White Coat Underground

This is, of course, an absurd question. Getting all 300 million of us to agree on this isn’t going to be easy. But a parody circulating on the internet shows how misunderstood we Americans can be.

National social programs are relatively new in the States—Medicare, the plan that gives medical care to those over 65, is only forty years old. Social security, the national pension plan for people who have worked legally for a wage, is about sixty years old. Welfare programs for the poor are often tolerated at arm’s length with the nose held.

But while many view these programs with disdain or suspicion, few turn them down. And many of us think these programs contribute to the salvation of our national soul. But the strong strains of individualism that have existed here for four hundred years cause many Americans to behave in a manner that seems insane to outsiders. But while ideology contributes to this fear of health care reform, it’s only a part of the picture.

In the U.S., most people under 65 get their health insurance from their employers, so as long as they have a job, they may feel safe. But this hold on health insurance is very tenuous. Employers looking to save money may drop plans. If you lose your job, you have to pay impossible amounts for private insurance. So when someone has insurance, they hold on for dear life, and anything seen to possibly interfere with the status quo may be feared. To an outsider, it may seem that a segment of Americans are fighting to keep themselves uninsured, but in reality, they are fighting to keep afloat, and change—any change—can seem like an existential threat.

What the reaction against health care reform tells me is not that we are a bunch of idiots who can’t recognize our own self-interest, but that we are so frightened we are paralyzed.

At least some of us. There is also a pretty big strain of insane wing-nuttery.

Comments

#1 Fred
August 15, 2009

If you would like to help pressure Congress to pass single payer health care in a democratic and constructive way please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php
#2 D. C. Sessions
August 15, 2009

One perverse consequence of employer-provided health insurance is that ensurers make no secret of the fact that they base their premium rates on the age and gender distribution of the employees. In other words, without any winks or nudges, an employer knows that there’s money to be saved by getting rid of older employees and to a lesser extent those likely to be having children.

Yeah, it’s illegal. Prove it.
#3 Shay
August 15, 2009

D.C.: so true. My spouse, an extremely healthy (in shape, doesn’t smoke, no high-risk behaviour, no allergies, pre-existing conditions, etc) male, pays an insurance penalty for being a schoolteacher, since most of his risk pool is female.
#4 Luna_the_cat
August 15, 2009

I’m going to do what is possibly a bad thing, and cross-post a rant I posted over at Dispatches. Sorry. (Ok, not really that sorry. It’s relevant.)

I’m a dual US/UK citizen. I grew up in the US. I currently live in the UK. I have family on both sides of the Pond, including elderly infirm family. I’ve accessed advanced, non-basic medical care on both sides of the Pond myself. So I can speak from personal experience. And, how wonderful, there is objective data which backs me up, too.

The NHS has its problems; waiting lists for some tests or services is one of them, in areas where there is a lack of appropriate specialists. That’s our “postcode lottery”, and yes, we tend to rail about it a bit.

Stack that against the following:
My parents (in the US) had Medicare, secondary insurance that my father retained from the job he retired from, and tertiary insurance against any disability aids that they might end up needing, paid for out of pocket.
My grandfather (in the UK) simply paid payroll taxes all his life.

When my father started having strokes, average paperwork to get coverage for hospital, physio, and mobility aids was at minimum 4 hours/week, and on one occasion took three members of the family two full days to wade through it all. And the parents still ended up paying many thousands of $$ out of pocket for some of it.

When my grandfather started falling and getting unsteady on his feet, his GP sent a letter to various appropriate services, and he had people turn up to install railings around his house two weeks later. When my British mother-in-law started having strokes, hospital provision and follow-up was immediate, involved no extra cost, and was arranged with a high degree of efficiency by the NHS itself. We had no paperwork, other than the responsibility of not losing the letters which told her when her appointments were.

When my grandfather was diagnosed with cancer, he simply went to hospital, and further treatment was carried out in clinic twice a month (anti-angiogenesis injections to control inoperable prostate cancer). This carried him through over 6 years.

At the end, he unfortunately had to wait almost three weeks to get a room in the appropriate hospice — that was a problem. But it was only a matter of waiting.

Paperwork: nil. Extra money: nil. Having to fight to get him treatment: nil.

In the US, my brother and sis-in-law are uninsured — as small business owners, they would have to pay for their own insurance entirely out-of-pocket, and because sis-in-law has asthma and an enlarged heart from steroid inhaler use, the premiums would cost them over 2/3 of their monthly income.

When my brother was in a serious car accident which left him with brain damage and badly needing physio, it was a matter of “too bad, so sad, you can only have it if you pay.” The cost was beyond their means; they did without. Their business tanked while he couldn’t work, and it has taken them a long time to rebuild.

That would not have happened in the UK. Here he’d simply have been given physio in hospital, for as long as he’d needed it. And the physio available here is good, too; just last year I saw a co-worker who had been in a serious accident go through it.

In the US a friend of mine who lives in south Florida was turfed out of an ER with an unset broken leg, not because she was uninsured even (she has insurance), but simply because ER was too busy and she wasn’t going to get seen, period. Here, the newspapers would have been all over that, in a heartbeat. There — too common, apparently.

Here in the UK, someone waiting 12 hours in an emergency room without getting seen ends up in the newspapers and sparks national outrage. In the US? That seems to be something that happens all the freakin’ time, and doesn’t get reported on.

Here in the UK, there are issues about cutting edge cancer treatment drugs or cutting edge drugs for Alszheimer’s not being available on the NHS, although you can get them if you pay privately or have private insurance. Basic treatments are always available, just not necessarily the newest and most expensive stuff, even though it might be the best.

Contrast this to the stories I’ve seen all over the net, of people in the US having to fight their insurance companies to get needles for their kid’s Type I diabetes, having to fight to get function tests for heart disease in high-risk situations, having to fight to get basic cancer treatments — another person I knew who was diagnosed with breast cancer had her insurance company decline coverage entirely — she had been with them just less than a year, and although she had just been diagnosed, their argument was that the cancer itself had to have *started* over a year ago, and was thus a “pre-existing condition” which they were not obliged to cover.

I read about people buying vet supplies online to treat themselves for chronic conditions, because that’s the cheapest option. I have a friend who is STILL paying off hospital charges from 1989, when she had a childbirth go disastrously wrong, and didn’t have insurance.

I could go on.

Then we get to the arcana, like the fact that insured people in the US are paying for the uninsured anyway, in the form of (rather high) hidden charges on both their premiums and their hospital bills which go towards treatment of catastrophic injury of the uninsured; and the fact that the US pays societally for all the lost productivity and people who end up on welfare because healthcare issues quite literally bankrupt them (losing small businesses, having to sell houses in order to pay for care, etc.). But because that is not as obvious as an open tax, it seems that the vast majority of the population remains unaware of the extent of it, and there is no mechanism to make it more open, either.

Overall, all I can say is that although the NHS has its problems, it is infinitely less broken than the American system.

But the protest in America has a long history — it isn’t just driven by GOP lies right now. Look up the Hill-Burton Act of 1946, and the protest against it, and how poorly it has traditionally been implemented. Look at the AMA propaganda against the evils of socialized medicine, from the late 1940s through the mid- to late 50s. And note that a lot of it plays off the ideas that:

Healthcare is not a “right”, it is a business and a service which people are privileged to buy
and
Your money shouldn’t be used to care for lollygagging, undeserving others!

Contrast this to the European and British attitudes that healthcare is not supposed to be primarily a profit-making business so much as it is an infrastructure issue. sure, there are profit-making businesses involved in its provision, much like there is in road-building or provision of schools – but much like roads and education, the basic thing is something which all citizens have a right to access and which benefits society as a whole to provision. And it works like public investment in infrastructure in terms of monetary investment, too — some people will get out more than they put in, some people will put in more than they get out, but on the whole, it balances out and it is there when you need it for your own investment.

Which last is, I’d like to point out, supposed to be the philosophy behind paying insurance, too.

The idea that we pay over the odds in taxes for all this, in the UK or in any EU country, is similarly counter to reality. I’ve personally contrasted what I pay in taxes in the US, plus insurance fees, deductibles and co-pays, vs. what I pay in the few open and obvious taxes here — and monetarily, I’m better off here. When insurance costs are factored in, even with VAT in my life I pay less here.

So frankly, I find the American attitude insane. But 60 years of propaganda and a national mythology of the rugged individualist has done its work.

Hokay, rant over for now. Sorry, I just had to.
#5 Sarah
August 15, 2009

I have a counter-story to Luna the cat. I also have family on both sides of the Atlantic, and here’s what I’ve witnessed.

Comparsion #1 — colon cancer:

My American grandfather got colon cancer, as well as cancer spread throughout many of his internal organs. He had cutting edge surgery being pioneered and lived. He was a train driver and his treatment was mostly covered by his insurance as he was below 65 and not yet covered by Medicare. He recovered completely.

My British grandmother had colon cancer. It was discovered late because, like many Europeans (and unlike Americans) she didn’t have regular colonoscopies. My mother, who is British, witnessed the treatment of both the British grandmother and the American grandfather, and believes the British grandmother got subpar treatment – delayed and not of the same cutting edge standard my grandfather received. My mother believes the late detection and the subpar treatment is the reason my grandmother died.

Comparison #2 — cataracts:

My grandmother in the US was diagnosed as having cataracts. She made an appointment and had them removed promptly. The bulk of the cost was covered by Medicare.

My great-aunt in Britain was diagnosed with cataracts. She was put on a waiting list, and two years later, she was able to have them removed. Imagine having to deal with cataracts for 2 years!

Final anecdote:

My aunt in Britain, who is one of my wealthiest relatives, found a lump in her breast. She went her state-funded doctor, who told her not to worry about it. However, in her heart of hearts, she felt something was wrong. Therefore, she took advantage of the private insurance she had to go see another doctor, who did more investigation and found out the lump was a malignant cancer. She was treated and recovered fully. However, she is a small minority in being wealthy enough to have private insurance. It is basically a scary example of subpar healthcare.

As far as I can determine, some 60 or 70% of Americans have great health care, much better than what they have in Britain. This includes the elderly on Medicare. This is because the gov’t doesn’t have to fund healthcare for everyone, just the elderly. For the remaining 30% of Americans, healthcare sucks. This affects our stats (as well as numerous other factors). I have great insurance and great healthcare. From a purely selfish standpoint, there is absolutely no reason for me to want any change. However, I think it is immoral for a country as wealthy as ours not to provide care to all of its residents (legal or not). I think we should all recognize the options, however:

1.) Decline in standard of care and cover everyone at current cost

2.) Keep current standard of care and cover everyone & enormous costs

3.) Massive reform across many things not being considered, such as reduction in med school costs and education required to be a doctor (much greater in the US than Britain), tort reform, limitations on the most expensive care, etc.
#6 10,000li
August 15, 2009

That was an excellent exchange of examples ‘twixt LtC and Sarah. Those who want some kind of government-mediated medical insurance/payment coverage will claim LtC’s example is more common. Those who want a more free-market medical system will claim Sarah’s example is more common.

Thre is one aspect that is without at doubt – Those who can afford it go for private insurance. Unless there is some provision to remove all options for private insurance, then, while we may no longer have to deal with “the haves and the have-nots,” we will still face the issue of “the haves and the have-it-betters.” (Well, to some that is an issue.)

Decoupling medical insurance/payment schemes from employment should be the first goal of reform. I, for one, would quit working for “the man” and spend more time on my own business if I had a way to purchase private insurance/payment plans for the same price I pay through my employment-based plan.

What would that do? It would free up this slot for someone looking for a job, and it would give me more time to build more wealth, which I will invest and spend, helping the economy grow. Isn’t that something good to have?
#7 VolcanoMan
August 15, 2009

I think we can all agree that there is superior standard of care in America (lower waiting times, cutting-edge treatments) for those who have the correct insurance to cover it. The apparent position of the anti-reformists is that extending the same level of coverage to all Americans will necessitate a decline in the standard of care; otherwise the programme will cost way too much. Is there fear amongst the people who already have coverage that they will receive sub-standard care in a system where equality prevails? The evidence suggests there is; Americans don’t trust their government, and in many cases, their distrust is warranted.

But I think there is also a persistent denial that in the absence of major change, their coverage will be compromised anyway. The system is on life-support now, but when tens of millions of baby-boomers hit 65 and are eligible for Medicare, the costs of the current system will become prohibitively high. Change is not something you can put off forever, and if you try, the consequences of inaction will hit every American in their wallet.

The single-payer option is not perfect, and there are many ways for the government to screw it up. But in the long run, a system that guarantees equal access to the very basics of health care – GP and hospital access, treatment for injuries and diseases, monitoring of medical conditions, etc. – will ensure that people seek medical advice on small problems that are easily fixable before they become big problems that the state ends up paying for anyway. The result is a healthier populace.

People are right to be afraid, but the object of their fear should be the state of affairs if nothing is done.
#8 q
August 15, 2009

The US health care is broken beyond repair – think of an ICU patient in a persistent vegatative state, trach’ed, on a ventilator, g-tubed, suffering multiple internal injuries, multiple broken bones, NIDDM, CHF, HTN, and COPD.

Sadly, many Americans in a particular demographic group (think Fox “News” devotees) are extremely misinformed and believe they are “going before the death panel” to keep the patient alive.

Health care reform would end problems like:

1) former employers pocketing COBRA payments and not forwarding them to the insurance company;

2) the need for COBRA;

3) inability of individuals and small businesses to purchase affordable health insurance;

4) insurance companies refusing to issue policies and/or offering inordinately restrictive and expensive policies to those with “pre-existing conditions”;

5) employers dropping health insurance and/or firing employees who are seen as having the potential to make expensive claims;

6) expensive state high-risk pool insurance as the sole vehicle for those who cannot qualify for Medicare and/or Medicaid and cannot get a policy elsewhere, and

7) unequitable 3rd party payments to primary care/IM physicians, among other things.

Having been on the receiving end of most of these issues, I say pull the plug on this “patient”.

Certain instigators have morphed various things the health care reform bill proposes into mendacity:

-Physician reimbursement for advance directive/end of life matters is not “throwing granny down the chute”. Not every state has statutory advance directives, and not everyone can afford a lawyer to draw up their will/trust/estate/powers of attorney.

-The ability to keep the insurance you have is not “socialism” or worse.

These lists are not all-inclusive, but many bloggers have made good, cogent posts. Joe Paduda’s “Managed Care Matters” and Shadowfax’s “Movin’ Meat” are among the excellent resources on this topic.
#9 Luna_the_cat
August 15, 2009

Sarah, *I* had a lump in my breast, 9 years ago. I made an appointment with my GP. 8 days later I had a mammogram, and the day after that I had a biopsy — all on the NHS. Biopsy came back benign, so I didn’t need surgery, but it has been monitored on a very regular schedule — the point of my being sent letters periodically to remind me to come in for a check. Again still on the NHS. If I had needed surgery, I was told that I would be able to get it scheduled within a week.

But then, Aberdeen has a very good team of breast cancer specialists. Perhaps your gran was not lucky in what doctors were like in her area — once again, a problem in the US, as well. It’s a “postcode lottery” to a certain extent everywhere.

Cutting-edge care in the US is fantastic, yes, if you have the right kind of insurance. The problem is, most people actually don’t. SOME people have the right kind of insurance, and the other insured people have HMOs or end up fighting for coverage of basics with companies like Aetna.

Yes, you can definitely find people in the UK who have been damaged by this system. There are merely far fewer of them, even if you count them in relative terms.
#10 Luna_the_cat
August 15, 2009

Sorry, Sarah, meant your aunt, not your gran.

…Anyway, I really wouldn’t go so far as to say that even up to 60% of Americans have “great” healthcare. I find it in my heart to doubt that even over 50% do. There’s just too much evidence of those who don’t. When my sister was one of the senior partners in her own family clinic, they employed one full-time person to do nothing but fight with HMOs and insurance companies for coverage of things the doctors felt were medically necessary. According to what I’ve heard, my sister’s practice was hardly unique in this. What kind of system would necessitate this, if most people had “great” coverage?
#11 10,000li
August 15, 2009

“Those who want some kind of government-mediated medical insurance/payment coverage will claim LtC’s example is more common.”

And LtC did that very thing! I ought to go to Vegas. I could beat those yahoos from the “21″ movie with my prescience!
#12 khan
August 15, 2009

Is everyone aware that Medicare is a government run program?
#13 Luna_the_cat
August 15, 2009

Well, there is one thing you’re wrong on, 10,000li. You said “Those who can afford it go for private insurance.” I had BUPA for a while here in the UK. I dropped it after the first time I used it, when I was trying to get allergies diagnosed and treated; quite honestly, I found that the treatment I got on the NHS was more comprehensive, so I didn’t see the need to keep paying for private. Which is ironic, given that there is a UK-wide shortage of allergists.

Aside from that, insurance in the US which does not depend on the employer is a fantastic idea. Isn’t that the main goal of Obama’s proposed reform?
#14 Freedom Lover
August 15, 2009

“National social programs are relatively new in the States”

—————

That is what is so scary – these two words used together-

“National Social”

Hey didn’t we see what happened to the last nationalist socialist party about 65 years ago?

I did read about the National Guard advertising for internment camp cops. maybe we “right wing extremists” really are going to be put in prison for speaking out. I feel scary of the coming disintegration of freedom. Then again, the fake americans in the Democrap party should be running scared. If they sign their name to this evil empire’s healthcare control mandate bill, they will be targeted and defeated in the next election. They sign their name to it at their own risk.
#15 Ramel
August 15, 2009

For the last time, saying sociaism is bad because there were a group of people who called them selves ‘national socalists’ and did evil things, is just as stupid as saying democracy is evil because there is a nasty goverment running the People’s Democratic Republic of Korea. Freedom lover, you are an idiot.
#16 Cthulhu's minion
August 15, 2009

When my mother was diagnosed with cancer a few years ago, the CFO of the small hospital where she had worked for 30+ years called a board meeting to discuss finding a pretext for firing her since her treatment would run up their insurance costs (we heard about it from the CEO who was a family friend). Even if she hadn’t died from a case of MRSA after her second bout with lymphoma, she would have been left with about $20k remaining in her lifetime coverage.

My brother (who has a heart condition that eventually required a pacemaker) was laid off from work and his cobra payments were 1/3 of his unemployment. When he finally did find a new job, his heart condition was a pre-existing one and excluded from his coverage. Now he is on disablility but will get no medicare/medicaid help for another year.

My grandmother’s medical bills (including drugs) run around $800 a month AFTER medicare and supplimental insurance. Her social security check is around $1000 so she is just going deeper and deeper in the hole.
#17 10,000li
August 15, 2009

“…insurance in the US which does not depend on the employer is a fantastic idea. Isn’t that the main goal of Obama’s proposed reform?”

I hope so. So far, we have no idea what the policy will look like, many versions are extant.
#18 Cthulhu's minion
August 15, 2009

@ 17

I also know people stuck in deadend jobs that can’t take a better paying job because they have a health issue that would be labeled pre-existing on their new employer insurance.
#19 10,000li
August 15, 2009

What states do you live in that don’t have “continuous coverage” laws? Here’s how it works in WA:

“Pre-existing condition waiting periods

Individual plans may require a nine-month waiting period for any condition you received advice or treatment about during the previous six months. (See Appendix 1.)

If your prior plan is equal or better than the new plan, the insurance company must credit your enrollment time in that plan toward the waiting period for the pre-existing condition.

For example, if you had nine months of coverage under your prior plan, the insurance company would waive your waiting period. If you had four months of coverage, you would have to wait five months for the new insurance to cover a pre-existing condition (Be aware that catastrophic coverage, plans with a $1,750 or more deductible, is not considered creditable coverage.)

Make sure if you switch plans, you submit your application for the new insurance within 63 days of ending your prior plan to receive credit.

Insurers may not impose a pre-existing condition waiting period on your coverage if you:
• have 18 months of creditable coverage (catastrophic health plans are not considered creditable coverage);
• qualify as an “eligible individual” under federal law (see Appendix 2).”
#20 Cthulhu's minion
August 15, 2009

I’m just going by what they told me. As a musician, i get my insurance through the union so none of that has come up for me.
#21 LanceR, JSG
August 15, 2009

the fake americans in the Democrap party should be running scared. If they sign their name to this evil empire’s healthcare control mandate bill, they will be targeted and defeated in the next election.

Actually, you may want to point this out to the Republican leadership. Privately, they seem to believe that national health care will cement a Democratic majority for another generation, a la the Democratic majorities after the New Deal. The American people WANT their system fixed. They LOVE socialized medicine, at least the ones that qualify for Medicare. So, if a robust public option survives the chopping block, the Republican leadership believes it will further damage their party’s already tarnished standing.

Just sayin…
#22 Donna B.
August 16, 2009

I too have a relatives that live in the UK. There are things about that system that are fantastic. Birth control coverage is one of them. Another is that once a problem has been diagnosed, the coverage — including medicine and other therapies are easy to access.

However, getting the diagnosis is not often that easy. My sis, for example has high blood pressure. The treatment includes many of the same drugs I might be prescribed here, but the optimum blood pressure numbers and symptoms requiring treatment differ.

In the U.S., my doctors aim for 120/70, but are satisfied with 130/80 provided my ankles and hands aren’t swelling and other signs are OK. In the UK, 130/80 seems to be considered fantastic and swelling of ankles and hands dismissed as not a concern. My sister’s UK doctor refuses to prescribe diuretics to control what is painful ankle and foot swelling for her.

So, while we are discussing whether the coverage is equivalent, perhaps we should also be discussing whether the measured outcomes are also equivalent.
#23 q
August 16, 2009

Khan said:

Is everyone aware that Medicare is a government run program?

Apparently not. At her town hall meeting, Sen. McCaskill asked all Medicare recipients to raise their hands. Lots of hands went up. Then she remarked that Medicare is a government program. She then asked those with their hands raised to keep them raised if they would leave Medicare now, knowing it is government run. All the hands went down.

Just sayin’.
#24 MikeB
August 16, 2009

Donna – Your sisters GP might the problem, rather than the NHS. Certainly my mother (a former nurse whose worked in the US, Canada and the UK) has had both terrible and excellent service from her GP’s – like the US system, the GP is the first (and for most people the only)port of call. If she’s not happy, get a second opinion. PCT’s have to make sure that patients are happy, because its something they get graded on.

We can all trade horror stories over which system is better, but an article in the Guardian said very well what all of us (European, Canadian, Kiwi or Aussie) feel about of healthcare systems. The author is a US academic based in the UK for many years. His take on the best thing about the NHS? The ‘absence of fear of becoming ill’. None of us want to be ill, but certainly none of us wants to think you may lose everything because of it. The article is here

http://www.guardian.co.uk/commentisfree/cifamerica/2009/aug/14/nhs-healthcare-america-britain

It makes for interesting reading.
#25 Donna B.
August 16, 2009

Actually, MikeB, I wasn’t questioning either GP or the treatment, just noting the difference in treatment of the same disease in sisters which probably has a hereditary component and asking if a different goal/standard of care/measurement… whatever might be a difference that should be explored.

The other reason I thought this comparison was interesting is because diuretics are cheap, so cost is not likely the factor in not prescribing them. I should also mention that the same BP medicine is prescribed for both of us at the same dose.

But, to your point — only part of the fear of becoming ill is related to health insurance. And health insurance is only one of the problems that family without a breadwinner faces.
#26 history punk
August 16, 2009

“I did read about the National Guard advertising for internment camp cops. maybe we “right wing extremists” really are going to be put in prison for speaking out. I feel scary of the coming disintegration of freedom.”

The National Guard, like every other unit on the planet, needs trained people to handle captured prisoners of war. This has been a continual practice since at least the 1980s given that handling POWs was something my dad did back in Gulf War I. Back then it was dealt with by MPs, however, from I have been told, they decided to split the POW responsibilities from MPs and hand them over to specialized units in the wake of the hillbillies (that’s hill william to you sir) running amok in Abu Gharib.

It was probably given to the National Guard to handle because you only need them during times of war, so keeping all internment cops on active duty would be wasteful.
#27 MikeB
August 16, 2009

Donna – I entirely agree that health coverage alone does not make up for being ill or for the many other things that life can throw at us. However, compared with my US relatives, I know that if my wife stopped working tomorrow, her health coverage would not. Nor do have to worry that when my two children are ill, we have to think whether its worth the co-payments of taking them to the GP, and if they need medicine, how we are going to pay for them.

Its one thing less to worry about. And if my GP refuses to perscribe something which I believe may be benifical, then I can get another doctor for an opinion – with no hassles from an insurance company saying it can’t be done.

The NHS isn’t perfect, no system is. But when even the leader of the Consrvative party (the heir to Churchill and Thatcher!) says he loves the NHS, and what it did for his son, you have to admit it has wide support. You don’t have to have our system, just one that makes your lives a little easier.
#28 Keith Harwood
August 17, 2009

It is my understanding that the poor in the UK, those totally dependent on the NHS, have better nett health outcomes than the rich, those who can afford the best, in the US.

OK, the NHS isn’t too terribly effective when it comes to euthanasing Steven Hawking and I will admit that the US system did a better job with Michael Jackson.

The position here in Oz is reasonably civilised. All citizens and permanent residents are completely covered in public hospitals. Tourist have to pay $99 a pop. Health insurance is reasonably priced and most people have it. Employers do not provide cover, so you don’t fear losing your job on that score. The insurance companies can not refuse to cover you, the most they can do it refuse payment for pre-existing conditions for the first six months of cover (though one company is now advertising six minutes).
The companies have no say in your treatment, whatever the doctor say goes.

The major public hospitals are all teaching hospitals, that’s where you go to get the best up-to-date treatment from the best in the business. You can go in as either a public patient or a private patient. As a private patient you are more likely to get a single room and you don’t have to pay for the television. The treatment is the same.

Private hospitals are generally at the same standard as the public, they tend to be smaller, less institutionalised (that is, prettier) and to speciallise in certain procedures. If you are insured you pay $200 per admission (not per day) and you have to pay a gap fee for any procedures. The doctor has tell you the gap amount beforehand, in writing. The food in private hospitals is better and in one I have been at, you can get a glass of wine with dinner. (Unfortately, that time I was fed brown glop through a tube for all but the last couple of nights, so I didn’t really appreciate it.)

I’ve been though a lot in the last six years or so. I seem to have a season ticket for the operating theatre at Wesstmead and I’ve been through a host of different tests and procedures. (All that radiation and I haven’t developed one measily little super-power; I don’t even have enough X-ray vision to see through girls’ clothes. How weak is that?) I’m pretty sure that if I were in the US I would be either bankrupt or dead.
#29 antipodean
August 17, 2009

Keith

That’s not quite right. The wealthy in the USA have access to very good healthcare and, only partially as a result, they have amongst the highest life expectancies and health-related qualities of life in the world. But they REALLY pay for it.

The exclusion of the poor in the US from healthcare (and many other things) brings down their national average considerably. This is where the cross-national comparisons start to look odd. Countries with much lower gross national income contributions to health have much better average health outcomes.
#30 SimonG
August 17, 2009

What’s the situation in the USA with sick pay? If someone is off work is their employer obliged to keep paying them? Is it something covered by typical health insurance?

I recall seeing a one of Morgan Spurlock’s “30 days” TV shows, with him living on minimum wage, with no health insurance. One of the things which struck me was that when he was forced to go to a free clinic for help with a work-related injury, he really sufferred financially, missing work not only for necessary recuperation but because of the long waiting time at the clinic. And he wasn’t able to take as long as needed over recovering from the injury.

Over here, (UK), it wouldn’t be great but someone temporarily unable to work would receive at the very least Statutory Sick Pay. (In my previous job – I’m unemployed at the moment – I was entitled to several months off on full pay under my contract, which is fairly typical.) But also, I can make an appointment with my GP, so time off work is predictable and limited. In most cases, I could pick a time such that I wouldn’t need to miss any work at all. My own GP keeps very good time: seldom more than a couple of minutes late.

If I needed treatment at the local hospital, that too would be by appointment to suit me, (although my experience has been that they’re more likely to run a bit late).

Universal health care is – or at least, can be – about more than just paying hospital bills.
#31 Donna B.
August 17, 2009

It seems some in the UK have as skewed a view of the U.S. ways (which is sometimes a lack of a system.)

Everyone who works is covered by the worker’s compensation laws of whichever state they are in. Some states are better than others, but all put the responsibility of work-related injuries on the employer. Employers pay the premiums for worker’s comp insurance, usually into a state pool based on the accident rate of individual companies and an industry rating of risk of the occupation.

Employers who do not buy the insurance are at risk of losing their assets and in all the states I’ve worked, the purchase is mandatory.

But it is liability insurance, not health insurance even though it covers the costs of the injured employee’s medical care.

Also, as far as health insurance, there are 50 different variations on regulations. What might be true in one state is not true in another.

For example, in Louisiana, while access may be a problem (travel-wise and wait times) any state resident can get any service either free or pay on a sliding scale based on income.

Even with Medicare, if one buys one of the supplemental policies of the HMO variety, it’s restricted to the area of residence. Permission and extra charges are incurred if you get sick outside of that area. The same is true of TriCare Prime.
#32 VolcanoMan
August 17, 2009

Until America treats health care as a right, not just for the working and the independently wealthy but for everyone, as a function of their American citizenship, the gap will remain; the rich will stay well-looked-after and the poor will be unable to help themselves to their share of the American dream. It’s the same thing with education; now is not the time to be laying off teachers because who suffers most? Those who cannot afford private schooling which as a function of private funding is insulated from the lack of public funds.

Life isn’t fair, but governments should at least pretend to try and level the playing field a bit. And nothing is more fundamental than the right to see a doctor without say, sacrificing next month’s rent. I am VERY disappointed with the Democrats on this one; they hold majorities in both houses and the freaking presidency and yet they are bullied by morons into making the reforms less potent and by extension, less useful.
#33 Keith Harwood
August 17, 2009

Antipodean:
Regarding the better outcomes for the poor in UK relating to the rich in US:

The report I am recalling (and a quick Google to locate it failed, sorry; it was something like two or three years ago) did remark that cost was one possible reason for the disparity, acting as a disincentive even for those with the necessary resources. So perhaps by `rich’ they didn’t mean `really, really rich’.
#34 Donna B.
August 17, 2009

oh dear VolcanoMan. We either define “right” differently or just plain disagree.

Health care is a service, a good to be purchased. I have no problem at all with government subsidizing the purchase of this service for the poor, but that does not make it a right.

Nor do I think we go far enough in subsidizing this service for some people. Nor do I think that being insured guarantees health or recovery from illness.

I don’t have a firm idea on how this reform should be implemented, but it should not be implemented without understanding what we’re doing. And we don’t have that yet. As I pointed out on another post, even the President seems to be a bit confused about the ultimate goal.
#35 SimonG
August 17, 2009

Thanks, Donna.
In the case of injuries, who gets to decide if they’re work-related or not? Some are fairly obvious, others less so, especially those which may have arisen over a long period and aren’t due to a single incident.

What about non-work sickness and injuries? What happens if someone simply comes down with flu and needs a few days off? Or falls and breaks a leg?
#36 10,000li
August 17, 2009

Cthulhu’s minion wrote:

I’m just going by what they told me. As a musician, i get my insurance through the union so none of that has come up for me.

There you bring up two important points:

1. What they told you may be wrong, because they haven’t looked into it.

2. In the union, your insurance is semi-protable, in that you can get group rates not through your employer, but through a larger group. I think all we need to do is open up the group size, and most of the problem will be taken care of.
#37 MikeB
August 18, 2009

#34 – Donna, even if you think that ‘Health care is a service, a good to be purchased’ (something which almost no other western country agrees with), look at it from the economics angle.

The UK spends less than 9% of GDP on the NHS, and even the French spend less than 12%
http://spreadsheets.google.com/pub?key=pqVgDLeO6WJ1Epmhi4w3rXg . The US spends 16% of GDP on healthcare, and is projected to spend 20% by 2018. The Swiss,using a system which the US could easily copy, spend less than 12%. The US system is expensive, uneven, and often has no better outcomes than other systems.

The reliance on employers to cover healthcare costs is a huge disadvantage for US companies. GM’s health care costs are adding $1600 to the production cost of every vehicle, with Ford having to make $1000 to pay for healthcare. Their European arms have far less costs, since healthcare costs are largely decoupled from the employer (in the UK, entirely). Its true that these businesses pay tax, but its a tax paid by all companies, not just the good ones. Put it this way, GM Europe hasn’t had to go into Chapter 11, even though sales have fallen. How much of GM is owned by the US government? Most of it.

The US healthcare system costs US taxpayers more money, it costs US consumers more money (drug costs 50% higher than Europe) and costs businesses more money.

As Clinton might have put it, its the economy…
#38 Donna B.
August 18, 2009

SimonG — it’s usually fairly obvious if it’s a work injury, though there are plenty of examples where it takes years for the injury to become apparent and those are, of course, more difficult.

As for pay for non-work related illnesses, most (certainly not all, and it’s not required) employers offer varying number of days of sick leave and vacation. There’s really no “system” to it.
#39 Donna B.
August 18, 2009

MikeB — I am looking at from the economics angle. Health care must be purchased, thus it is not a right. I’m not saying it isn’t something everybody needs or deserves.

And, while all you say about the U.S. spending more is true (likely so, I’m not going to argue that point anyway) there are huge differences in the U.S. that make it somewhat impossible to effectively utilize the same systems that work well in geographically smaller nations.

I do agree that health insurance should not be tied to employment in the way that it currently is, but from what I have read about the bill under consideration it looks to me like it would further entrench that system as one of the unintended consequences, ie change it but not remove it.
#40 LanceR, JSG
August 18, 2009

Health care must be purchased, thus it is not a right.

Hey! What a great idea! Guns have to be purchased… So do homes. Wow! In order to spread speech as far as possible, you have to purchase equipment!!

This is great! How many “rights” can we explain away today?
#41 Donna B.
August 18, 2009

Do you honestly think the 2nd Amendment says the government should supply everyone with guns? Or that that 1st says everyone must be supplied a printing press? Or that the 3rd says we have a right to housing?
#42 LanceR, JSG
August 18, 2009

No, why? Do you? By your logic, anything we have to purchase is not a right. Therefore, the first, second, and third amendments are right out the window.

My point is that just because we have, in the past, had to purchase health care does not mean, well, anything. Rights are what we say they are. Period. Full stop. This is simultaneously the greatest benefit and biggest drawback of representative democracy.

There are good arguments against healthcare reform… why do we only hear the tragically stupid ones?
#43 VolcanoMan
August 18, 2009

Capitalism, with its prime virtue, competition, has certainly served to make America a leader in medical technology. But in treating health care as a service to be purchased, it has also created a gap between those for whom health insurance is a minor expense and those for whom it is a major and sometimes prohibitively high expense. MikeB is correct: rights are exactly what we say they are, and in almost every Western democracy, health care is treated as a right. Furthermore, most of those countries also have cutting-edge technology, paid for by the government, and available to everyone.

If this fight is primarily about people being afraid of the government being able to exert some control over individuals, I say what a bunch of freaking whiners Americans are. Such a petty concern! People, yes even employed people, are letting minor health concerns develop into major ones because they can’t afford insurance. Temporary free care clinics are being set up by international organisations that do the bulk of their work in Africa and southern Asia. The idea that people have the right to choose not to be insured is truly bizarre; what person would truly wish to deny themselves access to something that will inevitably be necessary at some point in their lives? People who are “choosing” not to be insured now are simply forced into that choice…like prostitutes “choosing” to have sex for a living.

If this were about money, I would understand it a bit more, but empirical evidence from other countries suggests that a government-funded system would actually be less expensive for the vast majority of people. If this is about a perceived loss of an individual freedom, then the ruckus is clearly being stirred up by the very people who have a lot to lose here. The peace-of-mind in knowing that should an accident or illness beset you, you will get access to doctors, surgery, hospital stays, etc. without paying out-of-pocket should win everyone over; the fact that there are still angry people out there talking about “death panels” suggests a massive fear campaign. And if this is about your taxes going towards the health care of someone who you deem unworthy, someone who has lived an unhealthy lifestyle and who is reaping the rewards…where’s the Christian love? Judge not lest ye be judged? I am no religionist, but most Americans are, and yet they have a dubiously difficult time helping other people (the fear campaigners bring up the frightful s-word here…ooooooo…scaaaary).

Take a freaking stand and enshrine the “right to health care” in the law of your country…because right now, the rest of us in the developed world are shaking our heads and wondering where the madness will end.
#44 Charlotte
August 18, 2009

Health care must be purchased, thus it is not a right.

I know others have already questioned the logic of this, but the best analogy I can think of is the right to legal counsel. That’s a service where you have to pay for both the time of the person giving the advice and the related costs (admin etc, obviously these are a bigger component of medical care). Because it’s regarded as a right the government covers the cost of a basic level of service for those who can’t afford it themselves. You can, of course, turn it down and represent yourself if you’re qualified or crazy.

Now, how you define ‘basic’ is a whole ‘nother issue. The US already has emergency care provided free by hospitals – who pass the cost on to paying patients, right? – but in many countries basic care for the uninsured is a lot more comprehensive.

And in case I haven’t said it enough already, I <3 the NHS.
#45 Charlotte
August 18, 2009

Dammit, what happened there? That should read,

I (heart) the NHS.
#46 Donna B.
August 19, 2009

LanceR, if I write the sun will come up tomorrow, I think you’d find some way to make that “tragically stupid”. Your schtick is to deliberately misinterpret and attempt humiliation. Grow up.

VolcanoMan – the is that services will be limited under a government run plan. Medicare for all sounds great until you realize all that Medicare doesn’t cover and how other items are limited. The only thing worse than being on Medicare is being on Medicaid.

To some it appears that to insure 15% of the population, 85% is going to be asked to reduce the level, quality, and quantity of care. It’s not really a matter of money or taxes either — I think support could gained much easier for extending Medicaid (the rules to get coverage are draconian and unreasonable) into a workable program.

Charlotte — the right to legal counsel extends only when a government has charged someone with a crime. There is no right (in the U.S.) to legal advice or representation otherwise.
#47 LanceR, JSG
August 19, 2009

Actually, Donna, if you were to write that the sun will come up tomorrow, I would ask how that was relevant to the discussion.

Come on, *you* have made better arguments against “socialized medicine”… and then you fall back on the “it has to be purchased, so it’s not a right” tripe?

The vast majority of people on Medicare LOVE Medicare. Medicaid is a pain because we spend entirely too much time and energy worrying that someone may be getting “undeserved” benefits. This would cease to be a problem if everyone were covered.

The reality of national healthcare is that it works. All over the developed world, people have health coverage, and the world hasn’t ended. Let’s get beyond the bullshit and discuss reality, shall we?
#48 Charlotte
August 19, 2009

Donna, the right to health care free at the point of use in the UK only applies when you’re ill – most elective procedures aren’t covered. The point is, it’s a right that applies when you need it. Besides, I’d argue that the federally funded legal aid system provides de facto right to free legal advice under other circumstances. I find your arguments about this pretty thin, in any case.

To some it appears that to insure 15% of the population, 85% is going to be asked to reduce the level, quality, and quantity of care.

I suspect part of the problem is that many USians find it hard to accept that their healthcare system is utterly crap value for money, by any objective measure, and that they would be better off under most European/antipodean countries’ systems. It’s just not how you see yourselves.
#49 Donna B.
August 19, 2009

LanceR — an argument made in addition to other arguments is not “falling back” on that one argument. But the joyful news is that we finally agree on something — Medicaid is a pain and we apparently agree on why.

I’m marking this down on my calendar!
#50 LanceR, JSG
August 19, 2009

W00T! Common ground!

I have always maintained that reasonable people can reach reasonable solutions.

Now, how do we repair the issue? I would suggest:

a. Provide the option to buy into Medicare for anyone who wants in. Price this competitively.

b. Remove the cap on Social Security/Medicare payroll taxes.

c. ???

d. Relax in a healthier, happier country!
#51 Donna B.
August 19, 2009

c. A miracle occurs?
#52 Donna B.
August 19, 2009

a. I know you say everyone who has it loves Medicare, but it is rife with rationing, mostly in terms of hospital stays and it does not reimburse hospitals and physicians fairly.

I don’t approve of cutting costs merely by refusing to pay for services. Medicare currently pays hospitals a DRG (I think that’s the right initials) based on the admitting diagnosis. The story a hospital administrator recently told me was of a woman who was admitted with a severe allergy attack, which would probably have not resulted in a lengthy hospital stay.

Before being released, she suffered a heart attack and ended up having bypass surgery. The hospital was paid as if they provided no service beyond what would be reasonable for the asthma attack as that was the admitting diagnosis.

That is not right.

b. I have no problem with this and think it should have been done long ago. In fact, I would not mind looking into ways to extend this tax beyond wages though that would cause waves of howls.

Income tax reform is going to have to be an essential part of any successful health care reform and I don’t think there’s been any intelligent discussion about that so far in Congress.
#53 PalMD
August 19, 2009

I’m not sure I understand your point about rationing in Medicare…examples please?

The DRG problem is very real. Hospitals are conducting mandatory seminars to teach docs how to code properly, since the system is non-sensical in the way you described.

There’s a lot of talk about scrapping DRGs for a different kind of bundled service, but who knows.
#54 mikaela
October 5, 2009

what is healthcare?how does mean to be?
#55 PalMD
October 5, 2009

@Mikaela

Yes. Thanks you too many.