In the US, we appear to finally be making some headway on health care reform. There are people who have legitimate concerns about funding, what it means for their existing insurance, how competition between private industry and government services can work, etc. However, these legitimate debates are being completely overshadowed by people that have been fearmongered by our right-wing media establishments, who are going to public debates on the issue and drowning out legitimate criticism by shouting out things like "Obama scares me!", "Obama wants to kill my grandma", etc., and simply booing.

I was curious if the rest of the world is hearing about this, and, if so, what you think about it, from the health care issues involved, to the "debates" themselves.

If Americans want to comment, I don't really mean to exclude you; I was just specifically interested in hearing outside opinions.

For what it's worth, I think that the disruptive element is being counterproductive. There are any number of legitimate concerns about changing health care (none of which I personally agree with), but all that we're seeing from the opposition is crazy people.

I also think that this current bill does not go far enough. For example, while the "correct" answer to how private insurance can compete against government insurance is "the government insurance plan has to be self-sustaining", my preferred answer is "the private insurance industry has screwed the US populace for twenty-five years; it's time for them to be screwed." (Of course the "correct" answer also has the benefit of pointing out that a taxpayer-funded insurance company would not reduce healthcare cost burdens on the taxpayer, which is part of the heathcare reform plan, and one of the parts of the debate currently not being heard, but that doesn't invalidate my philosophical point.)

Less glibly, it also still doesn't guarantee coverage to the entire populace. One still has to independently purchase health insurance, even if it (might) provide group plans to people who currently have no access to one, and provide subsidies to the poor. It's still an additional cost in time and probably money for many of those people who currently can't afford it, and I think some people will still not get it.

Also, in case you haven't heard about these debates/yelling matches, the "Obama wants to kill my grandma" thing is based on two points. One is that there was a provision to provide consultation on end-of-life care for elderly and terminal patients, which was misinterpreted to mean that the government was going to encourage people to die. (The misinterpretation may have been intentional, but it was made by a Republican congresswoman, Michelle Bachman, who has that same sort of vacuous lunacy that Sarah Palin has, so who knows?)

It's being reported extensively, and it's even spilled over into the UK health-care debate. Here, roughly speaking, socialised health-care was invented by the Left, and is now supported by both sides (to the extent that the Tories now describe themselves as "the party of the NHS") -- but accusations that the Right are only paying lip-service are a commonly-used stick for the Left to bash them with. As it happens, the leaders of both main parties have had children who required a lot of NHS care and, even so, died young; both have said that the experience left them with great admiration for the NHS.

I'm not sure that anyone thinks the UK system is perfect, but I think it's very widely seen in the UK as superior to the current US system.

Mischaracterisations of the UK system by US partisans also abound; from the comical (Stephen Hawking) to the merely misinformed (e.g. the false idea that private medical care outside the NHS system is unavailable in the UK).

Peter

What we're hearing in the UK is that our health service is being held up as an example, to you, of why you don't want a national health service like ours:
Ours has much right, and much wrong and no doubt cases of its failures are the ones that are being used to stir up dissent - subjectively, I can't speak highly enough of our health service as a patient: In two serious, and in one case life threatening, emergencies calling for hospitalisation, I've received nothing other than professional and cheerful support from people who clearly enjoy their work, I couldn't and wouldn't have got better had I gone privately through health insurance.
If I need to see a GP I can rely on being able to do so same day, possibly longer if I specify a particular doctor.
However, as a supplier to the health service in my business over many years, I can see so much wrong, so much waste, so much mis-direction and our politicians seem unable, unwilling or just plain too naive to tackle it. "We're giving £50 million in extra funding", when will politicians realise that just throwing money at these services, whether health or education, does not give greater efficiency or better results?

The whole thing has been very confusing for me. I freely admit that I don't understand the whole story, but surely for people who, up to now, haven't been able to purchase such policies, this is a good thing isn't it? I'm unsure as to how it affects people who already have insurance already, I presume it's those people who are bitching about it.

People are very critical of the NHS over here, but I have benefitted from their treatment over many years. I don't have to put my hand in my pocket to see a doctor and the drugs that she prescribes (if any) are a single price (£7.20). I do currently have private health insurance, but that's was an auto opt-in when joined the company so I didn't really think about it.

Until I retired, I had private medical cover, when I retired, I discussed it with my broker, who said: "Let's be realistic, you're a diabetic and whatever you come up with, they'll disallow it as being linked to your condition" - isn't that always going to be the problem with any insurance/health company scheme with profit at the head of the motivation?

Sadly, in most Canadian provinces, private health care that duplicates state-run health care is unavailable, due to vagaries of the specifics of their system. (I forget the details, but it has something to do with reducing the resources available to the government system.) And since many in the US like to conflate the UK and Canadian health care systems, even though they bear little resemblance, you frequently get stuck with that misapprehension.

Oh, no, I've gone political, I was much happier with the French traffic lights!

Yes; there is basically no practical downside for them. They might have political philosophies that are against it, but in real life (not that philosophies are unimportant) they will be better off. Currently, those who are unable to afford health insurance either pay through the nose for doctors visits, spend an inordinate amount of time at a free clinic, or wait until it's an emergency and go to an emergency room. (I think that's a trauma ward or A&E ward to you Brits.) And, generally speaking, those who don't have health insurance are poor and work hourly jobs, so time off of work to see a doctor not only means an expenditure they can't afford, but a reduction in their pay. Often, the public picks up the bill for these people when they can't afford their ER visit, either through bankruptcy, or through the hospitals and doctors increasing costs to cover their losses, or both.


Their arguments seem to be along the lines of (from least unreasonable to most, loosely) "private companies can't compete with government companies", "it's going to cost too much in taxes", "the government shouldn't be involved in health care", "you're going to come between me and my doctor", "you're going to make me change doctors", "this is just the first step towards a complete government takeover of health care", and "you're going to kill my grandmother".

Most Canadians can pay for private health care by driving just a couple of hours south, to the USA.

Our system here still works, but only just. Its major problem, and I really mean MAJOR problem, is our proximity to the USA. Personal profit motivations draw many of our doctors south, which leaves fewer up here in the public system. Which leads to delays in health care.

Similarly, our proximity to expensive paycare down south means higher wages and drug costs up here under the public plan -- higher than they'd be if a more lucrative market didn't exist so nearby.

Please join the rest of the world (well, most of it), and convert to public care. Then our own system here will resume functioning properly.

Cheers

Thank you Bitt, that's described the issue a whole lot better than anything I've read so far.

One of the arguments people have made, though I've not heard it recently, is that if the government takes over health care (again, not part of the current plan), that means that doctors will get paid less and fewer people will be motivated to become doctors.

My counterargument to that has always been: "wouldn't you rather be cared for by someone who wants to be a doctor, and not someone who's just in it for the money?".

I don't know how much doctors in the UK get paid. One would assume that the private practitioners on Harley Street still get quite wealthy, but I doubt that any other doctor is in the poor house.

According to BBC News the average GP's salary is £106,000.

Is that a common practice?

And that's one of the major arguments against public health care in the US: that the Canadian health care is so bad that Canadians have to come to the US to get MRIs.

I'd argue that it makes more sense to modify your system to make private heath care more available. I'm sure those people that travel to the US to pay for health care would much rather pay the extra expense in Canada than the US. After all, the problems you cite with the private insurance in the US drawing Canadians are the exact same problems that the "banning" of private insurance in Canada was trying to avoid.

I would say that Peter has hit the nail on the head for the general point of view here in the UK. I would certainly agree with that.

The NHS is always being discussed, you often get into conversations about it. It is easy to pick holes in the NHS, most people do, but when people really need it the story almost always changes to a positive one.

I have heard several stories about people from the UK needing treatment abroad and being amazed by having to pay for treatment, and surprised the emergency services were not on hand within 5 minutes. I think that's when it hits home that in it's goal the NHS is far and away a more advanced and fair method of apply healthcare to the population than many other systems around the world.

I think it is a sad reflection that our system is being held up as an example of how not to do things, a society who can afford it should apply equal access to health care to all that need it. As a country who has Christian values at it's heart I would have thought the US would have wanted to help all it citizens equally. I'm an atheist myself but have always thought the story of the good Samaritan could be told a little more often.

Cheers

Cris.

No, it's simply that having the profit-driven USA system so close to us, means that our health care workers are naturally drawn south. Which makes our system more expensive to run (we have to overpay the ones that remain), and difficult to staff (making for longer queues, which is what drives some patients south).

If we had some ocean (and VISAs) between us and the USA, like the UK does, then the effect would be greatly lessened, and the public system here would likely work as it was designed. Just like in the UK and other modern countries.

Cheers

Sorry, I didn't mean to imply that it was a valid argument. But that's one of the arguments being made, and since its facts are correct, and merely the conclusions wrong, it's much harder to refute than many of the other ones.

The parallel problems in the UK system, FWIW, are (1) private medicine pays much better than NHS medicine, though fewer jobs in it are available -- thus potentially causing a similar "brain drain" to Canada's, except without needing to emigrate; and (2) British demand for medical professionals exceeds supply, so we in turn brain-drain other countries, which is arguably not being a responsible world citizen.

Mind you, that last one has probably had a positive effect on race relations in the UK -- African, and before that South Asian, doctors were many white Britons' first experiences of other races. Which were thus positive experiences.

Peter

The "average UK GP salary" figures that keep being shouted about are misleading for a number of reasons. The average combines truly salaried GPs and also GPs contracted to provide a service.

In the case of the second type of GP the "salary" that they talk about isn't salary as such, it is the amount the GP is paid for the services they provide. Therefore the payment looks higher than one might expect because the GP also has costs in providing the service that a truly salaried GP does not.

The average also includes GPs that run an on site pharmacy and the earnings from that are also included in their "salary".

When GPs who aren't truly salaried are excluded, the typical GP salary comes out to more like £45k-£80k. Not exactly on the bread line, but also not the levels that the media keep banging on about.

I'm sure that my personal politics are influencing my explanation, so take it with a grain of salt.

Unfortunately, very few of the people who call themselves Christians are actually Christ-followers. If there were more, there would be little need for government involvement in health care because of the overwhelming amount of personal charity, which is really a more faithful interpretation of parable of the Good Samaritan.

That said, in our society where a very small minority of those who call themselves Christians actually practice what they claim to, government sponsored healthcare is the next logical step. This makes sense to me.

My only personal hangup after spending a career so far in the education industry is what a massive failure our government seems to be at running any large system in a remotely efficient and effective way. But just because our government has an extremely high failure rate, I don't suppose that means we shouldn't give them a fair shot at trying to get something right. I just wont be optimistic about it.

It'll be interesting to see how it all shakes out.

Well, the only things in the moving target of the current bill are that the government is supposed to have a direct hand in is a health insurance marketplace for everyone to have access to group health insurance, a possible self-sufficient health insurance GSE (though it looks like that might get nixed), and a medical records clearinghouse.

In my personal opinion, when it comes to paying my doctor, I'd rather have one where the bar to entry is quite high. The amount of time, money, and risk involved in being a doctor means that the reward needs to be equally high. My father's a surgeon. He was 35 before he was finished with school and began working. He had incurred several hundred thousand dollars in debt before seeing a dime. What this means is the system in place has a built in mechanism for weeding out those who are just in it for the money. There are better, safer ways to make more money. The LAST thing I'd want to see is the level of skill required to become a doctor being lowered because there is less competition in the field.

I know you didn't ask my opinion, but if they really want to fix our healthcare crisis, one HUGE step forward would be limiting medical malpractice lawsuits. My dad pays over 50% of his income to malpractice insurance, and he's never had a lawsuit brought against him.

Then again, I'm one of those kooks that believes socialism of any kind breeds mediocrity. If the reward for success disappears, the drive for excellence does as well.

As to how a national healthcare would perform, all I can say is how can you think they'll treat you any better than they do our veterans? Have you ever seen a VA hospital? Keep in mind, our VA in New Orleans is STILL shut down from Katrina.

Actually, it turns out that there's a provision in the bill that everyone is required to hold health insurance, on penalty of a financial … penalty, and there is a legal minimum coverage level for healthcare insurance. Personally, I think this is backwards. We should assume that everyone has that minimum level of health coverage, and people can purchase additional coverage if they desire to do so.

I'm sure the reason it is set up this way is to placate the fiscal conservatives. Ultimately, the government is going to end up spending the same amount of money, since those who can't afford the coverage will be subsidized, which is effectively the same as giving it to them for free, but with the added overhead of the patient having to deal with a lot of paperwork. It also name-checks "personal responsibility". And I suppose there is a potential real financial difference between a default level of coverage plus addons and being required to purchase something that has at least that level of service, though I think there would probably be ways to deal with that.

Anyway, my point is that people shouldn't have to worry about this mess to begin with.

And there's still the possibility of going bankrupt from your cancer treatment.

While I agree that there are a significant number of frivolous malpractice lawsuits, I cannot think of a way to limit them without raising the bar for those who do have legitimate complaints. That's why we have juries and judges.

That said, there can't be too many of them if your dad has spent 35 years as a surgeon without a single one being brought against him. Surgeons have the highest level of malpractice suits, which explains the high premiums.

And, then, that said, is the problem the lawsuits, or is it the malpractice insurance company that's the problem?


Your argument is internally inconsistent. First you argue that the current system is not affected by those just searching for money, and then you argue that removing the people that are just searching for money would be bad.

That said, I don't think that the enormous debt that medical students racks up weeds out those who are only in it for the money; it merely weeds out those who don't plan long-term. I'm not saying that these people are bad doctors; I'm just saying that, given the choice between the two, I'd rather be treated by the one compelled to help people.

I have non-medical relationships with a number of doctors, and the one thing they pretty much universally hate is our current insurance system. One left private practice to become an employee of a hospital specifically so that he could avoid dealing with health insurance. Another has a problem with migraines that keeps her from practicing regularly, and she cannot afford to pay malpractice insurance if she isn't going to be working basically every day. Yet another retired early because she was tired of kowtowing to the insurance companies and limiting her patient interaction in order to plow through enough of them. Another regularly worked at least 14 hour days until her retirement in order to both see enough patients and actually spend time with them.

I feel certain that at least some people looking to enter the medical profession encounter these situations and, based on them, change their mind before they ever get started. They probably go into veterinary medicine instead.

First, the government runs the entire military healthcare system, including the VA, from providers to facilities. The healthcare bill has absolutely zero provisions for the government to be making any significant medical decisions; they'll merely be facilitating the purchase of insurance and the distribution of patient records and mandating base levels of coverage.

Second, the reason that the VA doesn't work as well as it ought to is because it's underfunded. There isn't really anything to underfund in the current bill.

What I was trying to say is that the high risks and monetary input weed out those who are just in it to make a quick buck. The fact that there are those that apply and are turned down is a GOOD thing. There are plenty that WANT do be doctors, even if it weren't for the compensation. But if someone has to crack my chest open, I want him to be not adequate, but the best. To get the best, the mediocre have to be weeded out.

As to a government run program, I fail to see how this will make matters better. As we stand now, all the costs are currently payed for by the paying consumer. Our prices are higher than they would be if the hospitals didn't have to write off the high number of non-paying customers. All we're talking about is shifting the money around. They money still has to come from someone. That someone is still me. This time it's in the form of higher taxes, not higher medical bills. Only now, a normally paying customer will have no greater access to coverage (think transplants) than the non-payers.

I guess it all boils down to the disagreement we have that medical care is a RIGHT. Something that does not have to be earned. I do not believe this to be true.

As to your reference to your medical friends, it seems all four would have been worse off if they were compensated less. In order to make any decent money, all 4 would have had to work more to achieve the same results and all 4 seemed to be trying to work as hard as they could already. All the doctors I know are merely comfortable. Only moderately more so than me. The ones that I would term as rich are working 6 16 hour days a week to achieve this.

So let me be sure I understand you - you are saying that you think people who can't afford medical care shouldn't get any?

Can I ask people in the US a question. I honestly don't know the answer, and what interests me if my perception of your healthcare system is true.

Lets assume I am a US citizen, I am a very low paid worker and have no part of my income available for healthcare insurance or visits to the Doctor (I am assuming you have to pay to see a GP?).

If I had cancer, I may not know this of course, what treatment, help and support is available to me as someone who has no medical cover? And a what point would any state based help kick in?

Now my preconceptions would be that I would basically be left to die painfully unless someone would be able to scrape the money together to help me. Is this actually the case?

If it is, I find it hard to get my head around the fact that a modern society could deny any fraction of it's people the technology and knowledge to help in a situation like that.

Cheers

Cris.