News & Politics - Health Care in the US

Lexis · 12-29-2006, 08:39 AM

I read this op-ed from the LA Times a few days ago and thought it was quite interesting.

Quote:

Going universal
The American healthcare system is, simply put, a mess, but we may finally be ready to fix it.
By Ezra Klein, EZRA KLEIN is a writing fellow at the American Prospect and a blogger at Ezra Klein.
December 26, 2006

THE STATISTICS, by now, are well known. Forty-seven million uninsured Americans. Premium increases of 81% since 2000. Small businesses failing, big businesses foundering, individuals priced out and, amid all this, skyrocketing profits for insurers, hospitals and pharmaceutical manufacturers.

The American health system, put simply, is a mess. An expensive one. Indeed, in 2002, we spent $5,267 per capita on healthcare — $1,821 more than Switzerland, the nearest runner-up. And yet we had higher infant mortality, lower life expectancy, more price inflation and an actual uninsured population, a phenomenon virtually unknown in the rest of the developed world, where universal healthcare is, well, universal.

hese are unsustainable trends. The U.S. healthcare system cannot, in its current form, go on forever, or even for very much longer — employers can't afford it, individuals can't handle it and the country's conscience won't countenance it.

And change may come sooner than most think. Across the country there are unmistakable signs that the gridlock and confusion sustaining our sadly outdated system are coming to an end and that real reform may finally emerge, possibly even starting in California, where Gov. Arnold Schwarzenegger is promising to spend his upcoming State of the State speech explaining how he will push the Golden State closer to universal healthcare in the coming year.

And it's about time. Few mention this, but the American healthcare system is something of a mistake. It blossomed out of a World War II tax reform meant to guard against corporate war profiteering. Liberals, with their usual combination of good intentions and inadequate foresight, imposed massive marginal tax rates on corporations, effectively freezing their profits at prewar levels. But the law had a loophole: Corporations could funnel their wartime riches into employee benefits, such as healthcare, thus putting the cash to use within their company. And so they did, creating the employer-based healthcare system.

But healthcare was simpler in the 1940s, and far less expensive. In the 21st century, it's not simple at all. Once a perk of employment, health insurance is now a necessity, and a structure that dumps such power, complexity and cost in the laps of employers is grotesquely unfair to both businesses and individuals. There's no logic to an auto manufacturer running a multibillion-dollar health insurance plan on the side; it should stick to making cars. There's no excuse for pricing the self-employed and entrepreneurial out of the market. And there's no reason the owner of a three-employee start-up should have to go to bed with a heavy conscience because his coffee shop can't pay for chemotherapy.

But health insurance is not only the inexplicable responsibility of business; it is a big business, which is why the system survives. The medical-industrial complex is a massive, remarkable beast, consuming a full one-ninth of the American economy and offering astonishing profits to many of the participants (indeed, Big Pharma was the most profitable industry in the U.S. from the 1980s until 2003, when energy companies wrested away the top spot). As with any lucrative industry, the winners are resistant to reforms, and they have a formidable army of politically lobbyists, PR specialists and image consultants helping to preserve their position, to preserve a mistake.

But there is evidence, finally, that their castle is being stormed. Massachusetts has passed the nation's first near-universal healthcare plan, creating a structure that should cover 95%-plus of its citizens by making healthcare as mandatory as car insurance. Nationally, the Democratic resurgence has returned universal healthcare to the agenda and its advocates to power. In the House, Rep. Pete Stark (D-Fremont), a staunch Medicare-for-all advocate, is expected to be chairman of the health subcommittee.

Surrounded by an unlikely array of union leaders and corporate chief executives, Sen. Ron Wyden (D-Ore.) has unveiled an inventive, comprehensive reform plan that would end the employer system forever. What businesses pay in employee premiums would be redirected to employee raises; insurers would offer their plans through state associations that would no longer allow price discrimination for reasons of health or job status; and everyone would have to buy in. Universal coverage would be achieved in under two years.

...

SOME OF THE industry's more enlightened members are going even further. In California, the heads of Kaiser Permanente — a historical "good cop" insurer amid the almost cartoonish villainy of the industry — have proposed a serious, albeit extraordinarily complicated, plan for achieving universal coverage in the Golden State. The details of the plan are unimportant; it's the constructiveness of the proposal that matters.

And joining them in calling for reform is Schwarzenegger, who recently seized on a report by the New America Foundation showing that cost-shifting caused by the uninsured population costs each family in the state the equivalent of $1,186 in annual premiums. His plans for reform will be announced at the State of the State address Jan. 9.

The work is not done, of course. There are arguments yet to be had, wars yet to be fought.

Insurers want to retain their ability to discriminate against the ill and the old; conservatives want individuals to assume more risk and expense in order to force wiser health decisions; liberals want the government to guarantee universality and utilize its massive market power to bargain prices down to levels approximating those paid by other developed countries.

What's important, though, is that for the first time since the early years of the Clinton administration, these arguments are being made, and employers, insurers, politicians and, most crucially, voters are making their way back to the table.

The realization that our illogical, mistaken healthcare system can't go on forever has dawned, and so it will end. The question now is what replaces it.

Going universal - Los Angeles Times

I'm from the UK were healthcare is free at the point of use (cost comes from your taxes). The system isn't perfect but it does mean there is some kind of equality in medicine although there are also private hospitals/insurers. But even if you use them, you are still required to pay taxes which go towards the NHS.

I'm curious as to what people's experience with health care in the US is, if you're happy with things the way they are or want things to change.

nopal · 12-29-2006, 09:47 AM

Healthcare costs here in the US are ridiculous. It is well past time for us to join the 21st century and have universal healthcare. As it is, a middle-class family can be hit by one major illness or accident and need to declare bankruptcy because of medical costs; and low-income families hav no chance whatsoever of financially surviving a major medical crisis.

elisheva · 12-29-2006, 11:33 AM

I live in Canada, but was born in the US. Before she could give birth to me, my mother had to sign a cheque for $600 to get into the hospital. She then got to spend close to a year chasing down her health insurance company to get that money back. Imagine how much worse it is for the millions without insurance?

There are problems with Canadian Medicare, obviously, but it's still a far better and more just system (as would be any European-style accessible health care service). There are plenty of great things about the US, but health care isn't one of them. There's no reason why the US shouldn't be able to establish universal health care - it's honestly ridiculous.

dayne · 12-29-2006, 12:10 PM

The medical insurance companies and even various lobby groups made of doctors carry a lot of weight in the US. I know that there are a bunch of physicians in the US that would be more than happy with being able to treat everyone regardless of their wealth, but when it starts biting into their pockets, many may just not be that supportive of such a proposal. The powerful players in the health care system are pretty well entrenched right now. Maybe, twenty years ago they could have done something about it, but a current overhaul would be close to impossible (IMO) despite the obvious benefits. Clinton tried to make significant changes, but even he failed.

Besides, do the majority of Americans want a universal health care system? I know that the obvious answer would be "YES!", but I am not so sure. They may just associate such a system as being more social democratic, and opposed to their inherent capitalist ideals.

Lexis · 12-29-2006, 02:02 PM

But is the idea that universal health care may somehow be "social democratic" really enough to make it an unappealing option? Is that a really strong issue in American society?

dayne · 12-29-2006, 05:18 PM

I can't say for sure. But I am sure that plenty of people would also balk at being "forced" to stand in line for treatment with other "common folk". Many might interpret it as some sort of infringement of their "freedom/right" to buy high-quality and readily accessible health services and not be stuck with the status-quo (whatever that might be). That's what is kind of happening in Alberta (Canada) right now.

Personally, I am glad that I live in a country where there is universal health care (Canada), but I can also see problems arising in trying to switch a particular society from one long-established system to one that can be totally different.

Lexis · 12-29-2006, 05:37 PM

Its tricky. There are flaws in state run healthcare and each country has to find something that works for them. But as I mentioned, the UK operates a dual system and it seems to go OK. I imagine the type of person who would be concerned about waiting in line with the common people might be the kind of person who would be able to pay for ritzier self-funded insurance/care. That's pretty much the way it works here.

ceilirose · 12-29-2006, 06:32 PM

Well I've been without health insurance and with it and having it is much better. I'm not sure how the mechanics of it would work or if it would be a mandated single payer system.

Right now my employer pays my monthly premiums. When I go to a doctor for just a visit I pay anywhere from $5.00 to $20. If there are tests involved then it just depends what percentage the insurance pays.

Waiting times - you generally have to wait about 6 weeks to 2 months to get an appointment with an ob-gyn, two to three weeks for other specialists. Waits for non-elective surgeries vary. My friend has to have back surgery - he was scheduled this week and the first opening is February 12th. I had a root canal this summer and had to wait almost 3 weeks for the endodontist to see me.

The big worry among the non-insured is that at any moment you can have an accident and have something relatively minor (broken arm, leg) and you'll be in debt for thousands of dollars. If you get something really serious then you're in danger of going bankrupt.

I don't know what would work best but there has to be some sort of resolution to it.

cls21c · 12-30-2006, 12:01 PM

I work with a person who is one of the millions of uninsured and that's because she refuses to pay for our health insurance. She does however have no problem ordering out for lunch everyday and buying every dvd she wants. This makes me wonder how many of the millions of uninsured are uninsured because they just won't pay for the coverage. Like Celirose is costs me just $5-$15 dollars for a doctor visit and nothing to get my teeth cleaned and $20 to get my eyes checked. I paid $28 for a $143 tooth filling. There's a difference between people who don't have insurance and those who don't have access to insurance. The latter are the only ones the government should be helping.

dayne · 12-30-2006, 04:53 PM

But how much do the medical insurance companies cover? I am assuming that in most cases, there is some sort of ceiling that is easily exceeded whenever one is forced to stay in the hospital for a while.

One of my friends is both an American and Canadian citizen. While living in the US, his father developed cancer - but the huge hospital costs easily exceeded their insurance limit. They came back to Canada, where he was treated without having to fork over their savings.

ceilirose · 12-30-2006, 08:24 PM

Quote:

Originally Posted by dayne (View Post)

But how much do the medical insurance companies cover? I am assuming that in most cases, there is some sort of ceiling that is easily exceeded whenever one is forced to stay in the hospital for a while.

One of my friends is both an American and Canadian citizen. While living in the US, his father developed cancer - but the huge hospital costs easily exceeded their insurance limit. They came back to Canada, where he was treated without having to fork over their savings.

I think it depends on the extent of your coverage. When you have Medicare (over 65) it pays pretty much for everything.

The system we have now in the US is unequal. If you have a job that gives you good coverage and you're fairly healthy you do ok. If not then it's a hardship. I'm not quite so sure that it can be all sorted out as quickly as the op-ed says it can. I just know that with new leadership we have in Congress we have a small opening to do something about it.

elisheva · 12-30-2006, 09:18 PM

Quote:

Originally Posted by dayne (View Post)

One of my friends is both an American and Canadian citizen. While living in the US, his father developed cancer - but the huge hospital costs easily exceeded their insurance limit. They came back to Canada, where he was treated without having to fork over their savings.

Hmm. As a Canadian taxpayer, I must say I'm not too crazy about people doing that. Seems unfair to live in a country and pay taxes in that other country (at a lower rate) then come back and profit from the higher taxes paid by actual residents of Canada.

Lexis · 12-31-2006, 07:30 AM

I understand why someone would do that but like elisheva, I do find it frustrating from an economic standpoint. This kind of thing has been dubbed "health tourism" in the UK.

I think its sad that someone had to uproot their life for treatment in another country though.

ceilirose · 12-31-2006, 09:00 AM

It is frustrating but on the other hand if you're in a literal life and death situation you do what you have to do. I can't imagine facing the ordeal of cancer with the underlying fear that you'll go bankrupt because of the cost of the treatments.

dayne · 12-31-2006, 09:28 AM

While, it can easily be seen as taking advantage of a system that you are no longer contributing to. And in a way it is. But when you are desperate.......

So, I can't say I blame them.....


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