Hr3200

[lightsandsirens5]

So, what is y'all's view on the health care reform bill currently before the senate? Personally I agree Sen. McConnell that "this bill is a mess." It dont really improve anythig in healthcare. Just mixes problems up into new coktails and re-distributed. I have some pretty radically consevative views, so I'll be quiet now.

I'm not going to put a poll because there are as many different answers as there are people in the US.

 

[MrBrown]

Whilst I am liberally conservative let me say that New Zealand has a free universally accessabe healthcare system, no matter how rich or broke or old or sick or whether you have a list of pre-existings a mile long ..... you still get healthcare for free.

Good, quality healthcare here is free no matter whether it's it costs $10 or $10,000,000 it's free to you as a citizen of this country. We pay for it through our tax system and the only things we do pay for some minimal part charges on Rx (like max $15) and primary care (GP).

Primary care and dentistry and privately run enterprises unlike with the NHS in the UK, we have to pay for them. I do believe there is some sort of cap on fees if you are on a low income for primary care, i.e. your physician.

Uniquely New Zealand is something called ACC as well. ACC is our national insurance scheme which we signed up for in the mid seventies by giving up our right to free-and-friviolous ability to sue the pants off of people and it's bloody fantastic, provided ACC does not have a $15 billion dollar debt and uses "act of God" as an excuse to get out of paying, touch of wood sort of thing right there.

This other component of our healthcare system means that ($15 billion dollar debt notwithstanding) ACC will pay if you get drunk and hurt yourself, if you have a car accident, if you fall off the ladder painting the house on the weekend and break your leg, if you get hurt at work etc. It covers things like rehab, loss of earnings, ambo's (ambo has a fee-for-service contract with ACC). It's kind of like universal workman's compo for all, well, it's universal compo.

Now I have experienced the American healthcare system firsthand, and it's a joke, it's totally broken and an absolute mess. The United States is the only developed nation without universal healthcare and you all get scared by the boogie man whipping up fear about "Government takeover" and "socalised medicine" *insert scary noises here.

A lot of debate (and again I have seen this firsthand) seems to be in the US is healthcare a right or a privledge ..... well, to ask me, it's a right, pure and simple. Perhaps we are forgetting that people don't choose where they are born and into what circumstance, now I'm not gonna wank on a lot of bleeding heart boo-hoo'ing but let me say this: I expect that I should be responsible for my own life and pay my own way as appropriate, I don't think access to healthcare however is counted in there; I expect to pay my tax and get certian things in return and if I find myself in the unfortunate situation of (for whatever reason) not being able to contribute, then I think I shouldn't be left out in the turf and told here's a $200,000 hospital bill that's gonna follow you around like a bad shadow for forever and a day.

Solidarity, those who can afford to pay, pay for those who cannot. That's basically what you guys in the US do, why do you think healthcare is so expensive, exactly for that reason but you stick your heads up your arses and forget basically you are already essentially doing what you don't want to do in the first place!!

That said I am not in favour of a bulk funded, Government run system like we have. The funding model is increasingly complex and very hard to administer and really I think what breaks our system.

NHS in the UK is totally Government run, everybody (except dentists and GPs) are direct employees of the Government and as far as I know local NHS trusts own all the infrastructure, which I believe is seperate to the Department for Health.

I also have mixed feelings about such a system.

Now I am much in favour of a "fee-for-service" type system like the US and Canada (and I believe Australia through Medicare) have. In Canada the Government pays up fee-for-service (variable cost) and has a system to meet fixed cost too - like they have a provision to ensure enough money is given to the healthcare system to meet certian targets or ensure a level of service regardless of volume of payment.

The point in all these systems is that they are free to you as a citizen (with one or two part charges) and funded through taxes. Now I know you all in the US don't like the idea of "more tax" but what do you think is going to work out cheaper, paying some god awful amount for health coverage only to be denied that coverage when you are sick because the health insurance companies want to make a profit or paying a little extra on your Federal income tax and not having to worry about the $1,000 a mo for health insurance?

Give the PPACA a chance please, you guys really have your gonads hanging out here with this whole healthcare mess and it doesn't do your country or your population any good.

 

[reaper]

The problem I have with comparing the UK or NZ to the US, is Population density!

The UK has 61.8 million people.
New Zealand has 4.5 million people.
The US has 310 million people.

So you can add the UK and NZ together and it may equal about four of our states. If we were only providing health care to four states, it would be simple.

Now, look at the demographics. This I will ask you about. How many people in NZ or the UK do not work or pay taxes? In the US this is a good amount of our population.

So, you still have those that have, paying for those that don't. This is the same setup that is use today. The tax payers are paying the costs of Federal Medicare, State Medicaid, and all the state run Children Insurances.

So where is the difference going to be?

Anyone can look to the VA system, for example of how well the government can run a health care system. It is a down right shame what the veterans endure on a daily basis. Is this what we want the entire country to have to endure? No thanks, i will stick to my own insurance!

 

[lightsandsirens5]

The problem I have with comparing the UK or NZ to the US, is Population density!

The UK has 61.8 million people.
New Zealand has 4.5 million people.
The US has 310 million people.

So you can add the UK and NZ together and it may equal about four of our states. If we were only providing health care to four states, it would be simple.

Now, look at the demographics. This I will ask you about. How many people in NZ or the UK do not work or pay taxes? In the US this is a good amount of our population.

So, you still have those that have, paying for those that don't. This is the same setup that is use today. The tax payers are paying the costs of Federal Medicare, State Medicaid, and all the state run Children Insurances.

So where is the difference going to be?

Anyone can look to the VA system, for example of how well the government can run a health care system. It is a down right shame what the veterans endure on a daily basis. Is this what we want the entire country to have to endure? No thanks, i will stick to my own insurance!

Excellet points.

And I totally agree with the VA system. Plus, coming from a military family myself, healthcare for active duty military is bad enough even though there is still some (very limited) freedom.

 

[MrBrown]

I think our unemployment is around 10% not sure however, the difference is in that you would remove medicare, medicaid etc as they would all fit into one system.

We only have one system and it covers everybody. Whether you administer it to 300 people or 300 million people it's really quite simple as far as I can tell.

One thing I do like about the US is you folk are feircly "anti-Federalisation" or simply you fight to the death to protect autonomy of the 50 states which while being advantageous it's also problematic in that it creates fragmentation and problems. One only has to look at all the threads on problems about inter-state reciprocity on this board to see my point.

Let me assure you that "nationalisation" is not a bad word but could be coz we only have four and a half million people!

I really like the "insurance exchange" idea; you can get groups of employers or whoever together and negotiate for better rates and conditions which is basically how a lot of places buy stuff on the cheap.

Then we have the problem of universal access. Everybody has access to Police and Fire and the National Park Service and the library and a bunch of other stuff, so why not healthcare?

I'm not totally against the "private" insurer model, I have private health insurance even tho I am covered by public option here. What I think most people have a problem with are three key areas

- Unreasonably high premiums and claim denials
- Insurance company superprofits
- Medicolegal litigation and "defensive medicine"

You know nothing wrong with somebody making a profit out there but hey some insurance company who charges my friend $900 a month for insurance, denies her claims and then takes away her coverage because she got sick only to post a few million dollar profit is pretty bad you have to admit.

The US spends the most on healthcare but has the least accessable system; you know there are tons of ways you guys could be saving money if you tweaked it up a bit and fixed the problems this Bill tries to address.

Again, to turn the other side of the coin, why should my friend in Florida have to pay like $120 for some salbutamol for his kid when I'd pay $3?

So what exactly do you think is wrong with the plan as it stands now?

 

[reaper]

Federal Government is what's wrong with it! It's is so fractured, that it is beyond repair.

 

[fma08]

Free Rider Problem anyone???

 

[MrBrown]

Free Rider Problem anyone???

Hmm so are you saying you should have to pay for healthcare? Should you have to pay for the Police or the Fire Department?

What about those who cannot pay, no job, six kids, prices too high, etc? Should the Police Department send them a bill for coming out to help them if they are needed because the person is from out of town and did not pay local tax which funds that police department?

If this is your argument look at it like I said before: Our system is built upon the concept of solardarity, those who can pay do so for themselves and those who cannot ensuring equal access, your system is the same; your prices are so high because you are trying to recover the loss of those who can't pay.

So you are essentially doing what you don't want to do but just shoving your head up your arse and ignoring that fact

 

[fma08]

Hmm so are you saying you should have to pay for healthcare? Should you have to pay for the Police or the Fire Department?

What about those who cannot pay, no job, six kids, prices too high, etc? Should the Police Department send them a bill for coming out to help them if they are needed because the person is from out of town and did not pay local tax which funds that police department?

If this is your argument look at it like I said before: Our system is built upon the concept of solardarity, those who can pay do so for themselves and those who cannot ensuring equal access, your system is the same; your prices are so high because you are trying to recover the loss of those who can't pay.

So you are essentially doing what you don't want to do but just shoving your head up your arse and ignoring that fact

Economics... Public goods... non-excludability/non-rivalry??

"What Does Free Rider Problem Mean?
1. In economics, the free rider problem refers to a situation where some individuals in a population either consume more than their fair share of a common resource, or pay less than their fair share of the cost of a common resource."

http://www.investopedia.com/terms/f/free_rider_problem.asp


Like it or not, health care is a business that costs money to keep operating.

What I don't like is when there are people that bog down the system and increase the expenses of those paying for the government run programs because they are too lazy to get off their "arse" and change their lives. Are there people that have legitamate reasons to need medical assistance or help from the government in paying for healthcare? Absolutely. Are there people that take advantage of the free money and have no intention of changing their lifestyle? Yes. The later is what I'm concerned about. I'm still trying to come up with a way to fix the issue, but haven't had any bright ideas yet, at least none that are feasable. That is why I mentioned the free rider problem to see if anyone else felt the same way. If there are none, I'll shut up, but in the future, please don't make assumptions about my views without asking what they are.

 

[lightsandsirens5]

Free Rider Problem anyone???

I agree 110% with you fma. But I have the same problem......no bright ideas.....

 

[MrBrown]

Hmmmmmm you know I do see your point and the concept is not a bad one however I think it's a bit of a misfit when it comes to healthcare.

By consuming more than their "fare share" do you mean people who turn up at the ER every time they have a cough or need a repeat Rx and abuse the system or somebody who needs $1,000,000 worth of anti transplant rejection drugs or lifelong assisted care or something of that nature?

The fundamental difference in countries with universal coverage is that no matter if you cannot pay, you still have the right to recieve access.

I'm not having a dig at your ideals or beliefs I am genuinely interested in having a good discussion, so, do you find something wrong with that idea?

 

[fma08]

Hmmmmmm you know I do see your point and the concept is not a bad one however I think it's a bit of a misfit when it comes to healthcare.

By consuming more than their "fare share" do you mean people who turn up at the ER every time they have a cough or need a repeat Rx and abuse the system or somebody who needs $1,000,000 worth of anti transplant rejection drugs or lifelong assisted care or something of that nature?

The fundamental difference in countries with universal coverage is that no matter if you cannot pay, you still have the right to recieve access.

I'm not having a dig at your ideals or beliefs I am genuinely interested in having a good discussion, so, do you find something wrong with that idea?

While yes I do think that people who need medical treatment should get it, I was primarily talking about those that call an ambulance or walk into the ER for the 5th time that week because their nose is still plugged up yet they don't want to buy decongestants because it is their way of taking down those evil pharmaceutical companies. Some people get in a bad way and are forced into the life of assisted care so I have no problems with that. My beef is mainly with those that truly abuse the system and are arrogant enough to not see that they may injure someone else because they are wasting resources. It would be nice if there was a set definition between the groups but in order to make one, first we have to shoot the lawyers

 

[MrBrown]

My beef is mainly with those that truly abuse the system and are arrogant enough to not see that they may injure someone else because they are wasting resources.

I'll jump on that one too; we have a little more flexibility but basically if you call 111 you're 99% bound to get an ambo unless you're on the list of psych patients who ring up every day saying the leaking tap in the kitchen is really the aliens coming to get you.

Personally I think we might be doing one or two things about people who roll up to ED chronically; see what you think of these http://www.moh.govt.nz/moh.nsf/indexmh/ed-tools-initiatives

 

[lightsandsirens5]

My beef is mainly with those that truly abuse the system and are arrogant enough to not see that they may injure someone else because they are wasting resources.

I have a story about that posted somwhere on here. We lost a pt because of one of those "stubbed toe" calls....

 

[fma08]

I'll jump on that one too; we have a little more flexibility but basically if you call 111 you're 99% bound to get an ambo unless you're on the list of psych patients who ring up every day saying the leaking tap in the kitchen is really the aliens coming to get you.

Personally I think we might be doing one or two things about people who roll up to ED chronically; see what you think of these http://www.moh.govt.nz/moh.nsf/indexmh/ed-tools-initiatives

As nice as a flagging system like that sounds, the caller obviously have some sort of mental disorder which means they are still a patient and ought to be treated as such. It's unfortunate that there is no good way to screen people like that. Just because they cry alien several times doesn't mean they aren't having an MI now. If we were to de-prioritize a patient based on a history such as psych problems, it could leave one wide open to all sorts of legal issues. I know if I looked the other way on someone and they fell over dead, I'd feel like s*** and probably wouldn't have any money left. The link you provided has some interesting ideas, although it needs to go into a bit more detail before I'd make a decision on it.

 

[Cory]

Federal Government is what's wrong with it! It's is so fractured, that it is beyond repair.

What a progressive view, that mindset is definitely what will get us further in this situation :glare:



As far as the bill now, I am very indifferent. I'm not going to go into my opinions about it.

Just wanted to throw a fact out there: someone mentioned Medicare. Well, medicare covers the low class citizens only. Medicare is only currently insuring 40% of low class Americans As of 2009 (yes, I realize it is weeks till 2010) 60% of unisured Americans were middle class status Americans, therefore inelligable for Medicare. Medicaid only covers a small percentage of Americans.

So, something has to change. Do I agree 100% with what is happening now? No. But I am happy to see that we are trying to do something about it. I only hope to God, by mid 2010, SOMETHING has changed in a positive way. Screw this "OMG SOCIALISM!" crap, we don't need it and we don't need the nut jobs who produce it.

Just my two cents.

 

[reaper]

Might want to study up on MedIcare and Medicaid!

 

[redcrossemt]

I'll jump on that one too; we have a little more flexibility but basically if you call 111 you're 99% bound to get an ambo unless you're on the list of psych patients who ring up every day saying the leaking tap in the kitchen is really the aliens coming to get you.

Personally I think we might be doing one or two things about people who roll up to ED chronically; see what you think of these http://www.moh.govt.nz/moh.nsf/indexmh/ed-tools-initiatives

One of our largest problems was mentioned above - and that's patients who can not afford to pay for GP/PCP care, or don't have a car/ride, or whatever reason - and instead go to the ER in an ambulance because they know it's free, good care, with a free ride there.

We also need to limit malpractice suits, which are one of the largest contributors to rising medical costs due to "over care".

Extending Medicare/Medicaid in the USA, or reforming the system to a "free healthcare to all", and still charging for GP/PCP care is not going to help. What we need is free primary care, easier access to primary care (transportation, schedule, and otherwise), and good public education about what illnesses actually require a hospital visit.