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View Diary: The Case for Universal Healthcare (117 comments)

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    •  Add: Walk in clinics for healthcare = pay $100 (25+ / 0-)

      Visited Canada last year and needed to see a doctor.  Found a walk in clinic, paid $100 for the privilege, picked up prescription and I was on my way!

      Note:  Military in the USA has full healthcare coverage.

      WHY NOT the rest of us?  
      Greed at the top.

      Only people learning truth and then waking up to participate together for REAL positive change will effect the outcome.

      All USA citizens should be covered.
      We pay for it.
      It is our right... (now, about those other rights they are taking away due to whatever excused the TBTF come up with vs. the Constitution and Bill of Rights?)

      Say Yes to Health Care.
      Say Yes to Democracy for ALL.

      •  Another good question or point would be... (25+ / 0-)

        Why should any American risk their life in war for someone else's freedom?

        If we should not pay for someone else's health care just because they are a fellow American then why should any other fellow American risk their lives in war for our right to be free?

        It always blows right winger's minds when I explain to them that the U.S.government already pays twice as much per person as the U.S. does for free healthcare for all.  Shouldn't we be able to get twice as good of healthcare as France without paying an extra nickle in taxes?  I always add to that by saying, I currently pay $500 per month for health insurance so if they increased my taxes by $3,000 or so a year for free health care, I would still be saving a ton of money and I should get three or four times better healthcare than France.

        "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

        by Buckeye Nut Schell on Thu Jun 06, 2013 at 09:33:19 AM PDT

        [ Parent ]

        •  Really good point, Buckeye. I have a couple of (11+ / 0-)

          Republican relatives and, so far, nobody has asked why they should pay for someone else's health care. One of my most Republican relatives is currently serving in the military (has been deployed to Iraq 3 times) and it always boggles my mind to see criticism of Obama, along with glorification of Republican philosophy, on his FB page. Should I ever see that question raised on his FB page I'll be sure to ask why he's willing to risk his life in war for someone else's freedom.

          The world is not interested in the storms you encountered, but did you bring in the ship.

          by Hanging Up My Tusks on Thu Jun 06, 2013 at 11:16:26 AM PDT

          [ Parent ]

        •  BNS - we pay twice as much per capita in the US (5+ / 0-)

          than the rest of the G8 because we train our physicians to practice medicine in a completely different manner, and they do. To change the economics of healthcare in the US we will need to add ten of thousands of additional physicians and train them differently. My fear is that the federal government will try and change the price of healthcare services without any attention at the underlying fundamental costs. That will lead to more physician shortages, particularly for rural and poor patients.

          "let's talk about that"

          by VClib on Thu Jun 06, 2013 at 12:42:57 PM PDT

          [ Parent ]

          •  I disagree (11+ / 0-)

            The cost of medical care is driven by administrative PROFIT.
            Check the profit margins of Blue Cross or other insurers some time. In addition, each insurer has to hire a slew of (underpaid- but it adds up) minions to administer the insurance, and it adds up. Each hospital has to hire admin staff to deal with the insurance companies - adding more to cost.

            Hear whining about malpractice? The cost of malpractice is driven by the cost of fixing the mistakes of the first doctor- which under a Canadian system is much, much lower.

            More whining about rationed care? We have rationed care- right now. Care is rationed by what the patient can afford.

            •  la moto - I completely disagree (1+ / 0-)
              Recommended by:
              Roadbed Guy

              The ACA has capped non medical expenses for big insurance companies at 15%. So with Medicare at 3% you have a savings of 12%. When you add all of the uninsured and people with junk insurance into the single payer pool it will overwhelm the 12% by a factor of two or three. The 12% is a meaningful savings, but it is a small part of why our healthcare costs are two times the rest of the G8.

              "let's talk about that"

              by VClib on Thu Jun 06, 2013 at 01:09:23 PM PDT

              [ Parent ]

              •  Please explain (2+ / 0-)
                Recommended by:
                elwior, JerryNA

                We are talking about NON MEDICAL EXPENSES, which you express as a percentage of MEDICAL EXPENSES. How does adding an uninsured person or a person with junk insurance to the medicare pool increase the PERCENTAGE (not the absolute amount) of non medical expenses?

                •  Under the ACA insurance companies now have to pay (0+ / 0-)

                  out 85% of premiums for actual healthcare. So that leaves 15% for all the administrative costs, including executive compensation. So if the federal government just took over the clients and claims of an insurance company it would have about 12% savings it could spend on new patients. If you add together all of the people in the US who are insured with private insurance you could have a savings of 12% on all of them. That's your pool if all of the participants were the same and everyone continued to pay into the healthcare system at exactly the same rate they do now. (of course that will change but I am trying to hold as many variables constant as possible) With our new pool of 12% of healthcare spending how many new currently uninsured people can we bring into the tent? My guess is that the number of uninsured is at least twice as large as our 12% savings.

                  Real reductions in healthcare expenses start with changing how we practice medicine.

                  "let's talk about that"

                  by VClib on Thu Jun 06, 2013 at 03:20:53 PM PDT

                  [ Parent ]

                  •  this is wrong — you are mixing two things. (1+ / 0-)
                    Recommended by:
                    elwior

                    that 12% you are claiming as saving is only over those with private insurance — not of overall healthcare costs. That is a much smaller amount.

                    Secondly, The low amount you claim for Medicare administrative expenses is deceptive. That is just for the costs of the payouts. The other costs are in HHS, FDA and the Justice Department plus the Congress which butts in too much. HHS does lots of work — which has to be paid for, to set fees and rules and has its owns team of fraud investigators. The DOJ by the FBI has a very active fraud program. Have you been ignoring the all the arrest of networks of criminals, of doctors, nurses and pharmacists primarily who have been ripping of Medicare and Medicaid of millions of dollars. This to the tune of 10% of all Medicare spending. The states run their own Medicaid programs and theft there is big also. In the last Florida election for Governor  the never refuted estimate was made of $3 billion in fraud. It is not much different

                    The private insurers don't have similar amounts of fraud. They can easily eliminate doctors that they suspect of fraud and .

                    The Obama administration has made big strides to get rid of fraud. Some law changes blocked some common frauds but it was and always will be an ongoing fight. And that fight is expensive. Add that to the total of administrative costs.

                    Yes, we must change how medicine is practiced. We must eliminate the sloppy practices leading to very extensive harm to patients and also rein in using  unproven and often potentially harmful treatments. Over treatment is a bigger problem that lack of treatment.

                    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                    by samddobermann on Thu Jun 06, 2013 at 10:28:26 PM PDT

                    [ Parent ]

            •  Not to mention... (11+ / 0-)
              More whining about rationed care? We have rationed care- right now. Care is rationed by what the patient can afford
              The insurance companies ration what care you can get every day.  I would trust the government to administer healthcare more fairly than I would a corporation whose profit margin is based on not paying for your treatment.

              "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

              by Buckeye Nut Schell on Thu Jun 06, 2013 at 01:17:57 PM PDT

              [ Parent ]

            •  Not true. Administrative expenses (2+ / 0-)
              Recommended by:
              elwior, Roadbed Guy

              are a small part of the cost of healthcare. It is the underlying costs of the medical care, the drugs, the equipment used and supplies that are driving costs.

              The cost of malpractice is driven by the cost of fixing the mistakes of the first doctor- which under a Canadian system is much, much lower.
              That makes no sense. The high medical CARE costs are because so many doctors and hospital staff commit malpractice — that is make so many stupid sloppy preventable errors that our system is plagued with. It is not the fault of the cost of either malpractice insurance of of court case judgments.

              Although it is changing now, hospitals and doctors who harm a patient get to bill for all the treatment designed to mitigate that harm. Thus sloppy care is enriching and raises the overall costs.

              Other countries don't have nearly as much of the problem of sloppy care that we tolerate.

              We have over 100,000 deaths and many more of harm to patients from infections that they get in the hospital. That is outrageous — and very expensive. We have another 100,000 deaths from other malfeasance of the providers of our medical care.

              Where is your outrage for these expensive costs that all of us pay for?

              One out of three patients in a hospital have serious errors made on them. And this is probably an understatement; dead people don't respond to questions. Furthermore many people are subjected to worthless procedures for which there is no evidence at all but they don't even know can harm them rather than help.

              The high costs of health care plagues even Medicare which is a single payer system. That is why much of the ACA is concentrated on the Medicare and Medicaid programs.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Thu Jun 06, 2013 at 08:10:12 PM PDT

              [ Parent ]

          •  There will be a transitional cost... (10+ / 0-)

            but the main differences in cost come from over priced medicine, financial incentives to treat the symptoms rather than the cause, insurance profit margins, hospitals overpricing to make up for the insurance companies bullying tactics and exorbitant salaries for hospital executives. A fifteen minute consultation and a  half a teaspoon of benedryl at the ER should not cost $300 deductible plus whatever the insurance paid(daughter had a bee sting that swelled up like a balloon when she was three).

            If the U.S. negotiated all medication under a single payer system, forced hospitals to treat the patient and not the symptom, encouraged prevention as opposed to cure, forced new medicines to prove they were better than the existing treatment rather than a placebo and held administration costs down to current medicare levels, the costs would decrease even with adding more doctors.

            Other things that would help would be to charge a processing tax on food for everytime it is processed and use the money earned to subsidizes unprocessed foods.  That would help poor people eat healthier and prevent the need for a lot of medical care.  Provide free clinics in rural areas where people could speak to a doctor without paying $30 a visit and prevent tying up emergency rooms for non-emergency issues.  It would also keep people from waiting until that chest pain becomes a full blown heart attack.

            "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

            by Buckeye Nut Schell on Thu Jun 06, 2013 at 01:13:40 PM PDT

            [ Parent ]

            •  Our healthcare system suffers from unchecked greed (4+ / 0-)

              and self-interest. The needs of the people are the last consideration. Many people have been trying for decades to bring about universal health coverage and some of its biggest enemies have been the AMA itself.

              It was argued by economist Irving Fisher in 1916 that Germany's industrial progress, physical preparedness of its soldiers and its comparative freedom from poverty were due in great part to health insurance. It started to gain ground but then the Kaiser blew that opportunity and the very notion of universal health insurance became "un-American". That propaganda still works today with calls of "socialism".

              I wonder how the label of "un-American  would have gone over when John Adams signed an "Act for the relief of sick and disabled Seaman" in 1798. Taxes were collected to build hospitals and provide for medical care for merchant and naval seamen.

            •  You haven't looked at real world problems. (1+ / 0-)
              Recommended by:
              elwior

              Find doctors for all the rural areas? There are Community Health Centers in most rural areas but you can't put a clinic  in every hamlet.

              What about you?

              A fifteen minute consultation and a  half a teaspoon of benedryl at the ER should not cost $300 deductible plus whatever the insurance paid(daughter had a bee sting that swelled up like a balloon when she was three).
              Why did you run to an ER? Did you call your own doctor? Did you call the nurse line? Virtually all insurers have nurse lines you are encouraged to call. Did you try treating her at home? You could have given her benedryl on your own. Unless the sting was affecting her breathing, which you didn't mention, it was hardly an emergency.

              Most non emergency visits are from people with some form of insurance. Like you.

              A part of the problem is that doctors fob people off and tell them to go to the ER. It is sometimes smart but it is often overdone. Then people with real problems have to wait.

              People need to take control and think about what they can and want to do. You choose to go to the ER.

              You really want government to force hospitals, and by that you mean doctors to practice the way you deem proper? The biggest opponents of that would be the doctors, not all but many. Patients are going to have to demand that; they won't change on their own or by fiat.

              And that goes for medicines. Patients often demand the newest of the new. Too often do they ask if there is any evidence for the drugs that are given. Patients often demand what they just heard about on TV or read on line or in journals. They swear by quack meds. How many times have you heard people extolling homeopathy? Or the herbal substances, most of which is bunk.

              Processed foods are not all bad. And not everyone would agree with you about what is bad or good. Look at the stink that went up about the NY mayor banning super size drinks. Now I think the way the law was written, excluding convenience stores got it tossed out. But that sort of regulation drives people crazy.

              Most first heart attacks are not preceded by chest pain and early treatment won't prevent all of them.

              It is true that if people would eat better and exercise more they would be in better health but that is not always achievable. Many areas are food deserts and people don't have access for healthy foods. And people with 2 or 3 jobs plus kids don't really have time to set aside for those things.

              And often people won't do what they even know they should be doing.

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Fri Jun 07, 2013 at 12:04:48 AM PDT

              [ Parent ]

              •  Well, I have apparently struck a nerve... (3+ / 0-)
                Recommended by:
                ScienceMom, Calamity Jean, JerryNA
                Why did you run to an ER? Did you call your own doctor? Did you call the nurse line? Virtually all insurers have nurse lines you are encouraged to call. Did you try treating her at home?
                Yes, I did call our pediatrician and due to how quickly she had a reaction, he advised that we take her straight to the ER.  We were broke so the $300 co-pay was not something we wanted to pay.  
                it was hardly an emergency.
                Thank you Captain Hindsight for that brilliant deduction.  You were not there and you did not see your 3 year old swelling up like that.  I'm glad that you can sit here and judge whether something was an emergency 14 years later when the doctor on the phone at the time who knew us and our child said to take her to the ER.  If she would have died, you would have been the first person to say that it was our fault for not taking her to the ER.
                You really want government to force hospitals, and by that you mean doctors to practice the way you deem proper?
                Well, it seems to be working in just about every other industrialized country in the world.  Not only do the vast majority of those countries enjoy better health care but they also pay less for it.  Give me an example of a country you would like to bench mark with.  What we are doing is obviously not working with skyrocketing cost and thousands of people dying every year from preventable causes.  You tell me what system you think would work.
                And that goes for medicines. Patients often demand the newest of the new. Too often do they ask if there is any evidence for the drugs that are given.
                Do you know why they demand the newest of the new?  Marketing campaigns aimed directly at the patients.  Ever wonder why they advertise prescription medication that people cannot buy on television?  Two reasons really.  One is as long as they are customers to the news media, they will not be targets of them and two, they know that patients will pressure their doctors for the best cures.  80% of pharmaceutical companies R&D budget is spent on tweaking existing medications for new patents.  It does not matter if it is better than the previous drug or not.  It only has to be better than a sugar pill and they can get a patent on it and market it as if it was the best thing since antibiotics.  If the FDA would not approve these medicines unless they could prove they were better than the existing treatment in some way then they would have to spend their money on truly finding new drugs.
                Most first heart attacks are not preceded by chest pain and early treatment won't prevent all of them.
                I have known two people in the last five years who died that experienced chest pain for hours prior to their heart attack.  One went to the ER and was denied treatment due to lack of healthcare (they said it was probably gas and sent him home) and one didn't even go to the doctor because of lack of healthcare.  Maybe whatever study you got your information from missed those two accounts.
                It is true that if people would eat better and exercise more they would be in better health but that is not always achievable. Many areas are food deserts and people don't have access for healthy foods. And people with 2 or 3 jobs plus kids don't really have time to set aside for those things.
                Well said.

                "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

                by Buckeye Nut Schell on Fri Jun 07, 2013 at 04:56:54 AM PDT

                [ Parent ]

            •  Many great points and truths in your comment BNS. (0+ / 0-)
          •  This is true for sure: (1+ / 0-)
            Recommended by:
            JerryNA
            we train our physicians to practice medicine in a completely different manner, and they do.
            But I don't see how it follows that by changing that, we'd need more physicians.

            the problem now is the medicine in the USA is mostly practiced on a reimbursement for procedure model - so, physicians have an incentive to pile on the procedures.

            the other model would be to have reimbursement for "keeping people healthy" - in this case the emphasis would shift to preventative care and away from after the fact procedures.  It would be both less expensive AND require fewer (or at least not more) physicians.  which is why they hate the idea, of course.

            •  Roadbed Guy - its supply and demand (3+ / 0-)
              Recommended by:
              Roadbed Guy, nextstep, JerryNA

              As we provide more access for more people we need more physicians to treat them. Even where I live, in the SF bay area, it is nearly impossible to find physicians who will treat Medicaid (we call it MediCal) patients and a growing number won't treat Medicare patients.

              I agree as we change the reimbursement model and that will help, but that requires enrolling people in a plan, like Kaiser, that has an incentive to keep people healthy and provides a mechanism to economically reward good outcomes.

              "let's talk about that"

              by VClib on Fri Jun 07, 2013 at 07:43:34 AM PDT

              [ Parent ]

              •  Yes, your last paragraph is what I was getting at (2+ / 0-)
                Recommended by:
                Calamity Jean, JerryNA

                Medicare spending in Rochester falls in the lowest 15 percent in the country — $6,688 per enrollee in 2006, “which is $8,000 less than the figure for McAllen.” Costs are lower because, among other reasons, Mayo pays its physicians salaries, taking away the incentive to bring in more income with more testing, more operations, more high tech imaging, more, more, more.

                Dr. Gawande then observed: “Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next 50 years) would be solved.

                link

                Again, with the vast reduction in procedures it is not clear to me that the incrementally more people who would be brought into the system would require a huge increase in the number of physicians.

                For comparison we already have about 10% more physicians than Canada - a country that is often touted right here at DailyKos as having better medical care for all its citizens than we do.

    •  It is! Thank you. nt (5+ / 0-)

      I was gonna listen to that, but then, um, I just carried on living my life. - Aldous Snow

      by GoGoGoEverton on Thu Jun 06, 2013 at 09:20:33 AM PDT

      [ Parent ]

    •  It certainly should be. (3+ / 0-)
      Recommended by:
      elwior, 3goldens, Rogneid

      But of course only if the RWs actually listen.

      Thank you for your very informative diary.

      Being the single intellectual in a village of 1,100 souls ain't much fun, especially when 1,099 of those don't think you're all that smart.--Lucy Marsden

      by Miniaussiefan on Thu Jun 06, 2013 at 10:31:19 AM PDT

      [ Parent ]

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