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Discussion in 'Et Cetera, Et Cetera' started by overshot, Jul 31, 2004.
I was just thinking about this today.
Javierdude22: Why the poll?
Well, all the evidence is that the main problem with health care is underfunding. Most of our health care spending goes toward marketing and CEO salaries because it's based on the profit motive; even countries like Chile have better health care even with more primitive medical technology.
But I will say, reservations have socialized medicine. A special bureaucracy, IHS, which gets less than 50% per capita than federal prisons. But if you want a tubal ligation, they're the people to go to; you don't even have to ask.
It would be interesting to hear some of the opinions on healthcare from our British friends. I've heard so many pros and cons on socialized medicine. Yes, I think the state of healthcare in the US is pretty dismal because of how insurance companies have jacked up costs and decreased coverage, yet at the same time (and this is my conservative side coming out--don't flame me ) I have to pay for my healthcare, so I feel everyone else should have to, also. Yes, it comes out of my paycheck, but it's my money that goes for the coverage. So I have mixed emotions about it. In a perfect world everyone would have coverage, but we're not in a perfect world. So let's hear from those who live in places where healthcare is a government benefit. I personally don't want to pay more taxes and don't want the government controlling one more part of my life, but is this going to end up being a necessary evil?
If my understanding on GATT [General Agreement on Tariffis and Trade] is correct, failure to have a government-sponsored health care system makes many products for export less competitive. It is possible that a substantial fraction of the jobs outsourced overseas are a result of the employee health care penalty.
huh? Currrent rules under GATT health benefit plans funded by employees and employers are defined as a benefit; in the EU on the otherhand, health care is a government program that is funded by taxes. When calculating the fair price for a product uner GATT rules in a trade dispute [think steel, paper, lumber, grain, widgets, etc], taxes are an expense and can be used in calculations related to the cost to produce. Benefits cannot be used in calculations for a fair and comparative value. Since national health care costs are about 15 percent of GDP, U.S. commodity products probably face a 15+% disadvantage under GATT. Oh yeah, jobs in steel and manufacturing pay more than flipping burgers.
For me this is one of the hot button issues that the Congress and the administration should be studying. Otherwise, we may become a nation of low-paying service industry providers and burger-flippers as the world passes us by.
Perhaps, the question is: Can we afford not to move toward government managed health care?
And there is the question of equity: How can government deny health care to child that may be asked one day to step forward and defend America?
Very interesting topic and one that needs more attention.
Jonb, you are absolutely right. IHS will make you wait for days, weeks, months for medically necessary services, but will perform things (tubal ligations) to keep us from populating. I will not get on a tangent about that, but..... :angry:
I think we cannot afford not to research do an indepth analysis on managed health care. Fortunately the state covers our healthcare cost (state employees) and contributes the full amount. The down side is that we do not have an HMO, so we have no other choices. The cost, however, is absurd.
I fully understand that taxes would rise, to cover the cost of such a program. However, I think over a period of time they would subside, especially considering that the market would not be able to fluctuate the cost of healthcare. I pay a considerable amount in taxes. Hell, a little more will not hurt me. The way I look at it is from a financial standpoint anyway. My parents are older, but are not able to have health coverage. They do receive some benefits from the tribe, but would have to drive over 6 hours away to get medical assistance. Hence, I normally flip that bill. With national coverage, they would have insurance would not have to make hard decisions about which medicine to buy or when to go the doctor.
We should explore other countries policies......
Trust me, BB: You don't want an HMO. They make IHS look competent. Hell, they make these fake "medicine men" with a plastic tarp over the sweat house look competent.
Taxes wouldn't rise as much as you think; if the government regulated medicine, medicine wouldn't cost as much. As it is, a lot of American health care dollars are ultimately spent on marketing and raises for CEOs. (Hard to tell which is more useless.)
This is info from 1998:
Americans spend 14 percent of GDP on health care; Germany devotes 10.5 percent of GDP to it; France, 9.7 percent; the Netherlands, 8.6 percent; Italy, Sweden and Japan between 7 percent and 8 percent; and Britain, 6.9 percent.
Source: Suzanne Kudski and Len A. Costa, "American vs. The New Europe: By the Numbers," Fortune, December 21, 1998.
The U.S. spends as much or more on health care as members of the EU. The difference is that in the EU all are covered; but in the U.S. around 40 percent do not have any health insurance. There are inefficiencies in our system such as $7.50 per Bayer asprin delivered in a hospital or the $3.00 q-tip....not to mention the insane paperwork. It is a system obessed with documentation rather than returning patients to health.
Maybe, but I'm more familiar with Indian health problems. The typical Indian gets less health care coverage than the typical felon.
As I said, the problem is on the supply side: With any product you buy in America, more money goes to marketing and CEO salaries than to, well, any other part of the corporate budget.
I follow you, jon. I think the variety or choice would be good though.
Anyway, I concur with you considering the plight of IHS and funding used to treat Indians. It is a treaty right, but as always, the government looks for its outs in offering that assistance.
One thing that I have noticed (I do a lot of consulting work for tribes in the states and Canada) is that tribal entitities are spending a horrific amounts of their health based funds to treatment centers. This is an epidemic in Indian country. The government is not offering more funds to provide healthcare, rather they are making tribes choose how to spend or appropriate their money. It is a shame. If you want to discuss further, send me a message....
As a federal employee, I belong to an agency subsidized HMO. When I moved to my present job, I researched as much as I could on the several plans available. I finally picked the health plan that consistently ranked at the top of employee satisfaction surveys.
Its not a bad health plan but it sure isn't great, either. While the individual caregiver components of the plan (doctors, nurses, therapists, techs, admin, etc) seem to be caring and competent, the sheer caseload they labor under often undermines their collective effectiveness. In other words, it often seems like the patient is on a medical assembly line that is moving too fast for follow up or quality control. Too often the patient is forced to jump off the assembly line, back up, and re-enter it again to insure proper care and follow up. Sometimes the patient just gets disgusted with the assembly line and abandons it altogether because of all its hassles and inadequacies.
I've found I must be very proactive and observant to insure I get the proper care for myself. I can't trust the HMO to look out after my health, I have to do it myself. I'm not a doctor yet I must ask a lot of detailed questions and press issues at times to make sure adequate care is coming. Sometimes the care I receive is adequate, sometimes it isn't. One thing is for sure, the whole HMO process leaves me with a very hollow feeling.
Would nationally sponsored government care prove to be any better for me individually? Probably not. Would it be better for the millions of Americans who have none at all? Probably so. I sure don't know what the best path is.
Definitely on the money when you point to CEO salaries, management inefficiency and the profit motive as major contributors to Americas needlessly expensive healthcare.
Theres an interesting paper from the University of Maine ( http://dll.umaine.edu/ble/U.S.%20HCweb.pdf ) which suggests current piecemeal system would benefit from more central control. The hodgepodge of employer insurance, managed care, government funding and personal out-of-pocket payments is a nightmare to administer. Management costs account for somewhere between 19% and 24% of total US health care expenditure. By comparison, my employer (a British professional services firm) spends 8% of revenue on finance, administration and management.
The Center for Medicare and Medicaid Services http://www.cms.hhs.gov/charts/healthcaresystem/chapter1.asp quotes some alarming statistics. In the two decades since 1983, the number of managers and administrators working in US healthcare increased seven-fold, quadrupling in the last decade alone. There are now more managers than doctors. To quote the late David Ogilvy, if you owned a farm, would you have more milkers than cows?
year 1983 /1990 /2000
physicians: 519,000 /577,000 /719,000
managers/admin 91,000 /174,000 /752,000
The lack of a central watchdog over US healthcare costs plenty. The system needs some intelligence and organization. But who should provide it? Many believe government to be incapable of such vision, and argue that the inefficiencies would be even worse if the public sector ran the whole thing.
But then again, maybe not.
Some Americans believe (naïvely, I think) that private enterprise always performs better than government enterprise. Even after we see the Enrons, Tycos, WorldComs, and sundry dotcom cowboys piss billions against the wall in the virtual casino that modern business has become. Auditors like Arthur Anderson and its ilk sanctioned horrific corporate waste. And the pageant of underperforming fat-cat CEOs continues unabated. Physicians for a national Health Plan report that when US Healthcare merged with Aetna in 1996, the $967 million received by CEO Leonard Abramson could have provided healthcare for every uninsured child in the state of Massachusetts until they reached puberty. http://www.systoc.com/newscomments/news/april98/cp040298.htm
The U. of Maine paper quotes some vivid evidence. Lets look at how much different kinds of hospitals spend on administration and management
Private, for profit hospitals---34% of turnover
Private, non-profit hospitals---24.5%
Medicare, the most thoroughly governmental part of the healthcare system, spends only 2% of its turnover on administration.
The competitiveness and efficiency of the private sector brings rewards to many aspects of life. But maybe medicine isnt one of them.
It strikes me that the benefits of free enterprise flow most abundantly in a market where purchases are discretionary. Companies can offer better (or cheaper) goods and services which spur people to choose to spend more money, causing the company and the broader economy to grow. Healthcare doesntnay, shouldnt work that way
If youre sick, you simply dont shop around; when run over by a bus, youre in no position to ask the ambulance driver to take you to the cheapest hospital.
Nor should one need to ask for a better hospital. We expect that there should be one high standard to which all practitioners adhere. Not much room to differentiate on quality in order to attract more custom, and thus to grow.
Healthcare companies cant develop their own market through the usual commercial methods. Honey, Kaiser Permanente is having a sale on colonoscopies. I think Ill stop in on the way home for a quick look up the wazoo. Humana makes being sick such a pleasure that I just want to run out and catch pneumonia! Yeah, right.
That leaves two ways for a healthcare company to grow its profits: cut corners or raise prices. Not a pleasant prospect for us customers, is it?
The dynamics of a free market simply dont give Americans better health. Market forces cannot regulate the quality and cost of healthcare--it's not like boxes of cereal or bars of soap. Few consumers have the technical skill to evaluate what they're buying. They're simply not in a position to exercise choice at point of purchase (or choose not to make a purchase at all), which is how competition works in the broader economy.
Betterand cheaperto pay not through the cash register, but through the tax collector.
In the developed world, only the United States and South Africa dont provide their citizens with some level of basic health care as a right. There is overwhelming empirical evidence from around the globe that universal, government-funded health insurance (accompanied by government policing of standards, service levels and costs) just plain works. The outcomes are often better than in the United States, and vastly more economical. Yes, most of these systems have some drawbacks, but let's not overlook their virtues.
These words may prove anathema to many. Americans let government into their lives reluctantlyas a last resort, when all else has failed. Given the performance of the US government on some occasions, they may have good reason. But do I want the government telling me what to do, or an HMO? On both their records, I'll take my chances with the government.
Which raises another question, even more pertinent. That question is not whether the richest nation on the planet can afford the best healthcare in the worldif it could just get its act together. But rather, why is it that the richest nation on the planet cannot afford (or doesnt choose to buy) the best public governance in the world?
Sorry to post at such length, but it's a pet peeve.