From the archives:
(21 January 2006) I had a great trip to the doctor the other day. I showed up for my appointment (one I had made only one day before), waited a few minutes, saw the doctor, and then I left. There was no paperwork, no long wait, no money exchanged, and no stress. Basically, there was nothing standing in the way of what I had come there for--medical care.
And, no, I don't live in some fantasy world.
I live in England.
I love universal health care, and for me it's because of the small things. I never had any major problems with my health insurance in the U.S., but I still had to fill out a ton of paperwork every time I went to the doctor, I couldn't always see the doctor I wanted to see, and I had to pay those really annoying co-payments. At least I had health insurance in the U.S., though, unlike over the millions of people left without coverage in the richest nation in the world. For these people, universal health care isn't about convenience: it's about life and death.
Even people with health care coverage in the U.S. are having trouble. The Bush administration's new prescription drug plan went into effect recently, and it has gone about as well as a doctor trying to save a shark attack victim with a Band-Aid, while denying access to any other treatment. Today The New York Times described the effect the drug plan is having on the mentally ill:
On the seventh day of the new Medicare drug benefit, Stephen Starnes began hearing voices again, ominous voices, and he started to beg for the medications he had been taking for 10 years. But his pharmacy could not get approval from his Medicare drug plan, so Mr. Starnes was admitted to a hospital here for treatment of paranoid schizophrenia.
Mr. Starnes, 49, lives in Dayspring Village, a former motel that is licensed by the State of Florida as an assisted living center for people with mental illness. When he gets his medications, he is stable.
"Without them," he said, "I get aggravated at myself, I have terrible pain in my gut, I feel as if I am freezing one moment and burning up the next moment. I go haywire, and I want to hurt myself."
Although this case, and the many others like it, will probably be unique to the current transition period, some changes will be more permanent:
At Dayspring Village, in the northeast corner of Florida near Jacksonville, the 80 residents depend heavily on medications. They line up for their medicines three times a day. Members of the staff, standing at a counter, dispense the pills through a window that looks like the ticket booth at a movie theater.
Most of the residents are on Medicare, because they have disabilities, and Medicaid, because they have low incomes. Before Jan. 1, the state's Medicaid program covered their drugs at no charge. Since then, the residents have been covered by a private insurance company under contract to Medicare.
For the first time, residents of Dayspring Village found this month that they were being charged co-payments for their drugs, typically $3 for each prescription. The residents take an average of eight or nine drugs, so the co-payments can take a large share of their cash allowance, which is $54 a month.
Capricious changes in fees and access are just some of the problems that arise from a market-based health care system. This system also relies on employers to pay for the health insurance of their employees, which can put a strain on small businesses. It also makes some unfortunate people dependent on companies that refuse to pay an adequate amount for health care, including Wal-Mart, the target of a recently passed Maryland law that forces Wal-Mart to finally pay up.
In the end, market-based or private health insurance is inefficient and costly. Private insurance companies spend 13% of their income on profit and overhead, as opposed to government programs, which spend none of their funds on profits and only 1-2% on overhead. The U.S. spends more than twice as much per person on health care than the next highest spender, yet the U.S. can also boast over 40 million uninsured people (see the Physicians for a National Health Program site for more background).
Just take a moment and imagine what would happen if we took the money that we currently spend on a private health care system and put it into a new national health care system. Not only would millions of people no longer have to go without health care, but we wouldn't have to deal with any of the really annoying stuff we seem to take for granted. It would undeniably be the greatest health care system in the world. Wouldn't that be nice?
The drug plan was typical GOP brainlessness. Instead of a 5-6 easy-to-understand plans run out of the feederal govt, you get hundreds of confusing private plans, some differing only in the fine print. They messed things up the SAME WAY with E-filing of taxes; instead of the IRS running one free, easy form, they have zillions of private firms of varying cost and reliability that you have to trust with the security of all your sensitive financial data! Not! I sense a culture of ideology-driven incompetance here. The culture of you're-on-your-own kid. Swim faster as the alligators chase you through the French Quarter.
Many people reckon US healthcare is the best in the world- and it probably is if you have money. Nice to hear someone praising the NHS for a change. Better enjoy it while it lasts... http://www.keepournhspublic.com/
It is if you have money. And, I think the US health care system fosters drug research by avoiding the trap of price controls. But, that covers al the positives: it is clear that some kind of carefully designed national system is needed. And we won't get it, because people would rather watch "American Idol" than impale their representatives on crude wooedn spears. In fact, few Americans even bother to vote, nor do we even know if the machines produce accurate results (Diebold. et al are Republica-controlled operations)
Actually, most assessments of our medical care is that it is substandard compared to other industrialized nations. I wrote about this misconception at one point.
One of the critical aspects of medical care is effective delivery and prevention. Yeah, we have fancy machines, good research and great drugs. But when people don't get them for stupid reasons, that means your healthcare is substandard. At the same time we pay more for healthcare per person than any other country in the world.
In other words, the US has the potential to give the greatest healthcare in the world, but only if you can afford to go to the Mayo Clinic. At the same time we're overpaying for a low level of access and poor preventative health, the two most important kinds (MRIs and fancy testing be damned, physicals and routine bloodwork are way more important for prevention of disease).
Therefore, given we pay the most and receive the least it's fair to say that US healthcare is the worst in the industrialized world.
"Actually, most assessments of our medical care is that it is substandard compared to other industrialized nations. I wrote about this misconception at one point"
Disagree. If you need a quad by-pass or a finger re-attached and have insurance, I expect we are top 5. If you need preventive care or any care and don't have insurance, on the other hand....
You are looking at "average" care, over the whole population; I am looking at what you CAN get. But it is all beside the point: we need single-payer. This is becoming painfully clear even to some businesses.
Imagine what might happen if someone ran for the U.S. Presidency with this issue as a major platform plank...
The US, according to a recent WHO International Health Report, is ranked 37th in world healthcare. Every country before it has some version of nationalised health care. It also points out that America spends more as a percentage of GDP (public and private) than any other country on health care - but apparently doesn't get much for it.
I live in England too. Despite what the tabloids say, my experience has always been uniformly good. I can get an appointment on the same day I book it if I don't mind which doctor I see, or almost always the next day if I do. I never wait more than five minutes, don't have to fill out any forms - and best of all, it's all free. I've never had any major surgery (apart from emergency surgery on my appendix, which was quick), so I can't really give my experience of waiting lists for things like hip operations, but according to the WHO at least it isn't that bad.