free" that when they needed it, yet now they have to pay again. 

If a private insurance company offered to indemnify you for something and took premiums for years on that agreement, then refused to pay up when you had a valid claim, you'd be throwing around words like "sue" and "breach of contract," wouldn't you?   

Why does the government get to just change the rules part way through the game?

I walked out of the surgery with 2 prescriptions in my hand. I had them filled at work later that day (I work in a Pharmacy) and I only paid £7.20 for both (one was free and I had to pay for the other).

Prescriptions are actually an early example of the rules changing.  They were "free" under the NHS initially, but demand resulted in charges being levied for them as early as 1952:

www.rpsgb.org.uk/pdfs/prescriptioncharges.pdf

One could argue, as Attlee said in the speech linked above, that the first few years of the NHS would be a time of stringency and attempting to build up the service to the eventual aims, but after a brief scrapping of prescription charges in the 1960s they were reinstated  20 years after the NHS began and have been with us ever since.