Welfare in the US

[Wonkish1]

I don't think it is ever good to have cancer.

Anyway, I know from the personal experience of too many of my close relatives that, actually, you do get access to expensive cancer treatment on the NHS. Quite how good depends on the cancer, for obvious reasons. There are also additional socio-cultural issues in the U.K regarding cancer (especially regarding the supposed embarrassment about talking about certain bodily functions; this might sound absurd, but is actually a very serious problem with men, especially older men), and there were some specific problems with cancer care until a couple of decades ago that (for what it's worth) had nothing to do with the structure or funding of the health service (and are no longer an issue).

I also know from rather direct personal experience that you also have access to expensive treatment for other serious illnesses on the NHS.

Certain other points need to be mentioned, I suppose. Firstly, private healthcare in Britain is not what might be assumed; actually it's mostly just the purchasing of a slightly privileged position within the same system as everyone else. Separate rooms, shorter waits for minor operations and so on. Same staff, same care, basically. It's a thing that people get in order to show that they've made it financially, more than anything else. Secondly, the NHS is not a massive cranking, clanking, semi-Stalinist bureaucratic monster, and never has been. It is actually fairly decentralised at an operational level. Whether that is a good thing or not depends on your point of view (personally I would like to see a more centralised service based around major regional hospitals as I think that is actually more effective and would guarantee quicker access to specialist care for everyone).

I also think that calm is a good thing, some of the time. A little more it would certainly be a good idea in this thread. Unlock.

Your response in regards to cancer in NHS is approximately what I've been able to piece together as well. Some expensive treatment is made available, but throughout the process there are key constraints that slow the flow of people utilizing these expensive treatments. It then elongates the reaction time and very negatively affects outcomes. If you are in Britain having a cancer or expensive illness that had these constraints is actually a good thing because the alternative is an expensive illness that either isn't covered at all or has such a tiny amount of supply relative to demand that you will likely never receive the treatment.

I agree about your characterization of British private insurance.

I disagree with your characterization of NHS not being a huge bureaucratic nightmare. Maybe at the patient level it doesn't seem that way. But the administration of that system is a bureaucratic clusterf**k approaching the 3rd layer of hell.


British NHS will only budget outlay so much for specialist care so you will not guarantee quicker access to specialist care. They are forced to place any of a number of constraints to you accessing specialists even in the event of your solution of moving to "major regional hospitals". Again the problem is the low expenditure on specialists leaving a smaller supply relative to demand. It has nothing to do with housing specialists in larger buildings. Waiting lists, gate keepers, bureaucratic red tape, etc. will be forced to pop up to account for that mismatch in specialist supply and demand. Waiting lists are the most common because that is just the default outcome when other things aren't put in place(like gate keepers).

[Filuwaúrdjan]

Your response in regards to cancer in NHS is approximately what I've been able to piece together as well. Some expensive treatment is made available, but throughout the process there are key constraints that slow the flow of people utilizing these expensive treatments.

All healthcare systems ration treatment (and not just expensive treatment), the only question is how this is done. Fundamentally, the question is whether you attempt to do so based on need (however defined), on some sort of market system or on a compromise between the two. Either way, there will be losers and so, ultimately, the decision is extremely and inherently political.

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I would be careful about making assumptions like that. The main reason for relatively low cancer survival rates in Britain is almost certainly late diagnosis (which is as much a social problem as it is anything else) and a couple of other things mostly not related to the structure of the health service (at least not from a social policy perspective). It is very unlikely that the problems that exist could be cured by changing to any sort of insurance system.

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All healthcare systems are (to some extent or other) bureaucratic nightmares. This isn't really even a bad thing; an effective healthcare system ultimately runs off paperwork, because you need to keep track of patients and their histories. People who have a problem with this should be kept at least thirty miles away from shaping healthcare policy. What I object to (because it is not true) is the characterisation of the NHS as essentially a grey Soviet monster that shuffles people and care around in a Kafkaesque manner. This is a characterisation created out of ignorance and ideological blinkers.

[Filuwaúrdjan]

British NHS will only budget outlay so much for specialist care so you will not guarantee quicker access to specialist care. They are forced to place any of a number of constraints to you accessing specialists even in the event of your solution of moving to "major regional hospitals". Again the problem is the low expenditure on specialists leaving a smaller supply relative to demand. It has nothing to do with housing specialists in larger buildings. Waiting lists, gate keepers, bureaucratic red tape, etc. will be forced to pop up to account for that mismatch in specialist supply and demand. Waiting lists are the most common because that is just the default outcome when other things aren't put in place(like gate keepers).

You've completely missed my point, I think. To make things absolutely clear, it is not a question about the size of the buildings. I tend to think that it would be better if the system was orientated around specialist care in major hospitals to a greater extent than it is at present (and to a far greater extent than it will be when the idiotic reforms being proposed for England are finally rubber-stamped). This would necessitate (of course) bigger budgets, but would also require the closure or downgrading of even more local hospitals than has been the case in recent decades, which means that it would be politically unpopular (and which is why it will never happen).

[Wonkish1]

Your response in regards to cancer in NHS is approximately what I've been able to piece together as well. Some expensive treatment is made available, but throughout the process there are key constraints that slow the flow of people utilizing these expensive treatments.

All healthcare systems ration treatment (and not just expensive treatment), the only question is how this is done. Fundamentally, the question is whether you attempt to do so based on need (however defined), on some sort of market system or on a compromise between the two. Either way, there will be losers and so, ultimately, the decision is extremely and inherently political.

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I would be careful about making assumptions like that. The main reason for relatively low cancer survival rates in Britain is almost certainly late diagnosis (which is as much a social problem as it is anything else) and a couple of other things mostly not related to the structure of the health service (at least not from a social policy perspective). It is very unlikely that the problems that exist could be cured by changing to any sort of insurance system.

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All healthcare systems are (to some extent or other) bureaucratic nightmares. This isn't really even a bad thing; an effective healthcare system ultimately runs off paperwork, because you need to keep track of patients and their histories. People who have a problem with this should be kept at least thirty miles away from shaping healthcare policy. What I object to (because it is not true) is the characterisation of the NHS as essentially a grey Soviet monster that shuffles people and care around in a Kafkaesque manner. This is a characterisation created out of ignorance and ideological blinkers.

Market based systems don't need to engage in that much rationing at all because they have high cost sharing(and lower premiums) so people decide on their own whether they think its worth it or not and take more control of watching their own healthcare situation to assess risks vs. costs. This exercise of constraint in utilizing healthcare because its some of your money that is partially paying for it allows people to self ration like they do in most other markets like candy and new cars.

In the US even the private based system is still a very mixed private/government system because government action has caused extremely high rates of 3rd party payment vs. insured payment relative to other insurance markets. So quite a lot of defacto rationing occurs in the US system, but a ton less so than in countries like the UK(and you can see that quite visibly in the differences in total healthcare expenditure in the US vs. UK).


So you think that late diagnosis in Britain relative to places like the US is solely based on the notion that British men are more squeamish talking about health ailments?
A) American men are squeamish about talking about health ailments, too. Actually I would probably bet that American men are a lot more squeamish about talking about health ailments than British are. There are a lot more conservative rugged men in the US than there are in Britain.
B) You really don't think it has anything to do with the fact that you have less equipment that tests things like cancer per capita then the US does? And that waiting time is extremely different? In the US, most areas can likely test you within the day of a doctor being worried about a problem because there is so much supply. Can you say that about the UK?



I don't know what a Kafkeasque manner is, but I don't even know of a system in Europe that is more bureaucratic than British NHS and that is by a huge margin. And bureaucratic doesn't mean reliance on paper/documents. Bureaucratic means that you rely on large quantities of administrators, rules, permits, approvals, waivers, etc. Your system is a damn mess and it delivers a very inferior product for the costs it runs. I mean for God sakes the degree of patient death because of hospital born infections in your country is off the charts. You go in for an injury and you come out with a life threatening infection. Most developed countries in the world passed that degree of hospital born infection when WW2 ended.

[Wonkish1]

British NHS will only budget outlay so much for specialist care so you will not guarantee quicker access to specialist care. They are forced to place any of a number of constraints to you accessing specialists even in the event of your solution of moving to "major regional hospitals". Again the problem is the low expenditure on specialists leaving a smaller supply relative to demand. It has nothing to do with housing specialists in larger buildings. Waiting lists, gate keepers, bureaucratic red tape, etc. will be forced to pop up to account for that mismatch in specialist supply and demand. Waiting lists are the most common because that is just the default outcome when other things aren't put in place(like gate keepers).

You've completely missed my point, I think. To make things absolutely clear, it is not a question about the size of the buildings. I tend to think that it would be better if the system was orientated around specialist care in major hospitals to a greater extent than it is at present (and to a far greater extent than it will be when the idiotic reforms being proposed for England are finally rubber-stamped). This would necessitate (of course) bigger budgets, but would also require the closure or downgrading of even more local hospitals than has been the case in recent decades, which means that it would be politically unpopular (and which is why it will never happen).

Well as you close down the local hospitals those healthcare consumers don't just disappear. They then move to getting serviced at the major hospitals. Specialists are a lot more expensive to the system than your average doctor. If you don't increase the number of specialists than everything remains the same except the waiting lists for specialists will grow exponentially longer if you remove the other constraints to accessing them. If you increase the number of specialists than your costs will explode because they are much more expensive than your average doctors and if there are more, more expensive care gets utilized.

Lets just face it your country can't afford many things as is. There is no way in hell even Labour could see a way today to increase the supply of expensive care in your country without triggering a Greek like moment.

[Marston]

First, I have to say, Wonkish, that you seem to have some semblance of understanding of healthcare policy but you kind of shoot that credibility to hell when you resort to petty name calling. That kind of stuff turns a lot of people off.

Now, onto the discussion at hand.

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Yeah, I know. We've kind of strayed off of that path a while ago, didn't we?

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First, I don't think people "shun" HMO's as much as you may think. Sure, there was a point in time (80's and 90's) where HMO's were widely but, like many things in the healthcare continuum, they evolved. Now, the HMO's I think you're talking about are the staff model types. The staff model exercises a great degree of control through paid, fixed salary physicians and control over practice patterns of their physicians. Hence, it is easier to monitor utilization. Enrollee's in this type of HMO might be somewhat upset do to their limited choice of physicians and all that. So, it's not a surprise that the number of staff model HMO's has declined over recent years.

Now, group model and network model HMO's vary in their popularity and each has its own attributes and disadvantages.

However, Independent Practice Association Model HMO's (IPA) have been very successful in terms of constituting the largest share of HMO enrollments. The IRA model provides an expanded choice of providers to the enrollees and also allows small groups and individual physicians the opportunity to participate in managed care and to get a slice of the revenues. So, you see that HMO's aren't the mean unpopular bully they're made out to be. You really have to define what type of HMO you're talking about before we can have a reasonable discussion on the merits of that model.

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Again, like I said, you have to specify what type of HMO you're talking about. I would probably join right alongside you in stoning to death the Staff Model HMO but I would defend IPA HMO's vigorously in terms of patient satisfaction of care and cost-effectiveness.

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What would you call it, then?

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Just so I'm clear, I will not be baited into defending 3rd-World countries healthcare systems. Corruption is rampant in many of these countries and it infects their healthcare systems to the maximum. Utilization review is not used as intended and there is a gross mismanagement of funds at the administrative levels. You cannot equate Costa Rica's healthcare system with Canada's or the United Kingdom's simply because they're government-run. That would be a big and naive mistake. I know that's not what you're trying to do. That was just a general statement on my part and why I have little to actually say in response to your statement on that.

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I think Germany' system does have its advantages, to be sure. However, it of course it not without its faults. It suffers from insufficient or inappropriate care, shrinking revenue, and an aging population - to name a few problems. I think there are certain aspects we could look at adopting from it, however.

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Ha. I admire anyone that decides to study health policy for fun. We're few and far between.

As for myself, I'm finishing up my double-majors in Health Science and Public Administration. I'm going to apply for a health education position in the Peace Corps to gain some practical experience before going for my MPP with a concentration in health policy.  

 

[Wonkish1]

First, I have to say, Wonkish, that you seem to have some semblance of understanding of healthcare policy but you kind of shoot that credibility to hell when you resort to petty name calling. That kind of stuff turns a lot of people off.

Now, onto the discussion at hand.

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Yeah, I know. We've kind of strayed off of that path a while ago, didn't we?

You must be logged in to read this quote.

First, I don't think people "shun" HMO's as much as you may think. Sure, there was a point in time (80's and 90's) where HMO's were widely but, like many things in the healthcare continuum, they evolved. Now, the HMO's I think you're talking about are the staff model types. The staff model exercises a great degree of control through paid, fixed salary physicians and control over practice patterns of their physicians. Hence, it is easier to monitor utilization. Enrollee's in this type of HMO might be somewhat upset do to their limited choice of physicians and all that. So, it's not a surprise that the number of staff model HMO's has declined over recent years.

Now, group model and network model HMO's vary in their popularity and each has its own attributes and disadvantages.

However, Independent Practice Association Model HMO's (IPA) have been very successful in terms of constituting the largest share of HMO enrollments. The IRA model provides an expanded choice of providers to the enrollees and also allows small groups and individual physicians the opportunity to participate in managed care and to get a slice of the revenues. So, you see that HMO's aren't the mean unpopular bully they're made out to be. You really have to define what type of HMO you're talking about before we can have a reasonable discussion on the merits of that model.

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Again, like I said, you have to specify what type of HMO you're talking about. I would probably join right alongside you in stoning to death the Staff Model HMO but I would defend IPA HMO's vigorously in terms of patient satisfaction of care and cost-effectiveness.

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What would you call it, then?

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Just so I'm clear, I will not be baited into defending 3rd-World countries healthcare systems. Corruption is rampant in many of these countries and it infects their healthcare systems to the maximum. Utilization review is not used as intended and there is a gross mismanagement of funds at the administrative levels. You cannot equate Costa Rica's healthcare system with Canada's or the United Kingdom's simply because they're government-run. That would be a big and naive mistake. I know that's not what you're trying to do. That was just a general statement on my part and why I have little to actually say in response to your statement on that.

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I think Germany' system does have its advantages, to be sure. However, it of course it not without its faults. It suffers from insufficient or inappropriate care, shrinking revenue, and an aging population - to name a few problems. I think there are certain aspects we could look at adopting from it, however.

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Ha. I admire anyone that decides to study health policy for fun. We're few and far between.

As for myself, I'm finishing up my double-majors in Health Science and Public Administration. I'm going to apply for a health education position in the Peace Corps to gain some practical experience before going for my MPP with a concentration in health policy.  
 

I hope you are referring to me calling Link a retard. Well, all I can say is that he deserves it for some of the crap he's posted on here. I wouldn't direct anything like that at someone like you who is engaging in meaningful fact based discussion on a topic.


The OP asked for generalizations of peoples views towards universal healthcare. I responded by saying that I think most people in employer provided healthcare are fairly content with the system. You called that an over generalization. I responded saying that is what the OP asked for. Am I missing something?


Network model HMOs really start to approach looking more like PPOs than traditional HMOs and they rely on cost sharing a lot more than gate keepers to get cost containment. There is a lot less managed care in them since they rely on larger out of pocket costs for cost containment. But yes what I was referring to when I mentioned HMOs was traditional staff model HMOs. A staff model HMO is very similar to many Nationalized Healthcare systems in practice. The American public hated staff model HMOs. Network HMOs are a lot less like Nationalized healthcare systems.


Again staff model HMOs = similar to many universal healthcare models. Network HMOs = much more similar to PPOs with higher spreads between in network and out of network payment than PPOs have and higher cost sharing(which is a lot more different than Nationalized Healthcare). Again the topic of HMOs was brought up not to say they are altogether a horrible option, but to provide the best example in the US insurance markets of what a national healthcare system would look like for average Americans and show how the American public didn't like it.


I would call it allowing for another form of bureaucratic 3rd party payment to take hold in the US.


You might call me crazy, but since I've spent some time visiting both the UK and Costa Rica I would probably take the Costa Rican healthcare system over the UK. At least in Costa Rica I have access to meaningful private insurance that will get me great coverage in the case of a catastrophic health problem. Plus Costa Rica seems to be the favorite of American health insurers that want to take advantage of healthcare jurisdictional arbitrage(aka medical tourism) between the US and some other countries. They can build an entire hospital, staff it with some of the best doctors in the world, fill it with state of art technology, add a beautiful resort to it, and pay for Americans plane ticket, stay, and medical procedures there for less than what it costs in the US.

Meanwhile, if I go a hospital in the UK for an average injury I may get a life threatening infection from the poor quality of their hospitals and if I get any rare expensive illness(which is the purpose of insurance) I'm probably screwed. And their private insurance is mostly useless.


I would say that Germany is a HUGE improvement over Britain, France, Canada, Spain, etc. but I wouldn't call it anywhere close to my ideal system nor really want to take advantage of any of their system. Currently, the system I like best in the world is probably Singapore's or what I like to call "Our system inverted".


I like to understand how the world works and how pieces fit together. I don't really think you can really do that without studying the enormous markets in healthcare and education(what I probably study a distant 3rd most) since they are so intertwined and have so much consequence on peoples lives.

[Link]

All healthcare systems ration treatment (and not just expensive treatment), the only question is how this is done.

I agree.  This should be obvious to everyone but it seems to be beyond the comprehension of many on the right.  I have never seen any useful asset or service that is not rationed.  The notion that we don't have rationing in the US is absurd.

[Wonkish1]

All healthcare systems ration treatment (and not just expensive treatment), the only question is how this is done.

I agree.  This should be obvious to everyone but it seems to be beyond the comprehension of many on the right.  I have never seen any useful asset or service that is not rationed.  The notion that we don't have rationing in the US is absurd.

Really explain to me how candy and cars are "rationed" assuming you understand what the word means?

[LastVoter]

Actually, it is because it creates a culture of dependance on government, and rich or poor, Americans do not like government interference.

That is different than most European democracies.  In the UK, government is thought to be responsible for the people.  In the US, government is thought to be responsible to the people.

What is one of the objections to people receiving welfare?  "You want to get all in my business," "I have to show you everything," or things along that line.

Conversely, in PA, if you want to run for local, county, or state office, you were required to file a public financial statement.  You had to, in the 1990's, show any gift from a non family member of greater than $500, any source of income of more than $500 (I think that excluded interest).  You didn't have to show the amount.  I've known people that have refused to run for office because they didn't want to include that.

It''s pretty obvious that most people are irresponsible as . Hence why European systems work better.
@ Wonkish: Expensive cancer treatment is synonymous with death. It doesn't matter if the treatment that will extend your life by 3 months for $1 million is available. A UHC system in US would make it available because it's such a rare case that only 1% of population would need those expensive treatments, that it's better to make them available than face the public outcry at "death panels" and other bullsh**t like that. For example government agencies(like EPA) do improvements if it's going to come out cheaper than $4 million/life. I can't believe this point is even being argued.

[Marston]

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Yeah, that's what I was referring to. It just comes off as somewhat arrogant in a sense, at least from an observer's viewpoint. Of course, we're all guilty of that kind of stuff once in a while. It's just best not to let it become habitual.

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No. I'm saying that we've crossed the line of generalizations a long time ago in this thread. For better or for worse, we've definitely strayed a long way from the OP's original question. Thus, it's kind of 'late in the game' to be still engaging in generalizations (especially when you and I decided to discuss a litany of issues pertaining to health care access and delivery domestically and abroad). I'm not sure if that makes sense. Regardless, it really doesn't matter now as long as we're not still rehashing old generalizations and stereotypes.

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Well, network model HMO's are really well suited for metropolitan area's where large group practices are located but that's besides the point. If we're to focus on staff model HMO's, I suppose you could make an argument that they are similar in some sense to national universal health insurance systems abroad but there's also some key differences. First, many staff model HMO's are really limited in terms of access. You really cannot compare on regional staff model HMO to an entire country in terms of access. That's a false comparison. I could make a case linking PPO's to some universal systems abroad but I won't because that's also a false comparison. You can find linkages between almost anything but it doesn't mean you should pursue them. HMO's are a uniquely American solution to cost-containment and utilization review issues. I don't really think they should be taken out of that context and compared to non-native health systems abroad.

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Yes, but it's market-based bureaucracy.  

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....

You know that can very well happen here, don't you? One of the few similarities between the U.S., UK, France, etc. is the fact that quality varies greatly among provider's. There are some state-of-the-art hospitals and outpatient centers in Europe. There are some really crappy ones, as well. The same applies for us here in the U.S. God knows I've told my friends and relatives which hospital I want to be taken to if I need acute care.


Look, I fear we're probably very close to going around and around in circles about HMO's and comparability and all that. So let me just say this:

The United States is plagued by two major issues: increasingly unaffordable cost of health care and a lack of insurance coverage for a relatively large segment of the population (we'll see how well the ACA does in tackling the second issue). We've been at the cutting edge of technological innovation. By affording the full cost of research and development for technology that other countries later adopt and use, we've indirectly subsidized the cost of healthcare in other countries. We also subsidize the care of a large number of illegal immigrants in the South. Other countries don't really have to contend with this - at least not at the same scale we do. Thus, I would say that any solution in the future is going to have to be uniquely suited to our problems and will probably not end of being a mirror image of Germany's system, the UK's, Canada's, etc.

I will say that universal health care remains a worthy goal but it really cannot feasibly be achieved without a massive escalation in total healthcare expenditures. Even then, universal health insurance is not necessarily equal to universal access, as you well know. If we're really going to shoot for universal coverage, we must first concurrently invest in training a multitude of primary care physicians (your gatekeepers), specialists, and nurses.

If we assume that your generalization is correct that most American's are content with their employer-based health insurance, would you be open to a pay-or-play type of system? It would, after all, be the least disruptive to the current system while expanding coverage to all segments of the population. Just curious.

[Wonkish1]

@ Wonkish: Expensive cancer treatment is synonymous with death. It doesn't matter if the treatment that will extend your life by 3 months for $1 million is available. A UHC system in US would make it available because it's such a rare case that only 1% of population would need those expensive treatments, that it's better to make them available than face the public outcry at "death panels" and other bullsh**t like that. For example government agencies(like EPA) do improvements if it's going to come out cheaper than $4 million/life. I can't believe this point is even being argued.

You sure about that? You think that there have been no people that have had cancer and had it disappear? Also apparently you don't know what remission is?

You think cancer is rare?

So do you really think that our system just takes a lot of this massive expenditure and burns it? Or do you think its actually spent on expensive procedures, treatments, drugs, etc.?-- albeit on a lot of which isn't necessary or wouldn't be made if people were paying even part of it themselves.

Am I to assume that you are saying that a government run system in the United States would just approve anything?

[LastVoter]

@ Wonkish: Expensive cancer treatment is synonymous with death. It doesn't matter if the treatment that will extend your life by 3 months for $1 million is available. A UHC system in US would make it available because it's such a rare case that only 1% of population would need those expensive treatments, that it's better to make them available than face the public outcry at "death panels" and other bullsh**t like that. For example government agencies(like EPA) do improvements if it's going to come out cheaper than $4 million/life. I can't believe this point is even being argued.

You sure about that? You think that there have been no people that have had cancer and had it disappear? Also apparently you don't know what remission is?

You think cancer is rare?

So do you really think that our system just takes a lot of this massive expenditure and burns it? Or do you think its actually spent on expensive procedures, treatments, drugs, etc.?-- albeit on a lot of which isn't necessary or wouldn't be made if people were paying even part of it themselves.

Am I to assume that you are saying that a government run system in the United States would just approve anything?

Yes it does some of that thanks to the insurance industry taking a 5% cut + cut over fighting whether or not something is covered in the plan. The real reason is that wages in the healthcare industry are higher in US than nearly everywhere. I suspect covering the entire population under current average standard would probably increase the healthcare spending by about 10% in the us, because of elimination of bureacracy and savings due to preventative care in other areas(not necessary healthcare, but worker productivity etc(of course to do something like this you would have to mandate flu shots which would piss off about 10% of US population majorly)).
I thought that we are talking about "expensive" aka "non-mainstream" cancer that's currently not covered in the UK and the like(first world single-payer). I don't know why are we even having this discussion though, it's just an epic strawman drawing contest, since I suspect neither of us is in the healthcare industry and can break down the cancers by type/price to treat/average survival rate after treatment before writing the posts. Last part would be a yes, based on other governmental agencies and how emotional people will get if it's not that way.

[Хahar 🤔]

All healthcare systems ration treatment (and not just expensive treatment), the only question is how this is done.

I agree.  This should be obvious to everyone but it seems to be beyond the comprehension of many on the right.  I have never seen any useful asset or service that is not rationed.  The notion that we don't have rationing in the US is absurd.

Really explain to me how candy and cars are "rationed" assuming you understand what the word means?

Those that can afford them get them and those that can't don't.

[Wonkish1]

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Yeah, that's what I was referring to. It just comes off as somewhat arrogant in a sense, at least from an observer's viewpoint. Of course, we're all guilty of that kind of stuff once in a while. It's just best not to let it become habitual.

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No. I'm saying that we've crossed the line of generalizations a long time ago in this thread. For better or for worse, we've definitely strayed a long way from the OP's original question. Thus, it's kind of 'late in the game' to be still engaging in generalizations (especially when you and I decided to discuss a litany of issues pertaining to health care access and delivery domestically and abroad). I'm not sure if that makes sense. Regardless, it really doesn't matter now as long as we're not still rehashing old generalizations and stereotypes.

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Well, network model HMO's are really well suited for metropolitan area's where large group practices are located but that's besides the point. If we're to focus on staff model HMO's, I suppose you could make an argument that they are similar in some sense to national universal health insurance systems abroad but there's also some key differences. First, many staff model HMO's are really limited in terms of access. You really cannot compare on regional staff model HMO to an entire country in terms of access. That's a false comparison. I could make a case linking PPO's to some universal systems abroad but I won't because that's also a false comparison. You can find linkages between almost anything but it doesn't mean you should pursue them. HMO's are a uniquely American solution to cost-containment and utilization review issues. I don't really think they should be taken out of that context and compared to non-native health systems abroad.

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Yes, but it's market-based bureaucracy.  

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....

You know that can very well happen here, don't you? One of the few similarities between the U.S., UK, France, etc. is the fact that quality varies greatly among provider's. There are some state-of-the-art hospitals and outpatient centers in Europe. There are some really crappy ones, as well. The same applies for us here in the U.S. God knows I've told my friends and relatives which hospital I want to be taken to if I need acute care.


Look, I fear we're probably very close to going around and around in circles about HMO's and comparability and all that. So let me just say this:

The United States is plagued by two major issues: increasingly unaffordable cost of health care and a lack of insurance coverage for a relatively large segment of the population (we'll see how well the ACA does in tackling the second issue). We've been at the cutting edge of technological innovation. By affording the full cost of research and development for technology that other countries later adopt and use, we've indirectly subsidized the cost of healthcare in other countries. We also subsidize the care of a large number of illegal immigrants in the South. Other countries don't really have to contend with this - at least not at the same scale we do. Thus, I would say that any solution in the future is going to have to be uniquely suited to our problems and will probably not end of being a mirror image of Germany's system, the UK's, Canada's, etc.

I will say that universal health care remains a worthy goal but it really cannot feasibly be achieved without a massive escalation in total healthcare expenditures. Even then, universal health insurance is not necessarily equal to universal access, as you well know. If we're really going to shoot for universal coverage, we must first concurrently invest in training a multitude of primary care physicians (your gatekeepers), specialists, and nurses.

If we assume that your generalization is correct that most American's are content with their employer-based health insurance, would you be open to a pay-or-play type of system? It would, after all, be the least disruptive to the current system while expanding coverage to all segments of the population. Just curious.

Link has done plenty to deserve it and it extends way beyond this thread. I'll just leave it at that. Also, my answer to arrogance is to be even more arrogant, but if your nicely and politely stating your case I'll do the same back.

OP: Asks for generalizations
Me: "Okay, lets start off with the fact that most Americans are fairly content with the current system since most of the premium cost is "payed" by their employer..."
You: "False. For that to be correct, there would have to be some actual sort of 'system' in place..."
Me: "But I am primarily referring to the sub system of employer "provided" healthcare...For those that are in the employer provided healthcare system they are widely content for now..."
You: "I am generally wary of generalizations and the people who make them. Just saying."
Me: "Well the OPs question asked for generalizations as to why Americans don't want to see a universal healthcare system deployed in the US"
^^^^See from the beginning I was just answering the general question as to why people are opposed to universal healthcare in the US. Well, one of my answers is that on the whole people are content. And then we went back and forth about how that is a generalization and me saying its because the OP asked for it. Yeah, but your right it doesn't matter.

Yeah of course its convenient when your network is down the road, but it doesn't take a rocket scientist to figure that out. At the same time it doesn't change the fact that people don't like having to get approval from a gate keeper every time they need expensive treatment. And they don't like having a lot of risk that if expensive treatment is needed that it wont be covered. What do specifically mean by access? They are the most similar to universal systems because they both take a bureaucratic approach to limiting expensive treatment. How do you disagree with that?


Well since our system has an extremely perverted sense of 3rd party payment relative to other types of insurances in the US and the rest of the world, I don't really see how creating another perverted 3rd party payer is really a meaningful market based solution.


Of course it can happen here, but its not really to much of a worry. It happens a ton more in Britain because of inferiority of their product across the board(on average). That doesn't mean that there aren't places in England where the odds of that happening are low. It just means that on average its extremely high.


And where did I say that I disagreed with those two "major issues".

Your 2 causes are big problems, but I don't see them as the biggest cost drivers in the US. The US has universal access! By that I mean it is has universal access-availability. It doesn't have universal access-affordability. That is a key distinction. The notion that there is anybody that cannot get insurance because nobody will approve them is a lie and myth. I have 4 words for you state high risk pool. That doesn't necessarily mean that everybody can afford insurance. Which means the issue still primarily means cost as not only its own very big negative, but also the driver of the amount of uninsured out there.

I really had to giggle a little bit about your solution about training more primary care physicians, specialists, and nurses. I'll tell you the reason why. Whenever I start a discussion with someone about healthcare who doesn't know much about how our system works I ask them one question that really gets to the core of showing a big part of whats wrong with our system(and by extension most other countries). This is that question and I'm curious about your answer:

In the late 1970s, Carter's HHS secretary developed a plan for getting healthcare costs down. His plan was greatly increase the amount of training of new nurses, doctors, and specialists. That way the amount of supply would increase and as we all know when that happens elsewhere increased supply means more competition and lower prices. Seems pretty reasonable, but what happened as a result of that plan?


Just because I think people are content with employer provided healthcare(now at least) doesn't mean I think its a great system. Please define play or pay!


I was a little surprised that you didn't comment on me mentioning that my probably my favorite system in the world is Singapore's.

[Marston]

All healthcare systems ration treatment (and not just expensive treatment), the only question is how this is done.

I agree.  This should be obvious to everyone but it seems to be beyond the comprehension of many on the right.  I have never seen any useful asset or service that is not rationed.  The notion that we don't have rationing in the US is absurd.

Really explain to me how candy and cars are "rationed" assuming you understand what the word means?

Those that can afford them get them and those that can't don't.

In more technical terms: rationed via ability to pay.

[Wonkish1]

Those that can afford them get them and those that can't don't.

But that it isn't the definition of rationing!!

[Wonkish1]

In more technical terms: rationed via ability to pay.

A) As I mentioned in the post above that isn't the definition of rationing
B) Many people have the ability to pay for those things, but that doesn't necessarily mean they'll buy.

[Filuwaúrdjan]

Market based systems don't need to engage in that much rationing at all because they have high cost sharing(and lower premiums) so people decide on their own whether they think its worth it or not and take more control of watching their own healthcare situation to assess risks vs. costs. This exercise of constraint in utilizing healthcare because its some of your money that is partially paying for it allows people to self ration like they do in most other markets like candy and new cars.

On the contrary, they engage in rationing every bit as much as something as overtly socialist as the NHS. It is just that it is done through market mechanisms and via exclusion. Fundamentally there is only a finite amount of anything related to healthcare (whether staff - including non-specialist staff - drugs or even buildings) and ways must be devised to manage this problem; we cannot all have what we want immediately. In this respect a market system is absolutely based around rationing, it is just that it rations based on the ability to pay. Anything else is semantics, and bugger that.

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Solely based on that problem? No, I don't think I argued that. Please do not twist my words into making claims that I did not make myself in order to make it easier to argue against my arguments. I do not like people doing that. It is dishonest and disrespectful.

It is certainly one of the reasons for the problem of late diagnosis though. Another issue with cancer statistics here, of course, is the fact that many cancer patients are elderly and there has always been an assumption here (and this was the case long before 1948) that there's not much point adding a few extra years to a life that was likely to end soon anyway. My own Grandad chose to fade slowly out to increasing doses of morphine rather than risk surgery that would have extended his life by a couple of years at the cost of what was left of his quality of life.

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If you think this then I think you cannot have met many British men, especially those that are older and working class. This has nothing to do with politics in the sense that you're thinking of.

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I think you'll find that in the US it isn't just a question of supply, as the little fact that large numbers of people are effectively excluded from access to large parts of the system. Not that there's any doubt that large US hospitals are extremely rich and can afford anything. Though it is interesting that you bring up cancer testing in that way; it has sometimes been the case in the past that drives to increase the number of people (again, especially men) getting themselves tested have failed because... well... guess.

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So you've never even heard of Kafka? I think that says everything.

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lol

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And you base this assumption on... what, exactly? All I know is that I'm alive now and wouldn't be if I was American. I accept that this may colour my perceptions somewhat, but then none of us is an objective observer of anything.

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As far as I am aware, hospital infection rates (if we believe the statistics that exist, and I don't because I'm not a credulous idiot, and if we also believe that it is a good idea to compare them, which I don't because not only am I not a credulous idiot, I am also not terminally naïve) are very similar in most Western countries, particularly given the sheer amount that estimates within particular countries vary from study to study. Most hospital infections are essentially unpreventable anyway and the statistics are (in all countries) a joke. You can go in for an injury and die of an infection in any hospital on the planet, and you're a fool if you think otherwise.

[Filuwaúrdjan]

You know that can very well happen here, don't you? One of the few similarities between the U.S., UK, France, etc. is the fact that quality varies greatly among provider's. There are some state-of-the-art hospitals and outpatient centers in Europe. There are some really crappy ones, as well. The same applies for us here in the U.S. God knows I've told my friends and relatives which hospital I want to be taken to if I need acute care.

This is absolutely true, yes.

[Filuwaúrdjan]

Well as you close down the local hospitals those healthcare consumers don't just disappear. They then move to getting serviced at the major hospitals.

'Healthcare consumers'? Christ. And that was without a hint of irony, I presume? Lord...

Anyways, that's the whole point. The entire and uttermost totality of the point. Because, you see, the quality of treatment from both specialist and non-specialist staff tends to improve when there is a major concentration of specialists. Hospitals, in that respect, are like Universities. And like Universities, you also want some serious teaching and research going on as well. A better atmosphere in general, and better care for the patients.

Oh, and if someone is advocating increasing the importance of specialist care within a system, then it is reasonable (and also logical) to assume that this person supports training and employing more specialists. It is possible that this hypothetical individual is bemused at the fact that he feels the need to point this out, it being so blindingly obvious.

Naturally this hypothetical individual would not dignify the rest of your post with a response and would be most unlikely to take any bait from from that general direction.

[Link]

It is certainly one of the reasons for the problem of late diagnosis though. Another issue with cancer statistics here, of course, is the fact that many cancer patients are elderly and there has always been an assumption here (and this was the case long before 1948) that there's not much point adding a few extra years to a life that was likely to end soon anyway. My own Grandad chose to fade slowly out to increasing doses of morphine rather than risk surgery that would have extended his life by a couple of years at the cost of what was left of his quality of life.

You just hit on a point that is huge.  Americans are only brave when they are dropping bombs on innocent women and children half way around the world.  When it comes time for them to face the reaper they wet their pants.  I've seen it time and time again.

You check out some of these amazing new cancer wonder drugs and you will see something like this... Spend six figures and come in for us to dump poison into your veins every few weeks and you may live a whopping six months longer!  If the government refuses to participate in this farce right wingers start screaming "Death Panel!"

You want to decrease ludicrous health care expenditures in America?  Then grow a pair and face death with some dignity and stop these pointless ludicrous expenditures.  And lose weight for Heaven's sake.

[Link]

Well as you close down the local hospitals those healthcare consumers don't just disappear. They then move to getting serviced at the major hospitals.

'Healthcare consumers'? Christ. And that was without a hint of irony, I presume? Lord...

Yup. I'm sure he was serious.  That's the way they talk about healthcare here in America.  It's be so cheapened.  You would think instead of saving lives doctors were selling widgets.  They think healthcare is some open air bazaar where patients, oops, I mean "healthcare consumers" just wander around the free market making wise well informed decisions and doctors, oops, I mean "providers" are at their beck and call.  I love that term "providers."  It's pretty cool that in America these right wingers have f'ed up the health care system so much we can refer to doctors and call girls with the same name.

[Wonkish1]

Market based systems don't need to engage in that much rationing at all because they have high cost sharing(and lower premiums) so people decide on their own whether they think its worth it or not and take more control of watching their own healthcare situation to assess risks vs. costs. This exercise of constraint in utilizing healthcare because its some of your money that is partially paying for it allows people to self ration like they do in most other markets like candy and new cars.

On the contrary, they engage in rationing every bit as much as something as overtly socialist as the NHS. It is just that it is done through market mechanisms and via exclusion. Fundamentally there is only a finite amount of anything related to healthcare (whether staff - including non-specialist staff - drugs or even buildings) and ways must be devised to manage this problem; we cannot all have what we want immediately. In this respect a market system is absolutely based around rationing, it is just that it rations based on the ability to pay. Anything else is semantics, and bugger that.

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Solely based on that problem? No, I don't think I argued that. Please do not twist my words into making claims that I did not make myself in order to make it easier to argue against my arguments. I do not like people doing that. It is dishonest and disrespectful.

It is certainly one of the reasons for the problem of late diagnosis though. Another issue with cancer statistics here, of course, is the fact that many cancer patients are elderly and there has always been an assumption here (and this was the case long before 1948) that there's not much point adding a few extra years to a life that was likely to end soon anyway. My own Grandad chose to fade slowly out to increasing doses of morphine rather than risk surgery that would have extended his life by a couple of years at the cost of what was left of his quality of life.

You must be logged in to read this quote.

If you think this then I think you cannot have met many British men, especially those that are older and working class. This has nothing to do with politics in the sense that you're thinking of.

You must be logged in to read this quote.

I think you'll find that in the US it isn't just a question of supply, as the little fact that large numbers of people are effectively excluded from access to large parts of the system. Not that there's any doubt that large US hospitals are extremely rich and can afford anything. Though it is interesting that you bring up cancer testing in that way; it has sometimes been the case in the past that drives to increase the number of people (again, especially men) getting themselves tested have failed because... well... guess.

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So you've never even heard of Kafka? I think that says everything.

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lol

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And you base this assumption on... what, exactly? All I know is that I'm alive now and wouldn't be if I was American. I accept that this may colour my perceptions somewhat, but then none of us is an objective observer of anything.

You must be logged in to read this quote.

As far as I am aware, hospital infection rates (if we believe the statistics that exist, and I don't because I'm not a credulous idiot, and if we also believe that it is a good idea to compare them, which I don't because not only am I not a credulous idiot, I am also not terminally naïve) are very similar in most Western countries, particularly given the sheer amount that estimates within particular countries vary from study to study. Most hospital infections are essentially unpreventable anyway and the statistics are (in all countries) a joke. You can go in for an injury and die of an infection in any hospital on the planet, and you're a fool if you think otherwise.

As I've established above, people choosing to pay or not pay by themselves is not rationing. Only a person who doesn't understand what the word rationing means would say that. Please be specific as to what you mean by "market mechanisms and exclusion". While healthcare supply is finite at any moment in time its not finite over time. In a market supply grows to accommodate demand.


It wasn't my intention to twist your words. I'm not like Link on here I don't like to score cheap points. I'm doing the best I can to figure out what your arguments are. Be more specific and you wont have to worry about it.

In the US, many elderly that are told that there lives can only be extended by a short period for expensive treatment pass. Probably more so than in Britain because a lot of times it comes with costs bore out of their own pocket that could instead to be passed to their kids(although I have no idea in which country that is more common in). Lets keep in mind that the answers to your questions need to show large differences in England relative to the US. Giving answers that are true in both countries doesn't show where the difference comes from. That said I personally believe you haven't given reasons that could even account for a fraction of a percent of the difference between the US and the UK on this issue. So keep searching for some more and bigger reasons than that.


I've vacationed in Britain before. I've watched documentaries that have interviewed old British coal miners and warehouse workers. I doubt you've met many rural, southern, and rust belt Americans before. A lot of these people go many, many years without ever stepping foot in a hospital. And I wasn't thinking of it in the sense of politics either. Lets just call it a wash before this descends into which country's men are on the whole less willing to admit health problems.


You just changed the subject from early detection of expensive illnesses because of our huge quantity of supply to one about uninsured(who aren't completely shut out they aren't denied treatment). But you should also find it quite amazing that the US maintains better aggregate outcomes and early detection across the board when looking at any specific expensive illness even while a significant amount of the public has only access to emergency care. If that doesn't show that Britain delivers a much inferior product I don't know what will.

Attempts to get people in the US to get more physicals, check ups, etc. have failed in the past as well unless its part of a wellness program that lowers their deductible, co-pay, premium, etc. So its not surprising.


Just googled her, I don't read fiction so that explains it. So my lack of knowledge of female fiction writer somehow sums me up? At least I admit things like that instead of running to Google every time to pretend I know something I don't(like Link).


Assumption is based on how your system is run, pieces of information I've put together over the years, etc. and comparing that to what I know about other European health systems.

Curious why wouldn't you be alive to today if you were an American?


Sibboleth, hospital caused infections is a big enough issue in your country to have been one of the top 5 political issues in your entire country in 2005. It is very far from ever being a major political issue in the US.

[Torie]

Well I shopped around for my face lift doc just like a consumer. I ended up choosing the one with the highest price.

You guys are not asserting that having health services consumers having some role in price maintenance/competition is but a fool's errand are you?