First, as one actually LIVING in England, I can tell you 90% of all Britons I have met tell me that NHS does NOT work. They call it a failure. They cite chapter and verse about long waiting lists, people with mortal diseases being shipped to Germany for surgery in the US they could have had within days or hours and yet in England even with Malignant Cancerous diseases, they have to wait weeks to get treatment. Some call it a way to slow the population growth.
They are working to shore it up, but most say “You have a health care system that ranks here (hand help up above head) and we have one that ranks about here (Hand held below knees)” That is a quote.
They have good ER depts and they do well in repsonding to calls. (I am sure Jeff will like to hear that). However, their subspecialist allocation is poor. Also, they wealthy opt out of the system and get private HC insurance and go to the new private hospitals creeping up in England. How’s that for NHS working? If it did, none of the American style HC tx systems would be showing up now would they? Its not a slam, but ultimately they are being taxed to hell in a hand basket to pay for a bloated system that is weak and slow.
Would ANY of you like to add in a 17.5% VAT to pay for an NHS? Get a service, pay 17.5% on top of it. Buy anything…add in 17.5% to the total.
Guess who gets screwed the most?..the working poor. Sure they get HC, but now they don’t buy anything as well. Can’t afford to…
I hear ya Joe,
My wife's aunt who lives in England was diagnosed with breast cancer. She was basically told that she lived a good long life and she should be thankful (she was 60 I think) – she did not get treatment and later died of the disease. Of course, here in the states, now having first hand experience with NHC, the family was horrified of how the NHC system really worked. Brings to mind your 'controlling population' remark.
However, I also agree that this country can and should do better in this area.
As I said before, NHS is not the only option for universal coverage. I'd vote for universal coverage via mandatory private insurance.
It's clear there are problems with the UK NHS, but what is the problem. Not enough funding, mismanagement, inefficiencies, what? It's easy to say it doesn't work - it takes more thought and work to identify how to fix it or what to propose as an alternative.
But as far as taxes go, I would be very happy to pay more taxes to provide more services - both for health care and education for everyone. (although, where I live, we don't need to because we each pay for our own insurance individually, rather than nationally through a national insurance (aka taxes). Again, you get what you pay for. I can never understand why people are against paying for these things.
By the way - Hi Joe! Hope you're having fun with school.
| QUOTE |
| find a CEO who makes 10, 25, or 50 million dollars a year while his employees go without health care coverage to be a far more scandalous figure than a doctor who has effectively spent half his life in school, has graduated with a quarter million dollars in student loans, and who has a salary in the low six figures. If you want to mandate universal health care, start by passing legislation which demands that every business with more than 5 employees provides health insurance and cap malpractice awards at $250,000. That will go a long way towards solving the problem you see without establishing a new government bureaucracy. |
I agree 100%. I lived and worked in both Germany and N. Ireland and have seen the inside of 'socialized medicine' from the perspective of an employee and a patient. The system in the UK as it is is really a catastrophe...but the way things work in Germany, as an employee you can either opt for govt. insurance or you can pay for your own private insurance....the same way that things work here. There were no wait lists, no problems with access to care, etc...though certainly there were other things that were not 'perfect'. I had public insurance because I didn't have a high-paying job and couldn't afford private insurance. I never had an issue with quality of care, ever. Now...I didn't get a private room with a view, and there weren't marble floors or imported wooden paneling on the walls, but in the grand scheme of things, I'd give up our private rooms here any day for healthcare access for more people.
I think it is scandalous that the CEO of Target just have himself a 3.5 milliion dollar raise for this year (up to 19.5 million) and at the same time he is both cutting and watering down the health insurance plans for his employees. The majority of the uninsured in this country are working americans...and many who are insured are underinsured.
In my eyes, a good solution would be to turn to the big companies. Maybe we shouldn't be allowing multi-billion dollar companies to set up multip off-shore tax-shelters...maybe we also should fine them heavily for moving their headquarters abroad to save money on employee expenses while still profiting from being a "U.S." company. If these American companies were paying their taxes here, it would certainly put money into a system to help small businesses afford insurance for their employees. Also, big businesses should be required to include good employee health benefits in ther numbers before they pay themselves the big bucks. Unfortunately, what we have right now is capitalism at its worst....as long as the big guys are allowed to give themselves the ridiculously huge salaries and can get away without being forced to provide health insurance (through HMOs or private companies, not the govt!) they will.
I think that we are in a great position to be able to evaluate what has worked/not worked in other countries. Instead of running away scared the minute universal coverage is brought up, perhpas we could find a way to take the best parts of other systems and minimize the pitfalls....The easy solution is to scream 'socialism' and do nothing...and that seems to be what happens most of the time when the issue is brought up in our media.
No one wants to increase spending to help with funding a universal system...but we generally don't wince when we hear that the govt. wants more money for the military, etc, etc....because we have set 'homeland security' as a priority. When will healthcare for hardworking americans be a priority worth fighting for?
kris
I know this is going to be unpopular but the reason malpractice insurance has risen as much as it has is not due to increased payouts and capping them will do NOTHING to help doctors. I feel like this is the elephant in the room no one wants to see. There are two industries in the US that are exempt from antitrust laws: baseball and insurance. The drastic increases paid by doctors are due to, among other things, bad investments made by the insurance industry. They are just passing along the loss. Don’t believe me? Look at California and Maryland — Maryland has caps on malpractice payouts and it has not reduced, or even prevented increases in premiums. California’s law, which has caps, has kept the premiums down but not enough. I also thinkl Virginia has caps on payouts and I think I just read premiums are going up by like, 30%?
The recent bills in Congress, most notably S11, which championed by Sen Frist and the AMA, limit the non-economic damanges that can be awarded. These already amount to approximately 1% of the payouts annually. The real problem I have with S11 was that it made no distinction in how many plantiffs or defendents or what type of ‘error’, for want of a better term was made. It also had a provision that once a drug device is approved by the FDA no suit could follow – so if you were injured by phen phen or a bad doctor, the same amount of money would be awarded.
Politicians love to look at a program and say, “The problem with program X (welfare, medicare, whatever) is waste and fraud. We can do more with less money.” Those claims are always popular, we are a society that wants a lot but doesn’t want to pay for it. The insurance industry, one of the most powerful, doesn’t want to be regulated so the blame is placed on 'frivolous lawsuits." Most of which never make it to a courtroom. Judges also have the abolity to reduce awards when they are excessive. Harvard put out a study on this with the end of the day findings being that so many cases get tossed out that that number includes a fair number that are legitamite malpractice cases. It’s the bleeding heart in me that also is troubled by totally tying how much someone deserves after an error by their doctor to how much they make. A friend said to me, if a person makes $500,000 a year, his loss of a limb is worth more than when someone making $20,000 a year. It’s simple economics." Maybe that point has its merits but to me, they both might have families to take care of.
To, me the real killer is how this issue is handled by pols. There is a real problem here for a large number of doctors and neither side helps it. The GOP trots out patient X who was injured horribly and wasn’t able to get medical care because all the doctors near by closed up shop due to the truly ridiculous rates they are charged. The Dems, in turn, trott out patient y who was injured horribly when their doctor fucked up.
The insurance industry has admitted if tort reform was signed today, it would be at least five years before any savings would be passed on to doctors – if then. Without adding any provisions mandating what insurance companies can charge this has no teeth.
One idea that I have only seen floated in Time was to have special courts for these cases. I think that would be a great idea.
This concludes my rant for this afternoon. Stay tuned for more hot button comments that will insire rants that probably interest few people. I spent a few days last week up on Capitol Hill talking to people who work on tort reform and got all worked into a frenzy.
I see now the subject has turned to national health insurance in this winding thread. Let me tell you about the Hawaii Prepaid Health Care Act where any employer in the state who has more than 20 employees working for them 19.5 hours per work or more is mandated to offer health insurance coverage to those employees at a group rate. So, the large working population, with the small number of indigent residents being cared for through Medicaid/Medicare or via the Hawaii State Health Insurance Program (state subsidization of payment of premiums for managed care providers) make for almost universal coverage. This combination of private and public health insurances/programs covers about 95 percent of the state’s 1.2 million population. Of course, the health care premiums paid for by Hawaii’s employers are a “pass through” which results in a slightlly higher cost of goods and services in the state but seems to be acceptable to all as this law has been in practice for 20 to 30 years now. It is the only state in the nation allowed to do this with an exemption to ERISA. Results? Well, Hawaii is often cited as the “Health State” and its longevity stats are among the nation’s highest due to its population genetics and due to its generous access to health care services. Aloha.
Gene (Former Resident and Dept of Health Employee)
Did anyone catch the article out in the New England Journal today? I haven’t had a chance to read it, but I saw an interview with Steffie Woolhandler today and it seems like a really interesting perspective. I’m not necessarily advocating a Canadian health care system here, but in the interview, she talks about the fact that if we could find a way to trim some of the expensive CEO administrative costs that those savings alone could pay for healthcare for the uninsured 
And before anyone screams about Canadians on wait-lists coming to America, let me just add that living in MN I have experienced carloads of Americans crossing the border to get medications that they otherwise would not be able to afford…and of course, Canadians have lower mortality rates and live on average 2 years longer than their US counterparts 
…If you don’t have insurance or any type of prescription benefits when you need them in the US…well, what good are they in general? Medical elitism…only the wealthy profit from the current system. Again, I don’t want to import Canadian healthcare here…but this article raises some interesting issues about administrative costs in the US.
Here is the abstract from teh NEJM website:
Costs of Health Care Administration in the United States and Canada
Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David U. Himmelstein, M.D.
ABSTRACT
Background A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs.
Methods For the United States and Canada, we calculated the administrative costs of health insurers, employers’ health benefit programs, hospitals, practitioners’ offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars.
Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada.
Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-industry personnel.)
Conclusions The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.
I take it “NHS” means National Health Service or something like that? Anyway, I want to add that just because it doesn’t work in England doesn’t mean it doesn’t work anywhere. I lived in Denmark, which has a nationalized health care system, and it works pretty well. Of course it isn’t perfect, but it covers everyone and the quality is very, very good. I’ve never heard a Dane say they’d rather have the US health care system. (However, I have heard numerous uninsured Americans say how glad they are that we don’t have any of that “socialized medicine” here–ok, that one I do NOT get…)
| QUOTE |
| Stay tuned for more hot button comments that will insire rants that probably interest few people. I spent a few days last week up on Capitol Hill talking to people who work on tort reform and got all worked into a frenzy. |
Calvin–you are not alone! I care about antitrust and tort reform too, and I think the insurance industry needs to be reined in. I know they are making “frivolous lawsuits” a scapegoat. However, I think that by not restricting lawsuits, we are getting into a pattern where litigation simply takes the place of government regulation. For example, it took those tobacco lawsuits to get rid of Joe Camel, didn’t it? Compare that to Sweden, where advertising to kids is largely prohibited to BEGIN with… Why can’t we have a little of that here? And now again, with the junk food in schools thing getting bigger, I can already see the lawsuits rolling in–when we could just pass a few decent laws on the subject and get the problem taken care of. I’m just afraid we’re letting lawsuits–which are often bizarre and entertaining–take the place of responsible legislation, which is boring and requires compromise. Ok, end of digression.
| QUOTE |
| If you want to mandate universal health care, start by passing legislation which demands that every business with more than 5 employees provides health insurance and cap malpractice awards at $250,000. That will go a long way towards solving the problem you see without establishing a new government bureaucracy. |
But Boeing–employment isn’t universal, so mandating coverage in the way you suggest wouldn’t give us “universal” health care either. What about children, unemployed people, students, homeless people, stay at home parents, the disabled, the elderly, and people who work for companies with less than five employees? As far as a government bureaucracy–which part are you opposed to, the “government” part or the “bureaucracy”? Because we already have a massive amount of health care bureaucracy. And more and more it is businesses, no less, who are advocating a national system that leaves them out of the whole mess. If nothing else, wouldn’t it just be cheaper to have a common system? I mean, those are my views, but I’m interested in knowing why you don’t want the government involved in running health care.
I happened to catch a link to this story on another site a few days back. It’s in a thread that’s on a website devoted to University of Texas athletics, of all things. What really, REALLY caught my attention was the large number of responses posted on that thread by practicing doctors. Their stories were, quite honestly, very sobering. Frankly, their responses to that thread shook me up a great deal more than the Washington Post article. As of this post, that thread had gone out to 88 responses, so it will take you awhile to read through it all. You will have to sift through several posts made by non-medical people, but if you take the time to read deep into the thread you’ll start to see the first-hand accounts that I’m talking about. Read into the 3rd, 4th, and 5th pages of the thread. That’s where a lot of the good stuff is. I highly recommend you take the time to read it all. Here’s a link.
The Link
P.S. - Be aware that this site permits profanity, but for non-registered lurkers it blanks out the bad words with a [censored] symbol. You can probably figure out what they’re saying, but I just wanted you to be prepared for that.
| QUOTE (2ndave @ Aug 22 2003, 01:21 AM) |
| But Boeing--employment isn't universal, so mandating coverage in the way you suggest wouldn't give us "universal" health care either. What about children, unemployed people, students, homeless people, stay at home parents, the disabled, the elderly, and people who work for companies with less than five employees? As far as a government bureaucracy--which part are you opposed to, the "government" part or the "bureaucracy"? |
Good point about employment not being universal. But the law could be tweaked to close those holes. For instance, you could modify Cobra to force companies to pay for a laid off/furloughed worker's health insurance for an extended period of time (5 years? 10 years?). Care for the indigent is already in place through Medicaid. The Elderly are already forced onto Medicare. If you work for a company with less than five employees, odds are that it's a very small business - probably a family business - and you may be related to the owners. Certainly, if you set that number as a cutoff, there are plenty of other opportunities for employement if you wanted to find a job that offered benefits.
I don't think it would be cheaper to have a common system - not when it would require the construction of a new national bureaucracy, buildings to house that bureaucracy, people to staff that bureacracy, and so on. One of the problems of managed health care is that it diverts dollars that are more appropriately used for patient care into corporate/investor hands. Likewise, a nationalized health care system would divert resources from the front lines of health care into a supporting infrastructure that's really unnnecessary.
In my opinion, all we need is a good dose of populist legislation which extends the current private sector infrastructure.
Here is an abstract from an interesting article in this months NEJM on the percentage of total health care dollars spent on adminstration versus Canadas Socialized system. It is controversial because of there methods but it focuses some light on a problem.The article is:
Costs of Health Care Administration in the United States and Canada
Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David U. Himmelstein, M.D.
NEJM Volume 349:768-775 August 21, 2003 Number 8
Background A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs.
Methods For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars.
Results In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.
Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)
Conclusions The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.
| QUOTE (dmaes @ Aug 22 2003, 08:01 AM) |
| Conclusions The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system. |
The problem with this study is that in general, the Canadian government is a more efficient provider of services than the government of the United States. Canadians have 1/2 the number of bureaurcrats per capita that we do. So what has held true for them more than likely (given our history) won't hold true for us.