IT'S TIME FOR UNIVERSAL HEALTH CARE

Advocate wrote:

A most telling fact is that the life expectancy in the USA is near the bottom of that in countries with universal healthcare.

You are fabricating "facts" again.

Average Life expectancy for the US and every country with Universal Healthcare:

1. Australia: 79.75
2. Sweden: 79.58
3. Canada: 79.43
4. Italy: 79.03
5. Spain: 78.79
6. France: 78.76
7. Norway: 78.65
8. Israel: 78.57
9. Greece: 78.44
10. Netherlands: 78.28
11. New Zealand: 77.82
12. Belgium: 77.80
13. Austria: 77.68
14. United Kingdom: 77.66
15. Germany: 77.44
16. Finland: 77.41
17. United States: 77.12
18. Ireland: 76.81
19. Denmark: 76.54
20. Taiwan: 76.35
21. Cuba: 76.21
22. Kuwait: 76.08
23. Portugal: 75.75
24. Chile: 75.74
25. Argentina: 75.05
26. Slovenia: 74.86
27. South Korea: 74.43
28. Paraguay: 73.68
29. Poland: 73.19
30. Venezuela: 73.07
31. Qatar: 72.37
32. Oman: 71.78
33. China: 71.38
34. Hungary: 71.37
35. Seychelles: 70.41
36. Saudi Arabia: 67.77
37. Russia: 67.19
38. Bolivia: 63.70
39. Brazil: 62.94

17th out of 39 isn't quite "near the bottom", is it?

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Excellent point. An even more vivid comparison involves the large - even moderately comparable to the U.S. countries in the list.

The UK has a large somewhat diverse population (though much less diverse than ours.) The probability that the observed 0.7% difference between their life expectency and ours is due to superior average health care is truly negligible.

Germany, with a well-developed public health care system and far less immigration than the United States, has a life expectancy just 0.4% greater than ours. A more detailed statistical analysis that takes all the relevant factors influencing the outcome into account would very likely conclude that our health care system does a much better job than theirs.

France has a life expectancy just 2.1% better than ours - this one may well be an example in support of the allegation, however, even here there are many other factors unaccounted for. (Not to mention the fact that France can no longer afford the social welfare system it currently maintains.)

For example, birth rates in the United States are very significantly higher than in any of these countries. If the data were adjusted for the known mortality effects of both infants and their mothers, I doubt seriously that there would be any difference at all.

Finally, Japan, with the highest life expectancy of them all, isn't on the list, because it does NOT have a government-managed universal health care system.

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georgeob1 wrote:

Free markets work much better. We already have government sponsored medical care for the poor and the old.

Funny, because you managed to show the contradiction in the current US system, in two subsequent sentences.

Of course, you could take that current approach, and modify it only to the point where you get a universal health care system. Universal health care doesn't have to mean single payer system, or the elimination of competition...

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Although those of us who paid into the social security system over our working years, and are now on Medicare, we still must pay the monthly fees - usually deducted from our social security benefit (appx $160/month). We also have co-pays for medical appointments and for our drugs. Nothing is "free."

All we need to do is the same program for a universal health care system; have fixed fees for everybody as a co-pay for service - which I believe in. No matter how we slice it, there will be some surgeries that many will not be able to afford otherwise.

If our country can afford to pay foreign countries billions of dollars every year, we should certainly be able to afford universal health care for all Americans. After all, it's our tax dollars - and the federal deficit that must eventually be paid back.

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old europe wrote:

georgeob1 wrote:
Free markets work much better. We already have government sponsored medical care for the poor and the old.

Funny, because you managed to show the contradiction in the current US system, in two subsequent sentences.

Of course, you could take that current approach, and modify it only to the point where you get a universal health care system. Universal health care doesn't have to mean single payer system, or the elimination of competition...

I see no contradiction at all. We have special provisions for those who, as a group, may merit public assistance, coupled with a relatively free market for everyone else. In fact we have (in my view) too much government interference in the health care system already.

Please provide some details of extant "Universal Care Systems", as you define them, that provide free choice of providers and preserve competition throughout all stages of care delivery. I am anxious to learn.

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cicerone imposter wrote:

Although those of us who paid into the social security system over our working years, and are now on Medicare, we still must pay the monthly fees - usually deducted from our social security benefit (appx $160/month). We also have co-pays for medical appointments and for our drugs. Nothing is "free."

All we need to do is the same program for a universal health care system; have fixed fees for everybody as a co-pay for service - which I believe in. No matter how we slice it, there will be some surgeries that many will not be able to afford otherwise.

Medicare is a poor example there. Medicare is a pay-as-you-go system just like Social Security is. Retirees only currently pay a small amount because there are others who are paying a portion of their wages into the system without being covered yet.

Once you eliminate private insurance and put everyone on the same system you wouldn't have those workers paying for the retiree any more (and teh portion of Medicare paid for through Gneral Revenue would probably also go away). If you had to pay the full cost of your Medicare coverage your "fixed fees" would eat up more than half of your monthly Social Security check.

Also, as pointed out to Advocate several months back, the States pay a large portion of the Medicare bill. He chooses to ignore that and pretend that cost doesn't exsist when he makes his little false comparisons.

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The free market doesn't always work. For instance, I don't see anyone calling for the destruction of social security and Medicare. They filled a need not met by private enterprise. Also, were it not for the post office, mailing things would be prohibitive, and many, many, areas would not have service. Many transit systems would be nonexistent. Etc., Etc.

What is more important than the availability of decent healthcare.

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Nothing works all the time in capitalism or socialism. There are some things in developed countries that justifies the social insurance of a pension plan, health care, military, security, international commerce, transportation, and "free" education.

Balance between the two extremes is necessary for the success of any country to survive and grow.

I will continue to advocate for a universal health care system; the details can be hashed out by our government(s). It's not for "personal" reasons, as I am covered under Medicare, and will continue to enjoy this benefit until I'm gone. I only wish it for our children and grandchilren; I believe it benefits everyone - especially the children. I would like to see them free access to health care irregardless of ability to pay.

I only wish this goal is really "universal."

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georgeob1 wrote:

Please provide some details of extant "Universal Care Systems", as you define them, that provide free choice of providers and preserve competition throughout all stages of care delivery. I am anxious to learn.

Don't know. Lots of models, george. Universal health care is certainly not the same a socialized health care system. There are many countries that have a universal health care system without having a single entity pay for all health care costs (single payer system).

There are systems that allow you to pick the insurance, physician, hospital that you want to, but make paying into a health insurance mandatory. That can be coupled with state run parts of the system (most likely insurance and/or hospitals).

I find the way Americans often use "Single Payer System" and "Universal Health Care System" interchangeably quite a bit confusing.

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Well, since we don't have either, perhaps the confusion is understandable.

I find your evident willingness to make fine distinctions between "socialized", "universal", and "single payer" systems a bit inconsistent with your blithe reference to "lots of models out there" as a substitute for specifics.

As far as I am concerned, if the system is universal then it must involve a substantiual degree of government compulsion and taxation. These almost inevitably lead to government regulation of the prices and availability of basic services -- both of which actions effectively destroy competition. What "single payer" is there besides government, or perhaps some illusory "independent" body created and regulated by government?

In my view the 'full service' social welfare systems and tightly regulated labor markets that prevail in Europe are workable only in a period of prosperity (usually generated by rawer forms of capitalism that preceded them) in countries with little immigration and cultural diversity. Moreover, I doubt that, even in such countries, they are sustainable in the long run. Western European nations are already moderating the worst of their excesses in this area. In addition, as is the case in France, such programs exacerbate other social and economic issues even in the presence of only moderate levels of immigration.

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georgeob1 wrote:

I find your evident willingness to make fine distinctions between "socialized", "universal", and "single payer" systems a bit inconsistent with your blithe reference to "lots of models out there" as a substitute for specifics.

Okay, georgeob1. I accept that you are a newbie to that kind of terminology.

Specifics. Right. Take Germany, for example.
There are private hospitals, state run hospitals, and stuff in between. There are hospitals run by the states, by communes or counties, by universities, by cities. The part of the system is not too different from the one you have.

There are multiple insurance organisations you can choose from, all linked by a common legal framework. Employees working for a company (not freelancers or contractors), people receiving payments from the government (unemployment, retirement, ... benefits) as well as students have to pick one of these insurance companies (there are about 242 to pick from). That part of the system is called the statutory health insurance.
Apart from that, there's the private health insurance. Employees earning a certain mininum amount (~ $63,000), civil servants, and self employed people can either choose from the list of those insurance companies or can decide to voluntarily pay into the statutory health insurance system (via picking one of the "public" insurance companies).

Visits to your physician are covered by your insurance. If you're paying into the statutory health insurance, you'll have to pay an additional 10 in charges for medical registration (a quarterly surcharge due at your initial visit to the doctor's office). There's no fee for checkups.

There are more details, but that's roughly it. As you can see, it's not a single payer system, but still quite universal.

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Oh, and as this thread is about health care systems, I ignored your quips about social welfare systems.

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old europe, Thank you! Good info. I'm sure there are other "universal" systems that can also provide flexibility and options that will make it more attractive to the general public that the US can use in planning ours.

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Imposter, as you aptly point out on another thread, universal education is broken. What makes you think universal health care won't do the same thing? Why do we have to go down the same failed path zillions of times to prove an age old principle, that being central planning does not work, plain and simple.

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old europe,

If I understand you correctly, in Germany all residents must join one of the approved ("linked by a common legal framework") insurance programs. No one has the right to simply choose a doctor or hospital and simply pay the bill himself. OK so far??

Just what is this "common legal framework"? Does it set a limit on the treatments available or covered by the insurance programs? Do these limits apply to all approved insurance programs? Who sets the limits? Are the insurers free to set their own premiums, or are they controlled (or limited) by the government?,

I take it the "statutory insurance program" is free to those receiving government payments, and that some self employed and high salary employees are free to join it if they wish by paying the government premium. Does it provide the same benefits up to the same limits as the other approved insurance programs?

I assume the fees doctors and hospitals can charge for their services are set by the various insurance programs. Are they the same for all programs, or do they vary? Are doctors and other service providers free to serve multiple insurance programs?

What you have described to me appears to be a program of socialized rationing of services, but with multiple choices, presumably of the cost and associated rationing limits associated with each insurer, available to all residents. How is the universality element enforced? Does the government know which insurer covers each resident?

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Huh. I'm not an expert on all of that, so I can only roughly outline these things.

georgeob1 wrote:

If I understand you correctly, in Germany all residents must join one of the approved ("linked by a common legal framework") insurance programs.

Not quite. If you qualify for private health insurance, you can pick one of the private health insurance companies, pick one of the statutory health insurers, or not pick one at all.
If you decide to leave the statutory health insurance, it's quite hard to join it again later - which results in many self employed and high salary employees remaining in the statutory system.

georgeob1 wrote:

No one has the right to simply choose a doctor or hospital and simply pay the bill himself. OK so far??

Well. You always have the right to choose a doctor or hospital. You can also pay the bill yourself. However, the number of people who choose to do so simply because they don't have any insurance plan at all is very small. It is estimated that there are currently about 300,000 people without any kind of insurance (out of ~82 million).

georgeob1 wrote:

Just what is this "common legal framework"? Does it set a limit on the treatments available or covered by the insurance programs?

Part of that common legal framework is a risk structure compensation scheme. Statutory health insurers pay a certain percentage (less than 13 percent) of the premiums they receive into a common pool, that will be re-devided according to risk and age structure of the members.
Another part is a "risk pool", managed in the way of a fond, that compensates insurance companies for the costs of high-intensity care patients (typically accessed by the insurers for less than 1 percent of their members). A couple of other parts are in place, too.

The limit on treatments is not set by the legal framework, but rather by the insurance companies, based on your premiums. Your premiums are also tied to your income (however, they will somewhat vary between insurance companies). You will pay a certain percentage (depending on the insurer) out of your salary, and premiums are paid in equal parts by the employer and the employee. You always have the option to pay into an additional private insurance (if you don't qualify for private insurance) or pay more for a different insurance programme or with a different provider within the statutory health insurance. In summary, you will pay more for the same programme when you earn more (though the percentage will remain the same), but you can decide to pay higher premiums for additional services.

georgeob1 wrote:

Do these limits apply to all approved insurance programs?

There's a large number of insurance companies offering a statutory health insurance programme. Programmes will slightly vary from one company to the other. You can usually choose to pay more, and have more services covered. You can also choose to pay into additional insurances. There are minimum services that an insurer has to provide. An insurer cannot choose to not cover these services. In that sense, these limits apply to all insurance programmes.

georgeob1 wrote:

Who sets the limits?

The limits in the sense of a list of minimum services that an insurer has to provide are set by the respective laws. There are also several types of statutory health insurers, e.g. insurance types for seamen, miners or farmers, or for company insurers (Siemens, for example, would have its own insurance plan, in the form of a statutory insurance [company]. That insurance could then decide to accept non-Siemens employees as well). Limits and conditions may vary between those various types (I don't really know enough about that).

georgeob1 wrote:

Are the insurers free to set their own premiums, or are they controlled (or limited) by the government?,

Insurers are free to set their own premiums. Premiums within the statutory systems may vary up to 3.5 percentage points.

georgeob1 wrote:

I take it the "statutory insurance program" is free to those receiving government payments, and that some self employed and high salary employees are free to join it if they wish by paying the government premium. Does it provide the same benefits up to the same limits as the other approved insurance programs?

Well.... It's the same system, and the same insurer. If you're self employed, you'll have to pay the premium that specific insurer within the statutory system charges you, and the programme will cover the respective services you pay for - just as it would if you would pay for it as an employee.

georgeob1 wrote:

I assume the fees doctors and hospitals can charge for their services are set by the various insurance programs. Are they the same for all programs, or do they vary?

They vary. There's no short answer to that question.

georgeob1 wrote:

Are doctors and other service providers free to serve multiple insurance programs?

Yes.

georgeob1 wrote:

What you have described to me appears to be a program of socialized rationing of services, but with multiple choices, presumably of the cost and associated rationing limits associated with each insurer, available to all residents.

Doesn't seem to be "rationing" to me. Rationing would assume that there's only a limited amount of something available. But you can always get more service for more money, in all programmes. You can pay more in the statutory programmes, you can certainly pick in the private programmes, and you can choose to pay for additional insurances. So it's more of a "rationing" as in demand and supply.

georgeob1 wrote:

How is the universality element enforced?

The statutory health insurance is mandatory, and is to be paid in equal parts by employers and employees.

georgeob1 wrote:

Does the government know which insurer covers each resident?

Not by definition. No.

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georgeob1 wrote:

If I understand you correctly, in Germany all residents must join one of the approved ("linked by a common legal framework") insurance programs. No one has the right to simply choose a doctor or hospital and simply pay the bill himself. OK so far??

Wrong so far. You can choose any doctor you want and any hospital you want, and your healthcare provider will pay for it. The only constraint is that the doctor works for your healthcare provider, but that's not a problem in practice.

georgeob1 wrote:

Just what is this "common legal framework"? Does it set a limit on the treatments available or covered by the insurance programs? Do these limits apply to all approved insurance programs? Who sets the limits? Are the insurers free to set their own premiums, or are they controlled (or limited) by the government?,

The government defines a catalogue of treatments that healthcare providers pay for. In Germany, this catalogue contains pretty much everything except alternative medicine (like homeopathy) and cosmetic medicine (the government pays for amalgam dental fillings, but if you want gold fillings or ceramic, you have to pay the difference between that and amalgam).

Generalizing from the amalgam example, you can simply go to the hospital or the doctor and pay the bill yourself. But it won't be all the bill. The government will pay the part that's covered by the plan, and you just pay the rest.

Insurance companies are half-free to set their own premiums. They must accept everyone who applies (with few exceptions not worth going into here). They must insure everyone at the same percentage of their gross income. But they can freely set this percentage.

georgeob1 wrote:

I take it the "statutory insurance program" is free to those receiving government payments, and that some self employed and high salary employees are free to join it if they wish by paying the government premium. Does it provide the same benefits up to the same limits as the other approved insurance programs?

Yes to all. And it pays for enrolled students who aren't covered by their parents' plan.

georgeob1 wrote:

I assume the fees doctors and hospitals can charge for their services are set by the various insurance programs. Are they the same for all programs, or do they vary?

Yes. The government negotiates the prices with doctors' organizations (I think), so the service costs the same whichever insurance pays for it.

georgeob1 wrote:

Are doctors and other service providers free to serve multiple insurance programs?

They are.

What you have described to me appears to be a program of socialized rationing of services, but with multiple choices, presumably of the cost and associated rationing limits associated with each insurer, available to all residents. How is the universality element enforced? Does the government know which insurer covers each resident?[/quote]

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There are minor corrections to what oe and Thomas said ... that's not only minor but very specified and generally not happening in someone's life (or if, totally unnoticed: e.g. some doctors, like specialists and/or university professors, can charge higher - but nothing the patients notice since covered by the insurance.)

Some, very few indeed, doctors only serve private insurance companies.
Generally, all doctors accept all the 242 oe mentioned and all the private companies.

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cicerone imposter wrote:

old europe, Thank you! Good info. I'm sure there are other "universal" systems that can also provide flexibility and options that will make it more attractive to the general public that the US can use in planning ours.

It's been suggested elsewhere that America follow the French version of Universal Health Care.

The problem with adapting the French program to the US, is that French physicians now make 1/3 as much in income as their American counterparts! Will American doctors be willing to have their salaries reduced by at least 67% in a Universal Health Care
program modeled after the French system?

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Miller wrote:

The problem with adapting the French program to the US, is that French physicians now make 1/3 as much in income as their American counterparts! Will American doctors be willing to have their salaries reduced by at least 67% in a Universal Health Care
program modeled after the French system?

So family doctors in the USA earn in average $200,000 and specialists $320,000 per year? (Based on the the French figures as of 2001, the last I could find online.)

I suppose, you find such in France as well as elsewhere .... for those, who practise outside the system.
Besides that, these figures only show what doctors got from their work paid by the insurance companies/health system: they don't show at all what they earnt from their private business(es).

I would see a much bigger problem that patients have to pay quite a lot themsleves in the French system, especially that they have to finance the bills completely in advance .... and don't get back more than about 70% later.

[The best paid medical doctors in Europe are those who get their money from the UK's NHS, btw. Statistically.)

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IT'S TIME FOR UNIVERSAL HEALTH CARE

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