Universal Health Insurance?

[question everything]

Well, yes. We all know, intuitively, that every resident of this country deserves decent health care. That people should not just die for lack of money.

We have moved a long way from 1990, when an actuarian of a major insurance company commented to me that "after all, not everyone drives a Cadillac" (and hence, not everyone deserves health insurance..)

We, liberals, believe in the good that a government can do and support various program funded by our taxes. And today even most conservatives realize that the "survival of the (healthy) fittest" is bad for our society and for our economy when so many resort to using the expensive emergency rooms.

But how will universal health care work?

We have to accept, from the top, that such a system will have to be rationed. Since it will be supported by tax revenue there will be guidelines of what can be treated and at what extent. Even if it does not, many of us, good tax payers citizens, will start demanding limits.

Unless we are lucky to die instantaneously from a burst artery, or from being run over by an eighteen wheeler, our dying process will be lengthy and expensive. I read some place - and, no doubt, some DUers know better - that 90% of our total medical expenses are incurred in the last year of our life. And this, before the swelling of hospitals, hospices and nursing homes with all the baby boomers.

Here are some questions that will be raised and, no, I have no answers:

- Shall an 85 year old woman, a diabetic and a heavy smoker be operated to by-pass her coronary arteries? Only to develop complications and to die a month later? (yes, I know of such a case)

- How aggressively shall we treat a long cancer patient who was a heavy smoker all his life? A liver cancer patient who is an alcoholic?

- How aggressively shall we treat patients who were obese all their lives, did not exercise, ate all the wrong food and now suffer from heart problems? What about individuals engaged in extreme sport? AIDS patients who enjoyed unprotected sex often and with many partners?

- Shall we support maternities of a single poor uneducated woman who keep getting pregnant - from different men - because she does not know any better? Shall we demand that she be sterilized?

- Shall we pay for birth control pills, viagra, fertility treatment for older women?

- How about a couple that underwent fertility treatment but refused to "thin" the number of embryos, ended up giving birth to six babies after 22 weeks, three died almost immediately and the other are in intensive care with a prognosis of many medical problems for the rest of their lives?

- Shall we demand that each pregnant woman undergoes amniocenteses and if the fetus is malforming, will require major medical attention all his life, demand that she aborts?

And these are just questions that pop into my mind as I am typing this.

We are Americans. We cherish the concept of our rights, our entitlement to get what we want when we want, the pursuit of happiness (of course).

Can any of us actually tell an aging loved one to just "let go?" Yes, our society is having problems with accepting death and dying. We live longer, we are scattered all across the country (and the globe) and when we rush to the bed of an aging parent we want that every effort be done to... often lengthen the life by a few months.

Many of us know the old family of cancer drugs. They did not do much, but their side effects were painful. In recent years several bio-technology companies came with better drugs that attack the tumors directly, instead of nuking the whole body. But such treatments cost $50,000 a year, and then there are the anti-nausea drugs and the booster for blood cells drugs that also are expensive. Yet, talking to a grieving widower recently, he said - money would not be an issue.

In the past few days I posted two "companion" threads here.

One asking whether employers belong in the health care system

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x3320350

Another, posting what I found in TIME, about a universal insurance proposal by Ron Wyden

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x3324309

The people who responded to them were very adamant that only a single payer system without employers and without private insurance company will do.

But I have to wonder. The reality is that most people do like their insurance and they like it because it is being offered by their employers (not the reason, but it is implied). Which is probably the reason why both Edwards and Obama keep employers in their proposals.

We, Americans, don't like others to tell us what do, to limit our options and the perception is that a single payer government program will do just that. Yes, "Harry and Louise" but if not, we need to detail how.

And then there is the mistrust of government even here, on DU - especially here, on DU.

Do we trust the Dept. of Defense? Do we trust FEMA? Do we trust the FDA? The FAA? The IRS?

In contrast to us, liberals, who do believe, in principle, in the good that a government can do, I would say that most Americans prefer the government to stay out of their businesses, except in cases when they want it, of course.

Which is why I have always compared a universal health care to public schools. All of us pay taxes to support our schools, whether we have children there or not. And many are free to pay for private ones.

Similarly, we need to have a universal, single payer system supported by our taxes to offer sound medical treatment, including prevention and end of life support to all. However, the ones who choose to purchase their own private health insurance should be able to do so.

Does this mean that the rich may get better medical treatment than the rest of us? Well, yes, maybe. They get everything else better and no one is going to change this fact no matter how much we dislike this.

The lofty idea of "from each according to his means and to each according to his needs" failed in face of human nature. The rich will always fare better everywhere. What we need is to make sure that the rest of us are not left in the ditch.

OK, start firing.

[Viva_La_Revolution]

1. just take the profit out of it

pay doctors well, and hospitals enough to keep everything up and running. spend the rest on the people, not the shareholders.

[aquart]

2. Was this an essay for class?

[endarkenment]

3. "The reality is that most people do like their insurance "?

I actually do not know one person who doesn't think that their health insurance is horrible. Where did you get this idea that "most people like their insurance"?

You make it all so complicated when really it is quite simple: we all pay in, we all get decent affordable health care. Yes indeed there will be issues of what is included and what isn't - AS THERE ARE RIGHT NOW UNDER THE CURRENT SYSTEM. The difference is that instead of a for profit insurance company making healthcare decisions for you based on their obligation to maximize profits; insurance paid for by your employer who is also interested in reducing his costs as much as possible; under a public universal single payer system these decisions are made democratically by OUR ELECTED REPRESENTATIVES, who answer to us, not to our employers, not to some group of investors, to us.

[question everything]

11. From someone running for office who is for universal system

but admits that it would have to be in stages as most people like their insurance.

On occasions someone would poll DUers and many are happy with what they have.

And on occasions some would post here expressing their dislike for universal health insurance, for a "Canadian style" system and even withhold their support for Edwards for this reason.

I don't know how many there are. This being DU obviously it would be tilted toward a government run system. Or perhaps some are afraid to be flamed... this is DU, after all.

Last, again, this is the USA - home of capitalism. While not everyone would agree with Gordon Gekko that "Greed is good," bashing the concept of profit will never get you anywhere.

[endarkenment]

26. "as most people like their insurance"

So your candidate is just making shit up to justify corrupt mandated insurance purchase programs posing as universal healthcare. How about coming up with some actual facts to back up with that assertion?

[datasuspect]

30. "bashing the concept of profit will never get you anywhere."

bashing, you are correct, will never you get anywhere.

you have to destroy it.

[gollygee]

4. People are able to have universal health care in other countries without taking away civil rights

I think we can do it too.

[niyad]

8. not that we have any civil rights to lose under * and cronies

[rasputin1952]

5. The iraqi's have Universal Health Care at US taxpayer expense

I see no reason why American citizens should not have the same benefit.


Insurance company profit margins are the ONLY reason we do not have UHC.

[Warpy]

6. Some rationing is being done along the lines you indicated

I know few surgeons who would do anything more aggressive than placing arterial tents in the 85 year old heavy smoker of either sex. They usually do die fairly soon after bypass surgery. It's too much stress to put onto any elderly body.

Denying people lifesaving treatment because we don't like their habits is cruel. I don't agree with limiting their care. It's just like denying people care when we don't like their genetics. I say this as a non drinking, non smoking whole foods person who realizes that no smoker ever wants to give himself cancer or loving person wants AIDS.

Considering the hue and cry over the Texas law pulling the plug on medically hopeless cases who lack insurance for indefinite artificial life support, I sincerely doubt limiting end of life measures for the elderly will be met with much success.

I seem to remember Oregon putting out a list of procedures that would be rationed or curtailed because of the declining rate of success for most of them. People howled with indignation because heroics for extremely premature infants was on there.

Still, anything is better than the system we have now, rationing care according to personal wealth. This is still a rich country even though the wealth has concentrated away from the people. I'm sure this country is rich enough to care for all the sick.

[DemocratSinceBirth]

19. I Know A Vascular Surgeon Who Did A Fem Pop Bypass On A Ninety Year Old Woman And It Worked

eom

[Warpy]

20. That's a little different from a bypass that could be treated conservatively

since she had little chance for quality of life with amputations instead and the risk was equivalent at that age.

Generally speaking, though, the elderly over 85 don't have good outcomes from major surgeries. Even the ones who have the relatively minor hip surgeries have a 50% fatality rate within 6 months. Most surgeons go with the statistics and the statistics are not good, even though there is a very rare patient who beats them.

(Since Condi Rice is an extremely successful black woman, does that mean all black women are extremely successful? Same thing.)

[DemocratSinceBirth]

21. My Mom Had A Colon Resection At 82 In 2000

She's in the other room...

I'm not usually one to say if we didn't spend money on tanks we could spend it on health care or education because the two are separate but the Iraq War is so fucking pointless that the hundreds of billions could be spent on universal health care...

I have my own small business and I'm about to pay $678.00 a month for health insurance...

[niyad]

7. how do you explain canada, great britain, cuba and france, just for starters?

[yy4me]

9. I believe your list is too short. Isn't health care provided

by just about every country in the world?

Just think what care we could provide for our citizens if not for this illegal war.

Or would the politico's still say there is not enough money to provide health care for all Americans.

[question everything]

10. I am not familier with the details

however I believe that the French and German systems are different, and better, than the British and the Canadians.

For every story about how wonderful the Canadian system is, there is another about how long one has to wait for elective surgery and about the "poor" Canadians who cross the border to get treated here.

Yes, people here on DU support a single payer but most Americans, who are covered right now, will shudder at the thought of having a Cuban style system. You can admit that, can you?

[Vinca]

12. You know what the difference is between a Canadian and an

uninsured American? The American will wait forever.

[Solon]

15. And if they both rely on a lifesaving procedure, the American is 6 feet under. n/t

[question everything]

16. I know. And this is why we need some type of a universal health

I am just saying that most Americans like what they have right now, they are suspicious of any government program and are afraid that some of their choices will be taken from them.

This is now a political issue and the candidates are careful to test the water. This is why the three leaders: Clinton, Obama and Edwards are staying away from the government as a single payer.

And except for Warpy, whose opinion I always respect, none of the responses here, so far, addressed the question of rationing.

Here is what someone from France, some years ago, posted on a different forum (I managed to search the archives):

The French have a goverment sponsored single payer system that takes care of collecting the premium and reimbursing you the expenses at 70% with no deductible.. with 30% out of your own pocket.. and if you want(it is not mandatory) you can cover the 30% out of pocket expense by taking a private insurance that will cover 20% of that 30%.

The National health care system contract with doctors regarding the maximum fees they can charge. Today it is $30 for a house call and $20 for an office visit if I recall correctly (The vast majority of the doctors and Hospitals Privates and Publics (of course) are enrolled in the system)... Some do not ... and if you go and see them ... you will be reimbursed up to the limit set by the National Health system.

It is not socialized medecine like the HMO here or in England because you GO TO THE DOCTOR OF YOUR CHOICE...and the doctor decides what kind of care you need... although they have to watch not to go overboard... since the National health care system ... thanks to computers nowdays... can monitor them.... ( they can see for exemple if such or such doctor is overdoing it in x'rays etc... in order to control cost... and if they do they can be penalized based on feedbacks I got when I go to France...

The system is not perfect... has it flaws... and there are a lot of room for improvements and cost saving.... but then if you do that you start to make it more complex...etc... The French system costed $2,320 per habitant in 1998 while ours here in the U.S. costed each habitant $4,120... in spite of the fact that my mother with heart problem stayed 2 weeks in the hospital while here for the same problem you would be out in a week if not less..? As a senior citizen.. it costed her nothing... This is roughly the French system that I advocate as a possible model with variances....

It is amazing that we only hear about the Canadian system and its shorfall... but never about the German or French system...Is it beacuse it is too good to spread the word around that would give people "bad" ideas for those who profit from our current system???

No one in France wants to get rid of system... which like any system can collapse if not managed properly... in a very complex world!

[Solon]

18. What choices?

Most Americans get their insurance through employment, they had no choice in plans to begin with, they are given a small list of premiums, co-pays, deducts, and see what they can afford. Usually they are given a book of approved doctors, dentists, etc. Generally the choices are broken down like this, affordable premiums OR unaffordable co-pays and deducts, unaffordable premiums, low co-pays and deducts.

[question everything]

23. Choices of physicians, unless you are an HMO

and need to go through a gatekeeper.

[endarkenment]

27. "I am just saying that most Americans like what they have right now"

There you go again. Please back up that assertion with actual data.

[Spazito]

14. Here are the facts regarding Canadians crossing the border to

get treatment, it is quite different from what you have been led to believe. Do Canadians cross the border for care, yes, but in such infintessimally small numbers as a percentage of the Canadian population that it is obvious why numbers are NEVER quoted when this propaganda is put forward by those who do NOT want the US to consider universal health coverage:

Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States

http://content.healthaffairs.org/cgi/content/full/21/3/19?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=phantoms+in+the+snow&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

[laundry_queen]

34. Thanks for that link.

It's good to see the numbers. Yet another bullshit myth put out by the For Profit Medicine industry.

[Spazito]

35. You are very welcome! My heart breaks when I read threads

and posts telling of the lack of availability to even the very basic health care and the financially back-breaking costs for those who have "insurance" never mind those who don't. To know I live, maybe, 4 hours away from someone who cannot get basic care or who have incurred debt in the thousands for having had to access care when I, for a total of $64.50 a month have coverage that includes any operations, hospital stays, dental, optical, affordable prescription drugs.

I am not promoting the Canadian system over other universal health care systems but I will stand up and correct any lies regarding so DUers and others have, at least, the facts with which to make their conclusions as to whether universal health care is something to fight for or not.

[gollygee]

17. My husband is Australian and lived under their system before moving here

and he assures me none of your ridiculous ideas of "cost-savings" forced abortions et. al happen there.

Nice right wing talking points in the OP though. All the forced abortion talk is an especially nice touch.

[question everything]

22. You may want to read more than one sentence

if you are capable.

And if you are capable of following a discussion that throws ideas for others to comment and not to take anything so literally.

Would you like your tax money spent on a person with known medical conditions for the rest of this person's life? Knowing, while in utero, that such conditions exist?

I can assure you that when it comes to people's tax money, some will ask these and other questions.

But when you see the world in black and white like the freepers, providing any explanations to you is a waste of time. This is aimed at intelligent people who read this.

[Solon]

13. At the same time, those who wish for private insurance still will have to pay for the public system.

Just like those who send there kids to private school still pay for public school.

Also, where does this BS come from that most people LIKE their insurance. That's false, most people don't have ANY choice in the matter!

According to a poll from 2004, more people(48%) thought Health Insurance companies are doing a HORRIBLE job providing for services, compared to those who think they were doing a good job(44%).

Link(PDF file):

http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss11.pdf

To be frank, I don't think most people are more enamoured with their insurance companies now than 3 years ago, after all, insurance premiums and coverage of people are now more expensive now.

[lovuian]

24. Its coming so get ready Universal Health is coming

its actually already in play...
the system can't keep jacking prices up 20% each year and cutting services

its over
Universal Health is on our doorstep the computer systems are already being put in place for single payer

[MisterHowdy]

25. I don't believe that.

Don't get me wrong, I hope your right.

But I think the US and its government are too far gone for that kind of change.
Corruption is king.

[OmmmSweetOmmm]

29. I wish I can be as optimistic as you are about it. This will never happen unless we throw out of

Congress all of the members that are in the deep financial pockets of big pharma and "health" care businesses. This also includes the AMA. I don't know if Americans are motivated enough to do that.

[datasuspect]

28. "The reality is that most people do like their insurance "

i'd like to meet some of these people . . .

what magical insurance do they have?

[Solon]

31. He's making shit up, look at post 13...

Polls in 2004 say that 48% of people disapprove of the job of insurance companies, I imagine that the numbers are higher now. On balance 44% like their insurance, then again, this could be much lower today.

[prolesunited]

32. One of the biggest problems is that insurance is TIED to the employer

The employer picks the provider, coverages, limits, etc., and sets what each employee will pay as their share. Many are no longer even offering the option of insuring family members. So what free-market choice is there in that for the individual?

Also, consider how this hampers free-market capitalism? How many people with good ideas for their own business or who want to change careers or spend more time working with the community or return to school are prohibited from doing so because they can't afford insurance premiums on their own or have so many pre-existing conditions that they are virtually uninsurable.

Also, from a company's perspective, how can they compete effectively in the global marketplace when are burdened with such overhead costs when company's in other countries aren't?

I would argue that the present system is a danger to capitalism.

[SoCalDem]

33. Universal Health CARE... NOT insurance..

"insurance" is the PROBLEM...not the solution.

[Bridget Burke]

36. How are these situations handled in other countries?

Most of which have better health care systems. Get back to us when you've done your homework.

PS: All treatments are not available for all patients here as it is. Cost is not the only factor--although HMO's & Insurance companies often have to be convinced. But some patients would not benefit from the most aggressive treatments--& good doctors will usually point this out.