Universal Health Care: What to Cover

The problem with 100% single-payer universal health care is that it requires a relatively healthy population, which we are not.  We take pride in our 1,400 calorie thickburgers and driving to the mailbox.  We likely use more prescription drugs per person than any other nation by a factor of five.  You can't compare the per-person costs of universal health care in, say, France, to what it would cost here.

How about something like this:

1.  All life-saving care with a predicted success rate of, say, 10% or higher is 100% covered for every citizen.  That covers all life-saving surgeries, treatments, and prescription drugs (like insulin or asthma medication).  If doctors feel the odds of a course of treatment working are extraordinarily low, then you'd have to pay for it yourself (or through a private insurance supplement plan.)

2.  All preventive care is 100% covered for every citizen, including yearly checkups, eye exams, dental cleanings, pre-natal, tests, etc.

3.  All life-improving care (Viagra, birth control, most orthodontics, etc.) is 50% covered for every citizen when recommended by a doctor, with the remaining 50% paid by the individual (or through a private insurance supplement plan.)

4.  No optional care (plastic surgery, tattoo removal, etc.) is covered.

In addition:

1.  Severely limit advertising for prescription drugs.

2.  Give the FDA power to police herbal supplements.

3.  Disallow the sale and/or marketing of any drug or supplement that can not be shown to significantly outperform a placebo for its intended task.

4.  Cap malpractice awards.

You will not need an "insurance card" from the government -- merely your SSN as proof of citizenship.  Benefits start at birth, or when you become a citizen as an immigrant.  

I don't think we can logically support covering undocumented non-citizens, because it's simply not economically feasible to grant free health care to 12-20 million people who don't pay taxes into the system to support it.  In fact, I believe we're the only country on the planet who currently DOES provide basic health care to non-citizens (in the form of hospital emergency rooms and not requiring citizenship tests for Medicare.)  I'm not saying we should take those services away, but... hmm.  Any suggestions on this?  Illegal immigration is a big hiccup when comparing health care options, and I haven't heard anyone come up with an equitable and logical solution yet.

Either way, I think the above guidelines will work a lot better than the "making it a law that you have to buy health insurance" proposals we're getting these days.

•  Where am I right/wrong?

  Let me know.  :)  It's a "work-in-progress" in my head, after all.

  by cartwrightdale on Sun Dec 09, 2007 at 01:54:38 PM PDT

  •  Several problems

    1.  Very few treatments are tested against each other to evaluate their relative efficacy.  Even fewer are tested long enough to find out if they actually improve health or prolong life.  Drugs, the only treatments systematically tested are tested against placebos, not against each other.  we have no way of knowing if one is better than another.

    -  Worse tests are not long enough to determine if the drug improves health.  The tests are not long enough.  It takes years to determine that.  Instead, reducing blood sugar levels, cholesteral levels, etc. are the results looked at.  But there are numerous effects of any drug.  Until there are long-term studies evaluating improvements in functioning or mortality, there is no way to know which treatment is "best".

    -  And this is for drugs, which are tested.  Medical devices (artificial joints, stents, you name it) are not even tested.  Nor are new (or old) surgical procedures.

    -  So how do you decide what to pay for?

    2.  Medical imaging procedures (CAT scans, MRIs) might be considered "preventive".  But they are expensive, overused and controversial.  Specifically, they may not be needed, and there is a significant danger that they produce numerous "false positives", finding evidence of disease that is not there.  That leads to more expensive and risky tests and procedures to look for non-existent disease.  Do you really want to cover all "preventive" procedures.

    3.  Where is your evidence that the US population is so much more unhealthy than the populations of all European nations.  I believe there is evidence of wide variation in health status among those nations.

    4.  Think hard about excluding immigrants.  Do you really want millions of people in this nation lacking treatment for communicable diseases, dying of cancer for lack of treatment, etc., etc.  

    by seeker on Sun Dec 09, 2007 at 02:46:10 PM PDT

    •  What's the alternative, though?

      Covering illegal immigrants in the full system would have to be paid by someone.  If you have 20 million people who need a very low estimate average of, say, $4,000 in medical care per year, that's $80 billion dollars per year additional, or around $1,000 additional per taxpayer per year.  

      Personally, my medical costs average around $16,000 per year, including all doctors visits, prescription meds, dental visits, and eyeglasses.  And that's not particularly high -- it's not like I need surgeries or hospital stays or anything like that.  :)  

      by cartwrightdale on Sun Dec 09, 2007 at 03:33:51 PM PDT

  •  I can assure you that the United Kingdom

    covers non-citizens. Once while I was on vacation I was in an accident and ended up in the hospital in the UK for 2 weeks and it didn't cost me a dime, the entire cost was covered by the United Kingdom's national health care system.

    I believe the same applies for France's health care system also because my sister was once hospitalized in France because of a burst appendix while vacationing at no cost to her.

    by MichiganGirl on Sun Dec 09, 2007 at 03:47:29 PM PDT

    •  In England and in Germany...

      ...as a tourist, I received free medical care.

      by nightowl724 on Mon Dec 10, 2007 at 12:10:55 AM PDT

•  Problem with who decides what's "necessary"

  For instance, most insurance companies now cover Viagra, but not birth control.

  Which I'm sure has nothing to do with shaming the sluts who have the nerve to want sex, versus those manly geezers with erectile disfunction.

  Also: you've fallen into the neocon, rethug trope of who "deserves" health care: not the fat asses, then becomes not the sluts, or women or want sex, or kids who broke their arms on skateboards, or those illegal immigrants . . .

  by judybrowni on Sun Dec 09, 2007 at 02:03:49 PM PDT

  •  And who deserves to die

    10% likelihood of saving a life gets cut to 40% during the next budget, then 50%, then 60%, then 98%.

    That fat ass could have overcome his genetics, and so 50 pounds overweight doesn't deserve saving, and so on and so forth.

    by judybrowni on Sun Dec 09, 2007 at 02:06:31 PM PDT

    •  But

      We can't just cover any and every surgery, treatment, or drug that a patient wants, either, because there's no way we could afford that.  The first year, everyone would get Lasik and liposuction and weekly massages.  :)

      by cartwrightdale on Sun Dec 09, 2007 at 02:10:15 PM PDT

      •  do you really believe that?

        that's something you really worry about?

        by rasbobbo on Sun Dec 09, 2007 at 02:15:16 PM PDT

      •  I thought by your

        comment below that I just misunderstood what you were indicating in your first paragraph, however with this comment I'm not so sure.

        I doubt I'd support what I think you're suggesting.

        I don't know anyone who's had cosmetic surgery or a message that was covered by their existing insurance.  I'm not saying this is the case with everyone, but I know no one who's been privileged in this way.

        What other things would go uncovered?  What about people who've got different types of cancer than run in their family's genetic line or something such as diabetes?  Do we eliminate them too?  Or children that're born with congenital illness(es), do they do without coverage as well?

        I think I understand what you're trying to say, but I feel it's a dangerous road to travel because when it comes to eliminating or not including certain "things", after the first step is taken, each step after gets easier . . .  

        Sorry, but everyone in this country deserves adequate healthcare insurance.  Everyone.

        by Dreaming of Better Days on Sun Dec 09, 2007 at 02:23:59 PM PDT

      •  Lasik and liposuction

        are generally elective procedures, not standard medical care.  Massages may be part of a necessary physical therapy, where they should be covered, or an optional stress reducer, where they probably would not be covered.

        You set up a strawman.

        by SarahLee on Sun Dec 09, 2007 at 02:27:37 PM PDT

      •  Today no insurance covers

        Lasik.  Some may cover medical massage if part of a physical therapy regime and some may cover liposuction in the case of obesity, but I doubt that last statement.

        Somehow, we have come to an agreement that purely cosmetic or recreational activities and procedures are not covered, even by private insurance.

        Why would public insurance be different?

        by seeker on Sun Dec 09, 2007 at 02:53:18 PM PDT

  •  Not at all

    I made no comment at all about who "deserves" health care.  :)  My point with the example at the beginning was that we, as a nation, make universal health care a more difficult option, as there are substantially more of us who, through lifestyle choices, increase our likelihood of medical care later on.

    by cartwrightdale on Sun Dec 09, 2007 at 02:08:39 PM PDT

•  why should the fda police herbal drugs

  i do not want the government everywhere. if the government patrols herbal wouldn't they become drugs?

  by lamonth on Sun Dec 09, 2007 at 02:13:25 PM PDT

  •  Herbal & Other Nutritional Supplements

    have been in danger of being crushed for years. The Office of Alternative Medicine in the National Institutes of Health has never been properly supported.

    The FDA wants no part of regulating supplements; they know a tar baby when they see one. Besides, they don't have the resources to do the work that's actually part of their mission.

    Only Big Med wants alternative medicine destroyed, especially Big Pharma. Therefore lists of dangerous herbal remedies are widely disseminated but actual research on remedies that work is unfunded.

    In the meantime, throw caution to the winds and take your Vitamin C, everybody.

    by JG in MD on Sun Dec 09, 2007 at 02:30:04 PM PDT

•  Same problem whether or not single payer

  How do we decide who gets a heart transplant? Do we charge smokers more?

  The questions are the same single payer, or not.

  by Bill White on Sun Dec 09, 2007 at 02:15:38 PM PDT

•  Universal means that everyone is in

  No one is out.

  That does not mean that elective treatments are covered by the public system - but it means that doctors and patients and not insurance companies decide on what treatments are needed and everyone has access to regular checkups, preventive care and treatments needed to manage disease.

  by SarahLee on Sun Dec 09, 2007 at 02:24:00 PM PDT

•  Factually wrong

  In fact, I believe we're the only country on the planet who currently DOES provide basic health care to non-citizens (in the form of hospital emergency rooms and not requiring citizenship tests for Medicare.)

  The UK NHS provides emergency treatment for everybody including any necessary operations and in-patient care (if, for example, somebody had appendicitis or an accident)

  by Lib Dem FoP on Sun Dec 09, 2007 at 02:29:33 PM PDT

  •  Good to know!

    I didn't get sick when I was there last, and wondered what would have happened.  :)

    by cartwrightdale on Sun Dec 09, 2007 at 03:34:18 PM PDT

•  Birth control must be 100%

  Benefits of birth control:

  1. Enormous cost savings over the long run.

  2. Can be life-saving; carrying a pregnancy to term is not safe for many women.

  3. Extremely inexpensive treatment that works very well for debilitating pain, mood symptoms and skin problems that would otherwise be treated with more expensive and damaging drugs.

  4. Reduces the need for abortions, which is critically important given the extremely low accessibility of abortion.

  Mental health needs to be 100% too, because it is life-saving and can help prevent the need for treatment of physical illnesses and injuries resulting from mental illness.

  Dental of the basic cavity-filling, tooth-pulling sort, at a minimum, needs to be 100%. Better fill/pull now than treat infections later - not only is it a cost savings but it also reduces loss of worker productivity. Cosmetic dental work (patient able to eat, not at risk of infection and not in pain) goes in the same category as plastic surgery.

  by kyril on Sun Dec 09, 2007 at 02:29:34 PM PDT

  •  Also

    what do you suggest for legal immigrants? I'm a permanent resident and I've been here since I was 8 and served in the military, yet I have to jump through quite a few unwarranted hoops to take advantage of the government programs that my and my parents' taxes paid for. Your bit about "proof of citizenship" suggests that you would make medical care one more of those, although the fact that you'd only require a social security number (which most legal immigrants have, even the non-work-authorized, non-tax-paying kind) means that you'd have no way of enforcing the citizenship requirement. Thoughts?

    by kyril on Sun Dec 09, 2007 at 02:37:04 PM PDT

    •  I see nothing wrong with

      extending the coverage to all legal immigrants residing in the U.S., regardless of length of stay or status.  If someone makes the decision to immigrate to the U.S., we have to assume they plan on sticking around and contributing to society, not just benefiting from it.  :)

      by cartwrightdale on Sun Dec 09, 2007 at 03:38:53 PM PDT

•  Read HR 676

  It will help you

  http://www.house.gov/...

  by army193 on Sun Dec 09, 2007 at 02:31:45 PM PDT

•  I think that the wrongness of your proposal was

  correctly stated by Martin Luther King. As long as one person is not free, or in this case covered by health care, no person is completely guaranteed care.  Or perhaps it comes across in the old saying, "Give them an inch and they'll take a mile." Any exception to universal coverage leaves the door open to injustice.

  by Tenn Wisc Dem on Sun Dec 09, 2007 at 02:54:00 PM PDT

  •  Well, wait

    Which part of the proposal are you critiquing?

    by cartwrightdale on Sun Dec 09, 2007 at 03:34:38 PM PDT

    •  The part that allows disallowing care

      any care.

      by Tenn Wisc Dem on Sun Dec 09, 2007 at 05:08:58 PM PDT

      •  So...

        ...anything anyone asks of any doctor, no matter if it's necessary for their health or life, should be 100% covered by the government?

        by cartwrightdale on Sun Dec 09, 2007 at 06:58:04 PM PDT

•  What about transgender procedures?

  Despite medical science stating that things such as hormone therapy, electrolysis, vaginoplasty, etc., are necessary for some patients, virtually no private insurance plan covers any procedure regarding sex-reassignment surgery, classifying it as elective.

  At the same time, transgendered persons are among the most vilified and discriminated people living in America.  It is difficult to find a job post-transition, and most states and cities still lack employment protection for transfolk.

  Should a national insurance plan help pick up the tab?

  by Ruthless Liberal on Sun Dec 09, 2007 at 03:10:31 PM PDT

  •  Funnyly enough

    Three British transsexuals who were refused sex change operations funded by the NHS have won a landmark High Court ruling that the decision by North West Lancashire Health Authority not to pay for their surgery was "unlawful and irrational."

    http://www.pubmedcentral.nih.gov/...

    by Lib Dem FoP on Sun Dec 09, 2007 at 03:58:44 PM PDT

•  Malpractice insurance

  The author doesn't consider that under a Single Protective Pool Plan all medical bills would be paid so the only thing left to sue over would be pain and suffering.

  by bthespoon on Sun Dec 09, 2007 at 04:38:51 PM PDT

•  It's not true that...

  ...most people would want medical procedures they don't need performed on them just because they could.  That's like wanting to go to the dentist (only worse) just for fun.  There will always be a few sick puppies but the providers can deal with that problem when it arises.  

  by bthespoon on Sun Dec 09, 2007 at 04:42:06 PM PDT

•  You are on the right track, but.....

   3.   All life-improving care (Viagra, birth control, most orthodontics, etc.) is 50% covered for every citizen when recommended by a doctor, with the remaining 50% paid by the individual (or through a private insurance supplement plan.)

    4.  No optional care (plastic surgery, tattoo removal, etc.) is covered.

  In addition:

    1.  Severely limit advertising for prescription drugs.

    2.  Give the FDA power to police herbal supplements.

    3.  Disallow the sale and/or marketing of any drug or supplement that can not be shown to significantly outperform a placebo for its intended task.

    4.  Cap malpractice awards.

  Viagra is a recreational drug and should not be covered.

  Pregnacy and childbirth is a choice and as I will be paying for birth control pills, patches, and the like I do not see why I should have to pay for your choices.  I will most certainly be very pleased to pay for education, school lunches and that sort of thing because the child is not culpable and not here by the child's choice or action.  The other point is that there will come the day when that child will hopefully be a contributing member of the society and it is in my own best interest to insure that the person will be able to function as a part of the society. If you are truly committed to having children then the least you can do is pay for the initial costs.  And if you can't do that then you probably should not be bringing the kids into the world.

  The diatary supplements need no further policing and the problem with the high costs of pharma is best handled by no more patents on drugs. The Reaseach and FDA stuff should be done in a global university grant system.  The people that actually do this stuff want a decent life, are very interested in what they are doing, and they seek fame as opposed to fortune.

  "Those are my opinions. And you can't have em" -- Bart Simpson

  by TheTrucker on Mon Dec 10, 2007 at 12:48:46 AM PDT