[normajean777]

I live in Canada. Alberta to be exact. We pay health care premiums (ambulance, and some other things, I'm not to sure). They aren't $1000s but they do add up. haha actually the Blue Cross insurance commercial says that a trip to the hospital could cost $1000s. So who knows what exactly we pay for and what specifically we don't.

Anyway then there is wait times. We have all heard about them. 1-2 years for some surgeries. Absolutely ridiculous.

Also our drug costs aren't as high as the states, but they aren't included in "universal healthcare".

Actually 2 funny things: 1) I just watched Sicko the other day (first time), basically its good timing, 2) Someone on the radio was pretending that they pay more for healthcare in alberta than they do in the States. It was ridiculous, no one could believe it (although in the rare case that it could be true, I'd be very surprised)

[Chrysostom]

Originally Posted by JerryLove

I think that "X" care is appropriate.
Many other people think that "Y" care is appropriate.

Y > X (life support for old people, saving crack babies, treating low-survivability disease, whatever (I'm not trying to pin you into any particular difference, just set an idea of what those might be))

Since I want X, I wouldn't choose insurance that covers Y and my insurance costs would be lower than those who would choose Y. I don't want to pay for Y since I don't want it, and so shouldn't subsidize those that do want Y.

Is that about right?

Pretty much, but with one distinction. My conclusion was less that I shouldn't subsidize those who don't want Y and more just that that's why my insurance bill is and will be cheaper -- not that I'm taking bets and winning. There's also the fact that since I live so close to Mexico and am generally able to self-diagnose, if I need any basic medicinal treatment I don't need insurance. So all I need is a "catastrophe plan" from insurance; I'm willing to accept all "regular" costs out of pocket, since those are minimal.

In the past I had dental insurance because I haven't seen myself as significantly below the mean annual dental cost, but now I'm willing to pay out of pocket because dental bills are fairly affordable. If I find a dental catastrophe that could cost substantially more than I am able to pay and would be covered by insurance, I'll probably get dental insurance again. (You might know?)

[Chrysostom]

Originally Posted by normajean777

Anyway then there is wait times. We have all heard about them. 1-2 years for some surgeries. Absolutely ridiculous.

What kind of surgeries?

I just ask because there are few surgeries that I would consider getting, personally, and I'm just wondering if those surgeries have a 1-2 year line.

[Epaphras]

Jerry is right about the fact that someone picks up the tab for indigent care. Contrary to what was shown in the film, hospitals don't deny or suspend treatment until the person is stable. If an uninsured person comes in with a gunshot wound, they get them stable, then the continuing care is dependent on the insurance. But, someone has to pay for that initial emergency room treatment.

My wife and I have been continually discussing the assumptions and assertions presented in the film, and she brought up how it will never change in the United States as long as people have an individualistic attitude. She (and I) don't know if it should change, but it certainly won't change as long as people continue to say, "Why should I pay for anyone but myself?" Danlongs' comment, "My charity goes through the church, not the government" is telling of this (not criticizing this attitude; you may be right, maybe not).

Another point that is worth mentioning: HMOs do suck. My mother is a nurse at a major hospital in Michigan, and when she saw the film, she said, "Of course HMOs are terrible; but are more private insurance structures out there, it doesn't have to be between HMOs and socialized healthcare".

We have a high-deductible PPO with a health savings account. We will continue to pay into the HSA until it can cover our maximum out-of-pocket ($7,000). Our premiums are only $115 a month, and that's with maternity coverage (after $10,000, but that will be a lifesaver as my wife's situation is such that our pregnancies will probably be more complicated than most).

What about a solution where the government continues to regulate the health insurance industry to ensure that abuses aren't taking place (denial quotas for doctors to save on costs, etc.), while each state creates a statewide fund or even a state-run insurance company for the uninsurable and underinsured. This would be cheaper than universal healthcare for everyone (plus it would require some people to pay more than they do now); instead it would take some of the money these people would be paying in the universal system, towards a fund for the people they already pay for (indigent care is reflected in our premiums). This might actually lower premiums for everyone, since insurance companies no longer have to pick up the tab on care for the uninsured. And it would provide coverage for those who can't get insurance or can't afford the insurance they truly need. This keeps the system relatively private while providing a fair system for those who are less-fortunate. I don't see many non-profit health insurance companies for the uninsured and under-insured out there.

[JerryLove]

This would be cheaper than universal healthcare for everyone (plus it would require some people to pay more than they do now); instead it would take some of the money these people would be paying in the universal system, toward a fund for the people they already pay for (indigent care is reflected in our premiums). This might actually lower premiums for everyone, since insurance companies no longer have to pick up the tab on care for the uninsured. And it would provide coverage for those who can't get insurance or can't afford the insurance they truly need.

One point I want to mention: The average cost of healthcare, per-person, is significantly lower (around half) in most countries with universal healthcare.

Many of these countries do something very similar to what you suggest. Some (Japan I believe) have private healthcare, but regulate it heavily. Some (France) have government health-insurance as a base-line and you can add to that (getting private rooms, faster elective surgeries, etc) with private insurance.

There are a couple reasons that prices drop. Canada-vs-America's drug prices show one pretty clearly. Another is that treating problems when they are small is cheaper than when they are big (no-insurance, no treatment for cold, hospital for pneumonia). Many of these countries have all-night clinics and on-cal doctors (cheaper than ER), and house calls save on rather expensive ambulance/ER combinations. Monitoring of the old/newborn (in France after a birth, the nurse comes by once a week just too see how everything is going) can catch many problems before they cascade.

From a purely pragmatic standpoint, it's cheaper than the current system: though some individuals will pay more (anyone in the "Church of Christian Science" for example, who presumably pays $0 now).

[adamwagg]

Originally Posted by JerryLove

So the row over waits is specific to "elective surgery for people who want it free"?

Pretty much - it's becoming an issue cause there's been a few cases of people getting a fair bit worse cause they have waited too long. (The wait is dependant on how critical it is - if it'll make you die without it really soon you go up the list. Annoying but not dangerous things go lower down the list). The big issues in elections normally are the economy, employment, education and health care.

(Note: elective surgery really means non emergency surgery.)

[Epaphras]

Could scale be one of the major obstacles?

The US has a very diverse population of over 300 million, half of which are overweight or obese. Great Britain has only about 30 million (correct me if I'm wrong) and Canada has 15 million (again, correctly if I'm wrong).

I know more population means more tax revenue, but it also means more expenditures. Is the population factor simply too daunting to get some kind of universal health coverage off the ground?

[JerryLove]

Originally Posted by Epaphras

I know more population means more tax revenue, but it also means more expenditures. Is the population factor simply too daunting to get some kind of universal health coverage off the ground?

Simple enough. Divide it into 10 or more groups by geography or age or income or whatever.

[Epaphras]

How would it be divided could be quite a point of contention. If by geography, isn't the South more obese than the North or West, and therefore require special attention? If by age or income, how could the system protect against malicious discrimination, since the elderly require more care and the poor don't have equitable nutrition or education/opportunity on preventative care?

[JerryLove]

It was really a silly answer to a silly question. The idea that it's possible to be efficient for 30 million people in France, but not 300 million in the US is without grounds.

But to continue the hypothetical... it doesn't matter. The ten systems will be efficient within their ten demographics. Don't fund the individual parts via their own constituants and how you divide is a non-issue.

Example:
I have 4 people in one insurance. Two use $10 per year and two use $20. I therefore collect $15 from each.

For the sake of efficiency overhead (the savings of which are not reflected in these numbers), I divide them into two plans. "cheap" and "expensive". Since money is still collected through a tax, I continue to take $15 from each person: funneling $20 into "cheap" and $40 into "expensive".

Of course, there isn't really any advantage to such arbitrary divisioning; but it doesn't really create the disadvantages either as they are not self-funded.

[3rdCrossBand]

It's all well and great but somebody has to pay for it. Not to be mean or anything but i get a little agitated when I pay , literally, hundreds a month out of my pay for health care, and get taxed on top of that for services that im not "eligible" for. .....Did my time in college, played the rat race game to get a "good" job to support the wife and kids, struggled alot, still struggling, all to watch a large number (in my area of the country anyway) of people coast through life and live off the government. But hey, nobody ever said life is fair right :P

[adamwagg]

I'm not sure how everyone getting essential health care is equal to some people coasting off the Government?

[JerryLove]

Originally Posted by 3rdCrossBand

Did my time in college, played the rat race game to get a "good" job to support the wife and kids, struggled alot, still struggling, all to watch a large number (in my area of the country anyway) of people coast through life and live off the government. But hey, nobody ever said life is fair right :P

I know a lot of vets that think the same of you college boys coasting along on US provided freedom off their blood, sweat, and tears.

You mooch