Oregon will start forcing doctors to accept Medicaid

[andersenpa]

Prevention doesn't prevent, it only reduces the incidence (which is a good thing, of course).

 

We cannot "ensure" universal primary preventive care, even with a UHC, and we damn well shouldn't "mandate" it.  Some folks are not going to get care (refer back to the population with highest neonatal mortality rate in the US) even if it is free.  

 

If people were responsible for their own health care (ie: they paid for it), they would take better care of themselves and get the preventive care they needed.  

 

Well I guess we could call it "incidence reducing care" but it doesn't have quite the same ring to it as preventive care, does it?

But you're just wordsmithing, the same nonsense output that comes from the political beuracracy you criticize.

We need to mandate that universal preventive care is offered, pain and simple. Cardiovascular disease is our greatest health issue. Blood pressure control alone would make a severe dent in the problem and cost. Universal care does not mean everyone will use it, just that everyone has the access without barriers. The cost of the program would be offset by the public health cost reduction in downstream high-cost procedures. Not to mention the awful approach we have to end of life care in the US.

 

To argue that people need to pay for their care (out of pocket or pretax) in order to be responsible is incorrect as you just have to look at the worldwide health systems where people use UHC type systems which are tax funded. They are using the system with excellent outcomes with, dare I say, responsibility.

 

One could say that every single thing in your life falls into the realm of "public health", and therefore is ripe for people to use to impose their will upon others.

 

 

No....I don't think the latest episode of "House of Cards" or that the neighbors' dog crapped in the yard again make a difference.

Just the important things like can I afford this, is it going to bankrupt me, will the treatment meet the need, etc. That's our job- look at everything and pick out the important things.

And it's not about imposing will, it's about making a smart financial decision to spend a penny up front to save a dollar down the line.

[PAMEDIC]

...

 

What do you think the "base level of care" would be if we nationalized the healthcare system?  It would be somewhere below terrible.

 

If I were King of America, I would say it would be something similar to what our MHS offers or what is available through the NHS. Neither of which is "somewhere below terrible".

 

I have already talked about the MHS. I also like the UK's NHS systems. They manage to insure their entire population and provide a high standard of care for about half the cost per capita or as a % of GDP than we do. And they aren't even the best system out there. France's system is pretty amazing. Taiwan has a great system.  I want a system that delivers more and costs less and there are other systems out there that we could use as instrumental models in fashioning a better system for here.

 

The problem with coming at this from an ideologue perspective as opposed to a pragmatic one is that you make the assumption that it is "the government" that is the big bad problem. That if we could somehow get rid of or remove the government and regulation from healthcare, things would be better. If more government = worse healthcare, do you think less government = better healthcare? That the more removed government and regulation are from healthcare that somehow we will have a better and better system? No government = perfect healthcare system? By that logic, you would expect Somalia to be a free market paradise of the world's best healthcare. Somalia is obviously a silly example, but I would be interested in hearing what you think the government's role is in healthcare. Give me a real world example of a nation that has less government or regulation that provides better societal outcomes at a lower cost. I would love to see it.

[Boatswain2PA]

We need to mandate that universal preventive care is offered, pain and simple. Cardiovascular disease is our greatest health issue. Blood pressure control alone would make a severe dent in the problem and cost. Universal care does not mean everyone will use it, just that everyone has the access without barriers. The cost of the program would be offset by the public health cost reduction in downstream high-cost procedures. Not to mention the awful approach we have to end of life care in the US.

 

To argue that people need to pay for their care (out of pocket or pretax) in order to be responsible is incorrect as you just have to look at the worldwide health systems where people use UHC type systems which are tax funded. They are using the system with excellent outcomes with, dare I say, responsibility.

...

And it's not about imposing will, it's about making a smart financial decision to spend a penny up front to save a dollar down the line.

I actually advocate a federally funded but tiered health care system to set a "bottom limit" for everyone. 

 

Tier 1:  Everyone gets basic preventive care - vaccines & prenatal care.  This includes illegal aliens, even those from mars.  We want everyone to have vaccines, and we want every pregnant mother to get prenatal care.  We can afford this for EVERYONE.

 

Tier 2:  US Citizens get a higher level of preventive care.  Of course, the devil is in the details.  Following Kitzhaber's original Oregon Health Plan, we have a citizen body rank order the long list of medical treatments.  Pap smears, colonoscopies, annual primary health visits, vision exams, hip replacements, heart caths, etc, etc, etc.  But we have a group of appointed citizens (not politicians) put these in order of public priorities.  Then we give that list to the actuarials to determine what it would cost to cover every American citizen at each point on the list (ie: how much to cover everyone with #1, how much to cover everyone with #1 & #2,  #1-#3, #1-#4, etc).  Then, using that estimation of what it would cost, we go to the politicians and see how far down the list they want to fund.

 

Tier 3:  You want it, you pay for it. This is a way to explicitly, above-the-table, ration care. 

 

The Oregon Health Plan was originally much like this, but was broken by politicians who, of course, pushed to insert their own pet projects into the list.  Kinda like how the court system forced CMS to start covering dialysis and kidney transplants. 

 

If I were King of America, I would say it would be something similar to what our MHS offers or what is available through the NHS. Neither of which is "somewhere below terrible".

 

I have already talked about the MHS. I also like the UK's NHS systems. They manage to insure their entire population and provide a high standard of care for about half the cost per capita or as a % of GDP than we do. And they aren't even the best system out there. France's system is pretty amazing. Taiwan has a great system.  I want a system that delivers more and costs less and there are other systems out there that we could use as instrumental models in fashioning a better system for here.

 

The problem with coming at this from an ideologue perspective as opposed to a pragmatic one is that you make the assumption that it is "the government" that is the big bad problem. That if we could somehow get rid of or remove the government and regulation from healthcare, things would be better. If more government = worse healthcare, do you think less government = better healthcare? That the more removed government and regulation are from healthcare that somehow we will have a better and better system? No government = perfect healthcare system? By that logic, you would expect Somalia to be a free market paradise of the world's best healthcare. Somalia is obviously a silly example, but I would be interested in hearing what you think the government's role is in healthcare. Give me a real world example of a nation that has less government or regulation that provides better societal outcomes at a lower cost. I would love to see it.

You will never get he quality of the MHS in any other national health service.  There is a level of accountability in the military that you simply will not find anywhere else.  If, when I was active, you had given poor care to one of my sailors, I could have called your boss and had the problem fixed.  If that didn't work, my boss could have called your bosses boss.  In the military, the docs/corpsmen work for the military guys who rose up the ranks putting their asses on the line and understand the consequences of shoddy work.  This simply doesn't exist in the non-military government bureaucracies.   Comparing the MHS to any NHS isn't just comparing apples to oranges, it's comparing apples to brussel sprouts.

 

I'm not an anarchist, I understand the dangers of no government.  But, likewise, I am not a socialist, I understand the dangers of too-big a government.  It's been tried before, and never turned out well for the population.

 

I also think you have a rosy picture of the NHS in England.  Lots of stories and data coming from there showing that it's not so good.  Look at the wait times in the EDs, they are worse than in most of our urban centers. 

 

Lastly, comparing heatlhcare in the US to a tiny country like France or Taiwan doesn't make sense.  Perhaps if the U.S. let the states run their individual health care systems (like should happen in a Republic of states), then comparing France to Texas would make sense, or Taiwan to...what....Rhode Island?

 

Good conversation everyone.  I'm glad we can all keep it professional.

[cinntsp]

If the program covered plavix and f/u appts q month for 6 months it wouldn't be an issue for the patient, but would certainly be an issue for the taxpayers.  You know, the few of us who actually pay taxes.  By the way, June 15th is right around the corner, time to write another huge freaking check to Uncle Sam....

 

I would not have had a problem admitting this guy for obs.  Give him IV abx for his infection, feed him well, and have social work do their magic in the morning.  I'm glad I work where I do...

 

 

So you are against some outpatient appointments and a program that pays for plavix(which will be negotiated to a highly discounted rate in a single payer system), but have no problem admitting someone under obs for inpatient care and IV abx for an infection easily treated with a $4 PO rx? I thought you were concerned about your tax dollars.

 

You're contradicting yourself. It seems like you just want to offer an excuse for every idea that doesn't support our current disaster of a medical system.

[Boatswain2PA]

There went the adult conversation.

[dmdpac]

I didn't say we have the best health care system in the world.  I said we have the best healthcare.  Except, of course, for the areas where the federal government run the health care, like our VA.  Then the healthcare is often terrible.  

 

The talking points about "higher health care expenditures with worse outcomes than much of the developed world" is as accurate as any other heavily biased statistic quoted by biased people.  It is right along with sayings like "statistics lie, and liars use statistics", or Mark Twain's "There are lies, damn lies, and then there are statistics."  People can mine data to make statistics say anything they want.  The health care administration/public health fields typically draw people with liberal ideologies, and that bias shows in its research and statistics.  

 

But things that are "public" are also political, which usually leads back to the "some animals are more equal than others".

 

This is an interesting tactic.  Negatively label the message/messenger without offering any real counter argument.  Interesting, indeed.

 

You're right.  You didn't say health care system.  You said health care.  This begs several questions.  What defines "best health care"?  What defines "best health care system"?  Can a broken health care system provide the best health care?  In light of the above implication can comparison, justification or quantification to support the idea that the US has the best health care be made without getting into statistics or referencing any kind of benchmark?  How, then, can it be reasonably argued that we in the US have the best health care?

 

As you have put forth the idea that we in the US have the best health care I'm interested in how you define and quantify it.

[rev ronin]

The assertion that the U.S. has the best health care system in the world isn't particularly hard to understand or controversial, really.  It's clear that in America, those who can afford it have essentially unlimited access to the best healthcare.

 

It doesn't mean Mississippi doesn't compare unfavorably (sorry, triple negative there) to several developing countries in many metrics, because that's not what the assertion is about: in a system where a few get richest, you have a lot of people aspiring to be those folks.  In that way, medicine is not unlike law, sports, music, or other entertainment occupations, where the income is disproportionately held by a few, and the rest of those aspiring to such greatness make little or nothing.  It's that competitive system that both attracts the best and the brightest into healthcare, while at the same time leaving vast swaths of insufficiently prosperous people without adequate basic preventative care.  Fix the one without breaking the other, and the world would be a much better place.

[Boatswain2PA]

This is an interesting tactic.  Negatively label the message/messenger without offering any real counter argument.  Interesting, indeed.

 

I'm not even sure what that means.  My point was that most of the data produced regarding health care metrics is produced with people with extreme bias, kinda like the NP studies that show how stellar they are.

 

You're right.  You didn't say health care system.  You said health care.  This begs several questions.  What defines "best health care"?  What defines "best health care system"?  Can a broken health care system provide the best health care?  In light of the above implication can comparison, justification or quantification to support the idea that the US has the best health care be made without getting into statistics or referencing any kind of benchmark?  How, then, can it be reasonably argued that we in the US have the best health care?

 

As you have put forth the idea that we in the US have the best health care I'm interested in how you define and quantify it.

 

Some things you just can't quantify.  How much do you love your children?  How much do you love your spouse?  If those are quantifiable, then you can determine if you love one child more than the other, or more than your spouse.  Of course, none of this is quantifiable because it is so subjective.

 

 

Like Rev alluded to above, we have the best health care in the world because our system encourages innovation and improvement.  This is why the head of Quebec's health care system came to Boston for his heart procedure.  He wanted the best, and he (being one of the top animals at the farm) could get it.  Of course, the "regular" animals at the farm he came from would never be able to get the "best care in the world" like he did.  Wait, that kinda sounds like the U.S. system, doesn't it!

 

Please don't think I am saying our health care system is perfect because we all know it's not.  It's ripe for abuse from both patients and providers, and yet leaves people falling through the cracks.  However those who think a UHC system is some panacea are myopic. 

 

 

[CAAdmission]

I imagine you have seen this. The WHO thinks we rank 37th in the world. look at who is above us:

http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

 

Most of these countries have the luxury of focusing on healthcare because they do not have to spend much on defense (mostly because in military matters they are suckling at our American teat).

[CAAdmission]

my response was sarcastic. I am in favor of universal coverage and one payor.

 

If a monopoly is a good idea, why does the government make them illegal in most cases?

[cinntsp]

Most of these countries have the luxury of focusing on healthcare because they do not have to spend much on defense (mostly because in military matters they are suckling at our American teat).

 

Or rather they are laughing behind our backs for needlessly spending so much on it while gladly accepting our handouts.

[PAMEDIC]

Most of these countries have the luxury of focusing on healthcare because they do not have to spend much on defense (mostly because in military matters they are suckling at our American teat).

 

There is a whole bunch of wrong packed into that one sentance.

 

First, you are making the false assumption that because countries like the UK and France don't spend as much on their military, this frees up resources and they then spend more on their healthcare. The problem with this is that it is completely wrong. The UK and France and every other industrialized nation in the world with universal healthcare (regardless of what type of system they have) actually spend less (per capita and as a % of GDP) than the US. The UK spends about 1/2 as much as the US does (again... per captita and as % of GDP) and insures everybody. France, who by most measures has one of the best systems in the world, spends a liitle more than the UK but it isn't even 2/3rds the cost of what the US spends. Here in the US, we pay significantly more for less.  Let me repeat that. We pay significantly more for less.

 

Second, and this is coming from somebody in the military, the US doesn't have to spend as much as it does on defense. It chooses to... often with a pretty significant opportunity cost. But again, the fact that we spend a bunch on defense has no bearing on why our healthcare expenditures are the highest in the world. To put this in perspective, we spend about 3.8% of GDP on defense. We spend 18% on healthcare.

[PAMEDIC]

 

You will never get he quality of the MHS in any other national health service.  There is a level of accountability in the military that you simply will not find anywhere else.  If, when I was active, you had given poor care to one of my sailors, I could have called your boss and had the problem fixed.  If that didn't work, my boss could have called your bosses boss.  In the military, the docs/corpsmen work for the military guys who rose up the ranks putting their asses on the line and understand the consequences of shoddy work.  This simply doesn't exist in the non-military government bureaucracies.   Comparing the MHS to any NHS isn't just comparing apples to oranges, it's comparing apples to brussel sprouts.

 

 

As much as I love military medicine and the MHS, I wouldn't go so far as to say it is superior to the NHS or healthcare in France or most other modern industrialized nations. Other system have their flaws. No system is perfect. But these other systems still manage to insure and provide exceptional care to their entire population for the fraction of the cost that the US is paying. Other systems have managed to figure out the accountability issue. They operate with more governance and more unions and worker protections, but have still found a way to make it all work more efficiently than we have.

 

 

 

I'm not an anarchist, I understand the dangers of no government.  But, likewise, I am not a socialist, I understand the dangers of too-big a government.  It's been tried before, and never turned out well for the population.

 

I am certainly not a socialist. I am a pretty serious market advocate in most things. But rather than being wed to some ideology, I choose to address things pragmatically. If a public system can provide a good or service at a equal or superior quality or efficiency with a lower price, then it is the superior option. I am also not an absolutist. I mentioned the NHS because it is a system that provides a guaranteed public baseline but also allows for the individual freedom to go outside the NHS and get supplemental insurance or to purchase care  from private sources. And this system does it for about half the cost (per capita and as % of GDP).

 

I also think you have a rosy picture of the NHS in England.  Lots of stories and data coming from there showing that it's not so good.  Look at the wait times in the EDs, they are worse than in most of our urban centers.

 

I never said it was perfect. Nor did I say the MHS is perfect. They have their flaws but the NHS provides medical services for 100% of their population for 1/2 the price that we spend. If they chose to allocate more of their GDP towards healthcare, these problems would be eliminated. But the NHS is only one of the many varied systems. Almost every UHC system in the modern industrialized world is different and has chosen different ways to organize their systems.

 

Lastly, comparing heatlhcare in the US to a tiny country like France or Taiwan doesn't make sense.  Perhaps if the U.S. let the states run their individual health care systems (like should happen in a Republic of states), then comparing France to Texas would make sense, or Taiwan to...what....Rhode Island?

 

 

This is why when talking about costs, it is important to use per capita expense and total spending as a share of GDP instead of raw dollars. This allows you to make comparisons on a level playing field.

Also, there is a strong argument that can be made that the economic efficiencies of a larger aggregate pool at the federal level would be able to provide the best care for the lowest cost. If there is one thing governments do better than anyone else, it is aggregation. It can use monopsonistic purchasing power to lower costs. And the greater the aggregation, the greater the savings.

 

As far as the efficacy of state versus federally run agencies, again a strong argument can be made that a single federal agency is able to accomplish far more than 50 independent state agencies. Take NASA as an example. NASA was and is able to achieve far more as a singular federal agency than if it had instead been 50 uncoordinated individual state-run and state-financed agencies. The Rhode Island Aeronautics and Space Administration would have never been able to put a man on the moon. :)

[andersenpa]

If a monopoly is a good idea, why does the government make them illegal in most cases?

because those monopolies are privately held interests

single payer is publicly owned

[Maverick87]

The military is the exception to the inefficiencies of government because there is, generally, a level of accountability found within the strict military rank structure that you will not find in government bureaucracies. 

 

LOL

[rev ronin]

In the past three weeks, I've had to give three expensive diagnoses to people without insurance--RA, some sort of a blood cancer TBD by oncology, and I forget what the third one was at the moment.  And by no insurance, I mean people who paid cash to see me, because we don't take medicaid, so either they don't have any insurance or they lied to us in order to be seen.

 

The individual mandate is in full swing, so each of these three patients should have had insurance.  They didn't.  So, they will each go GET insurance now, and have full access to sharing the costs of their care, but only now that they're sick.

 

Is that right?  It seems like a perverse incentive that some people can pay once (and only when) they become sick, essentially their premiums never going to support other people's care, while those who honor the expectation to provide care for themselves are forced to pay for these non-contributors' care.  There's no upside to doing the "right" thing, since anyone can get insurance essentially whenever, and no downside to doing the "wrong" thing, because the enforcement has been chopped out, so once again we have rights without responsibilities.

[zoopeda]

The military is the exception to the inefficiencies of government because there is, generally, a level of accountability found within the strict military rank structure that you will not find in government bureaucracies. 

 

Agreed.  This comment is hysterical.  My brother-in-law and all his marine buddies have been sitting on the beach in San Diego for the last 12 month, on full pay, simply because the the next phase of their training is backed up.  Once they complete the next 2-month training (probably 3 more months from now) they'll likely have another year off before they get to anything other than busy work.  We choose to fight everybody's wars for them and pay plenty of soldiers to sit around the states before we remember they're standing by and ready to work.  My concern is that our government is less capable of tackling our healthcare challenges than more health-centric nations (i.e. the 36 above us on the WHO list).  By coincidence, those countries embrace a single-payer system--the crux of Obamacare before the GOP gutted it into a windfall for private insurance companies.  We're in serious trouble as long as for-profit conglomerates and their massive lobbies hold the reins.  

[CAAdmission]

because those monopolies are privately held interests

single payer is publicly owned

 

Gotcha.

 

I guess that is like how the government can listen in on our phone calls and take photos in our bathroom windows with drones but I can't.

[Boatswain2PA]

As much as I love military medicine and the MHS, I wouldn't go so far as to say it is superior to the NHS or healthcare in France or most other modern industrialized nations. Other system have their flaws. No system is perfect. But these other systems still manage to insure and provide exceptional care to their entire population for the fraction of the cost that the US is paying. Other systems have managed to figure out the accountability issue. They operate with more governance and more unions and worker protections, but have still found a way to make it all work more efficiently than we have

 

I am certainly not a socialist. I am a pretty serious market advocate in most things. But rather than being wed to some ideology, I choose to address things pragmatically. If a public system can provide a good or service at a equal or superior quality or efficiency with a lower price, then it is the superior option. I am also not an absolutist. I mentioned the NHS because it is a system that provides a guaranteed public baseline but also allows for the individual freedom to go outside the NHS and get supplemental insurance or to purchase care  from private sources. And this system does it for about half the cost (per capita and as % of GDP).

 

I never said it was perfect. Nor did I say the MHS is perfect. They have their flaws but the NHS provides medical services for 100% of their population for 1/2 the price that we spend. If they chose to allocate more of their GDP towards healthcare, these problems would be eliminated. But the NHS is only one of the many varied systems. Almost every UHC system in the modern industrialized world is different and has chosen different ways to organize their systems.

 

This is why when talking about costs, it is important to use per capita expense and total spending as a share of GDP instead of raw dollars. This allows you to make comparisons on a level playing field.

Also, there is a strong argument that can be made that the economic efficiencies of a larger aggregate pool at the federal level would be able to provide the best care for the lowest cost. If there is one thing governments do better than anyone else, it is aggregation. It can use monopsonistic purchasing power to lower costs. And the greater the aggregation, the greater the savings.

 

As far as the efficacy of state versus federally run agencies, again a strong argument can be made that a single federal agency is able to accomplish far more than 50 independent state agencies. Take NASA as an example. NASA was and is able to achieve far more as a singular federal agency than if it had instead been 50 uncoordinated individual state-run and state-financed agencies. The Rhode Island Aeronautics and Space Administration would have never been able to put a man on the moon. :)

I'm not so sure about the "exceptional care" you claim that France (et al) provide.  I'm sure there is some, but who is measuring what is "exceptional"?  Is it just noting numbers of people covered?  In that case, Oregon is exceptional as well....until they find out that coverage does not equal care.  I guess I am just cautioning you on your beliefs that France, and other States with socialized medicine, have great health care.  That is what you read in academia, and that is what you read in much of the American press, but if you read much of the English press they ain't too happy with it.  Likewise in Canada, many people are not happy with what they think the quality of care is there.  While they may cover 100% of the population for half the price, where does that cost savings come from?  It comes from governmental rationing of care.  

 

Your suggestion for a NHS that provides basics, but allows patients to go outside of the NHS with cash/insurance, is in many ways what we have with CMS.  I think it could work much better with some tweeks.  

 

We have a much different government in America now than we did when NASA went to the moon.  The Democratic president at that time said "Ask not what your country can do for you, but ask what you can do for your country."  The Democratic president of today gives the country away to those who have done nothing for it.  

 

Good discussion!

 

LOL

 

Glad you can bring such in-depth discussion to the topic.  

Agreed.  This comment is hysterical.  My brother-in-law and all his marine buddies have been sitting on the beach in San Diego for the last 12 month, on full pay, simply because the the next phase of their training is backed up.  Once they complete the next 2-month training (probably 3 more months from now) they'll likely have another year off before they get to anything other than busy work.  We choose to fight everybody's wars for them and pay plenty of soldiers to sit around the states before we remember they're standing by and ready to work.  My concern is that our government is less capable of tackling our healthcare challenges than more health-centric nations (i.e. the 36 above us on the WHO list).  By coincidence, those countries embrace a single-payer system--the crux of Obamacare before the GOP gutted it into a windfall for private insurance companies.  We're in serious trouble as long as for-profit conglomerates and their massive lobbies hold the reins.  

Suit up for twenty years, command two operational units, then come and tell me that the comment is hysterical.  I've made that call for my sailors, and the problem got fixed.  That doesn't happen in the VA system, and it wouldn't happen in a NHC system.    Your comparison of your brother-in-law and "all his marine buddies sitting on the beach in San Diego" to the ability to use the military chain of command to redress personnel issues shows your complete lack of understanding of anything related to the military. 

 

Yeah, it's all the GOP's fault.  How many republicans voted for it?  That's right, none of them.  Remember, the Democrat speaker of the house said "We have to pass the bill before we can read the bill".  You might want to check your partisan hack card at the door.  

[zoopeda]

Your comparison of your brother-in-law and "all his marine buddies sitting on the beach in San Diego" to the ability to use the military chain of command to redress personnel issues shows your complete lack of understanding of anything related to the military. 

Yeah, it's all the GOP's fault.  How many republicans voted for it?  That's right, none of them.  Remember, the Democrat speaker of the house said "We have to pass the bill before we can read the bill".  You might want to check your partisan hack card at the door.  

 

Actually, it was my brother-in-law (a career marine and officer) who pointed out to me the gross inefficiency of the system and how he and his (yes, he calls them) "marine buddies" have literally been sitting on the beach--not doing paperwork, recruiting, or helping old ladies cross the street--sitting on the beach for a year waiting for their next assignment.  He bought a surf board and is taking lessons during the week.  He's being paid full time as an officer and feels, personally, it's a gross misuse of taxpayer money and a travesty that so many eager marines are being held in limbo at the taxpayer's expense.  Call them crazy, but they'd rather be at work for the country than surfing in San Diego.  It's the military inefficiency, in this case, that's literally preventing marine officers from being marine officers. 

 

#2.  Had congress not removed the public option from the ACA, it would not have passed at all.  One of the major reasons it did pass (if not the only reason) is because the public option (and only balance to the insurance company monopoly) was removed in the tenth hour.  Bottom line is, the great majority of those countries ahead of us on the WHO list utilize a public option (i.e. government participation and taxpayer funding) as the backbone of 36 healthcare systems that are all less expensive (per capita) than ours and, objectively, more effective.  One could argue these 36 examples of lower cost and higher efficacy are due to the efficiency brought about through a public option.  It's hard to argue with that when the proof is in the pudding in so many cases.

 

Have you worked with a private insurance company, by the way?  For just a week or two to see what it's like to get simple bills paid in a medical office?  I lived in China for 2 years, and even there (the most corrupt place I can imagine), I did not witness the kind of inefficiencies that persist day in and day out in the nightmare that is our private insurance billing system--a process I, sadly, do have experience with.  (I'll never get those long hours on-hold or filing third and fourth resubmissions back...)

 

I'm not a partisan.  I'm as sick of the democrats as I am the republicans and have a hard time voting every two years because of it.  But in this case, you just gotta call a spade a spade...

[Boatswain2PA]

Actually, it was my brother-in-law (a career marine and officer) who pointed out to me the gross inefficiency of the system and how he and his (yes, he calls them) "marine buddies" have literally been sitting on the beach--not doing paperwork, recruiting, or helping old ladies cross the street--sitting on the beach for a year waiting for their next assignment.  He bought a surf board and is taking lessons during the week.  He's being paid full time as an officer and feels, personally, it's a gross misuse of taxpayer money and a travesty that so many eager marines are being held in limbo at the taxpayer's expense.  Call them crazy, but they'd rather be at work for the country than surfing in San Diego.  It's the military inefficiency, in this case, that's literally preventing marine officers from being marine officers. 

 

#2.  Had congress not removed the public option from the ACA, it would not have passed at all.  One of the major reasons it did pass (if not the only reason) is because the public option (and only balance to the insurance company monopoly) was removed in the tenth hour.  Bottom line is, the great majority of those countries ahead of us on the WHO list utilize a public option (i.e. government participation and taxpayer funding) as the backbone of 36 healthcare systems that are all less expensive (per capita) than ours and, objectively, more effective.  One could argue these 36 examples of lower cost and higher efficacy are due to the efficiency brought about through a public option.  It's hard to argue with that when the proof is in the pudding in so many cases.

 

Have you worked with a private insurance company, by the way?  For just a week or two to see what it's like to get simple bills paid in a medical office?  I lived in China for 2 years, and even there (the most corrupt place I can imagine), I did not witness the kind of inefficiencies that persist day in and day out in the nightmare that is our private insurance billing system--a process I, sadly, do have experience with.  (I'll never get those long hours on-hold or filing third and fourth resubmissions back...)

 

I'm not a partisan.  I'm as sick of the democrats as I am the republicans and have a hard time voting every two years because of it.  But in this case, you just gotta call a spade a spade...

#1:  I'm not even suggesting military doesn't have inefficiencies, trust me they are there, and they are many.  However it does have a strong chain of command that can set $hit straight when a member isn't being taken care of, such as if/when a member (or their family) gets crappy care at a MHS.  Take the inefficiencies of the military, remove the ability of rank hierarchy to fix problems, and you get the VA (or any other federal health care system.).  It stinks.

 

#2:  Then it shouldn't have passed.  It is not only illegal on several fronts (it's a tax but didn't start in the House, giving subsidies through the federal exchanges, etc), but it is a terrible idea through and through that will NEVER WORK.  Obamacare is breaking our already-crappy "system" even worse.  That being said, there are a few good things:  #1)  It is managing to push the price of health care back to some of the patients through much higher premiums and astonishingly high deductibles (although only doing this for patients who pay their own insurance, not for the millions it is forcing onto CMS), and #2) pre-existing conditions (although, again, like Rev said above, this is good for the patient but bad for society).  

 

I have some experience working with (against?) private insurance companies, and their bureaucracy is just as overwhelming as trying to get a soldier help from the VA.  I think much of this could be fixed by increasing competition.  If there were more insurance companies, and an insurance company refused to pay bills, they would lose customers to other companies with better customer care.  This doesn't happen with the competition stifling policies our government puts in place.  

 

Sorry for the political hack comment, your choosing to bash only the Republicans in your comment made it seem like you were.  I agree, both parties have run us into the ground.  Look at how Boehner is giving TPA to the President without letting any of the details out.  It's another "we gotta sign it before we can read it" kinda thing....so much for transparency.

[zoopeda]

Obama lost me when he gave up his commitment to diminish the ability of a lobby to directly buy a congressman.  Obamacare lost my enthusiasm when they sucked out the public option.  And both parties lost me when the only two options they offered were a) windfall to current private insurance companies (which are beyond despicably unethical and bureaucratic) and b) status quo (attitude: we could care less about millions of uninsured-uncared for and the fact that medical bills are the number one bankruptor in the nation).  I'm behind whomever is able to grant free or cheap basic healthcare to every American while preserving my ability to repay my PA student loans and send my kids to college.  At least right now we're nearing the goals of universal coverage and diminished medical bankruptcy filings; no question we have a lonnnnnnng way to go...

[Boatswain2PA]

You want free or cheap healthcare (and I assume we can add "high quality" to your list as well, right?), yet you want a $100K+ a year to repay your loans and send your kids to college.  Not sure if that balance exists.  Something (free/cheap or quality) will have to go.  Free/cheap rarely equals high quality.

Again, I'm not saying we have a great system (although we do give great care), I'm just saying that a government run system would be worse than the quasi-government run system we have now.

[zoopeda]

You want free or cheap healthcare (and I assume we can add "high quality" to your list as well, right?), yet you want a $100K+ a year to repay your loans and send your kids to college.  Not sure if that balance exists.  Something (free/cheap or quality) will have to go.  Free/cheap rarely equals high quality.

 

Again, I'm not saying we have a great system (although we do give great care), I'm just saying that a government run system would be worse than the quasi-government run system we have now.

Ironically, in many of the 36 nations listed, education is government (taxpayer) funded!  This means I wouldn't need to make $100k because I wouldn't have loans and neither would my kids.  Mind...blown...

[Boatswain2PA]

Which leads to the question....what SHOULDNT government pay for then my friend? Health care, & education. Housing? Oh yeah, already do for many. Food? Yup, already do for many. Cell phones? Check, already free for many. Child care? Yup, done.

 

Where do we draw the line?