National healthcare question.
February 2, 2005 6:30 PM   Subscribe

The truth about national healthcare....

Every time the subject comes up in the US. It's my experience that someone has this knee-jerk reaction about the horrors of National healthcare elsewhere. I've always felt that such reactions were somewhat ridiculous...

Where does the truth reside?
posted by Shanachie to Society & Culture (49 answers total)
I've never paid for a doctor in my life, nor has anyone I know. Being sick or having an accident doesn't cost money for me. I can go see a doctor without hesitation if I'm worried about something, or I want a checkup, or whatever. whatever other problems socialized healthcare may bring, that's fine with me.
posted by Jairus at 6:57 PM on February 2, 2005

If you're monied, private health care is fabulous. If you're not, public health care is fabulous. Given that most people aren't monied, I tend to think that public healthcare is a no-brainer... but then again, I don't work for a massively profitable and super-entrenched insurance company.

Qualitative differences are hard to assess, so much of the discussion ends up being about 'wait times', 'waiting lists', and convenience more generally. Private health care is fast but extraordinarily expensive; public health care is slower, but won't bankrupt you.

Many people here, in Canada, talk about horrendous wait times for some procedures. Understandably, it is frustrating to wait days, weeks, or months for certain high-demand diagnostic tests... but I have yet to hear any non-apocryphal anecdotes about patients actually being harmed (in terms of their overall health, post-treatment) by slower service. Waiting lists are generally prioritized by need, so if you're being forced to wait then it's most likely because you can afford to, both medically and monetarily.

Of course, when your national healthcare system draws illogical distinctions between care that it covers (medical services related to your torso and limbs) and those that it does not (medical services related to your eyes, your teeth, or your mental health -- not to mention prescription drugs), this is no utopia.
posted by onshi at 7:04 PM on February 2, 2005

I live in England, home of the much-derided National Health Service. I'm always able to get a same-day appointment with my GP and it doesn't cost anything. The problem, I hear, is getting to see a specialist--sometimes the waiting lists are several months longer. But it's still free. Unlike in the U.S. where insurance had to be paid for as well as a big honking copay each time.
posted by grouse at 7:04 PM on February 2, 2005

When I hear the knee-jerk reactions, I usually translate them in my head as "I have good coverage now, or at least I think I do, and I don't know what coverage I'll have under a single-payer system but I'm very worried that it will be worse."

I'd prefer some manner of single-payer system myself, if only for the joy of watching the jillions of useless leeches in the insurance industry and the insurance-form-processing industry suffer the Instant Crash recently inflicted on telemarketers. But I don't think that the baseline concern -- I have it good enough now and I don't know what I'll have under System X -- is silly or dumb, even if it's not usually couched in those terms.
posted by ROU_Xenophobe at 7:08 PM on February 2, 2005

Unlike in the U.S. where insurance had to be paid for as well as a big honking copay each time.

I work at a peds clinic, and copays can range from 0 to 30 dollars (generally). They average around 15 bucks, which isn't big or honking.

Of course, some parents bring their kids in for the most ridiculous things, and it can add up.
posted by justgary at 7:19 PM on February 2, 2005

the truth resides in the almost 50 million Americans (and growing each year) without healthcare, and their needs, and our ideals and beliefs as a nation.
posted by amberglow at 7:22 PM on February 2, 2005

I should also add that there's the equal knee jerk reaction when it comes to people who desire national health care. They may have never experienced it, nor talked to anyone who lives under a system, but they hear it's free and immediately support it.

Basically, people hate paying for health care. Trying to get people to pay is like pulling teeth. They will buy big cars, carry a cell phone, and eat out often, but pay the 100 dollar bill for missed copays? They'll fight you every time (a generalization, but happens often).

Go to best buy and buy a computer, you come home with it. Go to see a doctor about your illness, you have nothing to show for it except a prescription that'll cost you more money. That's a hard concept for most people, so if the government will pay the bill, why not?
posted by justgary at 7:25 PM on February 2, 2005

I remember hearing healthcare advocate Dr. Quentin Young on NPR years ago. According to him, only 3% of Canadians surveyed said they'd prefer the American healthcare system to theirs. He also said that's the same percentage of people who believe that Elvis is still alive. (An unfair comparison, as he himself pointed out, but it sure helped me remember it.)
posted by hydrophonic at 7:32 PM on February 2, 2005

I work at a peds clinic, and copays can range from 0 to 30 dollars (generally). They average around 15 bucks, which isn't big or honking.

While copays for pre-scheduled office visits to a regular doctor on my plan are still $10, my coverage recently decided to pay zero for urgent care visits. I found out when I received a bill for full retail after seeing a doctor for something that seemed "urgent" enough not to wait 2-3 weeks to see my regular doctor, but not so urgent as to require emergency room attention. Used to be the same $10 copay, now it's closer to $120 in full.
posted by gimonca at 7:35 PM on February 2, 2005

There is actually a very good series of articles in this week's Canadian Time (who'd have thunk it?) called Inside a Canadian Hospital.

I work in a Canadian hospital. There are compromises and short-comings to this system, but overall the healthcare is very good, at least in cities. I have never experienced an unreasonable wait, and seeing a specialist isn't much more onerous than it is in the U.S.

IMHO, the real difference is public health. SARS almost brought Toronto's health system to its knees. But it would have been far worse in an American city where the uninsured avoid treatment. I grew up in the U.S. with great insurance, and had great care. But I have never been disappointed here, and I like seeing poor people getting good care. I am not sure that the U.S. can continue to afford to not have public health care.
posted by gesamtkunstwerk at 7:39 PM on February 2, 2005

In a snowboarding accident, I ended up strapped to a body board and taken to the local hospital, passing in and out of consciousness. I hit emergency, then xray, stitches, a private room on horrendous amounts of IV drip, and all sorts of monitoring. A CAT-scan the next day determined that my skull was not fractured, ergo no worries about meningitis, and the following day I was put into a four-bed room. Two days later, I was allowed (on my strongest insistence) to go home.

I paid a few bucks for the ambulance ride. All else was covered. The emergency room response was superb, and their concern for the injury was dead obvious.

My wife was run over by a truck last year. The ambulance was there within fifteen minutes, along with fire trucks and police. She was strapped to a body board and whisked away. Within the hour she was in a six-hour surgery in a remarkable attempt to salvage her shoulder and elbow. Three pins in the shoulder and a Home Depot worth of screws and straps in her elbow. Then a week in the hospital, with endless nursing care. This was followed by several more elbow surgeries over the next few months to finesse the elbow ("broken popcorn" was the description of the mess in there.) Umpteen more visits to the surgeons for checkups, enough x-rays to make her glow in the dark, and she's finally done with that part of the repair.

Again, no charge for all that.

I sure like our system.

I never, ever worry about health care in this country.
posted by five fresh fish at 7:48 PM on February 2, 2005

I would, however, like to see a waivable minimum fee for emergency room and doctor's office visits, just something on the order of ten or twenty bucks. Just enough to encourage people to quit being stupid about ordinary flus. There's just nothing that can be done to fix a viral flu, so go to bed, drink chicken soup, and ride it out. Don't go to emergency, dammit!
posted by five fresh fish at 7:53 PM on February 2, 2005

I've lived in Canada (Ontario) and the US and had serious health problems while living in the US. I very much prefer the Canadian system.

First, when I'm in Ontario I get to choose my doctors. Not choose from a list of "participating providers" or choose, but it costs more if I see a doc from one list than if I see one from another. I just choose... any doctor I want. I make an appointment, I show up. I don't pay a penny.

In the US (where I did have insurance, which is supposedly relatively decent coverage), when I needed to see a specialist there was basically one who was covered (though, there was some system where you could get 3 visits a year with outside specialists). I had to wait 2 months to get an appointment with this specialist.

In Canada my mom made an apopintment with the same kind of specialist today. The appointment is for Tuesday.

My insurance in the US has changed such that I now have to pay $10 each time I see a doctor. Sure, it's not monstrous, but honestly it does make you hesitate (which is why they charge it, of course). Whether people should hesitate or they shouldn't, they DO.

In my case, it took 4 or 5 appointments before my problems were diagnosed. I would never have gone if I had to pay $10 for each of those appointments. My only symptom was redness in the corner of my eye. I couldn't even see it (because I had to look to the side to make it visible and I couldn't look in the mirror while looking to the side). It ended up being the only symptom of something serious, but I wouldn't have spent $50 to find out why my eye was red. If I hadn't gotten it checked out it would have been far more advanced by the time I developped other symptoms and had it diagnosed.

I've never had any problem getting a same-day appointment with my family doctor. I've also never had any problem getting specialist appointments reasonably soon (in fact, I've gotten same day specialist apointments, too).

Also, you'll note I referred to my family doctor. Same doctor for about 20 years, now. Since there's one insurance system and it pays for any doctor and any doctor takes it, I can stick with the same doctor if I want. I really don't understand how some people would think it acceptable that if you changed insurance coverage or got a new job or whatever you would end up having to change doctors. Or that the doctor you saw couldn't be the same doctor your extended family saw (if they so chose) I like that many of my family members see my saved me the trouble of remembering my family history.

Of course conversely, if I don't like a doctor in Toronto I just switch. I went to three appointments with a dermatologist and every time he was running an hour or more late. Well screw that. I got a new dermatologist who doesn't waste my time. In the US my choice of docs is more limted.. I think they have two dermatologists. In Canada I can choose my doctors based on any criteria I want (sex, close to work, close to home, languages spoken, reception area magazines...whatever. Nobody is second guessing my choices) and if I find someone who meets my criteria, I know they're covered.

Also, I find the US system needlessly complicated. It really irritates me to see all those commercials where insurance companies talk about how wonderful and friendly their customer service people are. i'm thinking "if I'm calling you, you've already done something wrong. Insurance should be completely invisible. There's no good reason I should ever have to call my insurance company. I don't want you to be "partners in my health." My doctor is my partner in my health. Having the person who pays for my health care decide what health care I need is a conflict of interest.

Oh, and lots of people in the US seem to think that doctors are civil servants under socialized health care. They are not (at least not in Canada). They're in private practice. They bill the government the same way American doctor's in private practice bill Blue Cross.

Last comparison...I think this is specific to the places I get my healthcare, but I feel very much like I'm being processed in a factory when I get my healthcare in the US. I have to check-in with a receptionist who never looks me in the face and is too focussed on being efficient to know there's a person standing in front of her. A nurse (different one each time) comes out to the waiting room to get me and does the temperature taking/blood pressure etc. and asks why I'm there. Then after she leaves I sit and wait and eventually the doctor shows up and asks why I'm there all over again and does the doctor thing.

At my doctor in Canada I walk in and say hello to the receptionist, who knows my name and often chats a bit. My doctor comes out and says "Come on in..." She doesn't stand there calling my name because she knows who I am and thus can direct her "Come on in." directly to me. As we walk towards the exam room she asks how I'm doing, asks how my family members are, how my thesis is going etc. This chat continues through the routine parts of an exam.

I realize that this sort of thing isn't so directly related to my health, but it does make me more comfortable asking awkward questions and confiding things I otherwise might not. I also know that this is more about two doctors' practices than about two health care systems. I'm sure there are curt and efficient practices in Canada and warm friendly practices in the US...but in Canada I can choose any doctor I want and decide I want to go to the warm and friendly ones. In the U.S. I can't just go wherever I want.

And I think it's important that everyone has the same insurance. If you have a system where the government only pays for health care for people who can't afford it (putting aside the problems of defining that), it becomes easy for the people who aren't counting on the government to claim that certain services aren't really necessary, or are too expensive, or aren't needed all that quickly, etc. etc. When taking it away from someone else would take it away from you, too, all of the sudden it doesn't seem so unnecessary.

I don't know if it's still "knee-jerk" if it's based on getting health care on both sides of the border, but that's my reaction pro-single-payer health care systems.
posted by duck at 8:02 PM on February 2, 2005

My insurance in the US has changed such that I now have to pay $10 each time I see a doctor. Sure, it's not monstrous, but honestly it does make you hesitate (which is why they charge it, of course). Whether people should hesitate or they shouldn't, they DO.

And they should. The system already gets abused, without a copay, I can't imagine. If ten bucks makes someone hesitate about going to the doctor, they don't need to go.

In my case, it took 4 or 5 appointments before my problems were diagnosed. I would never have gone if I had to pay $10 for each of those appointments.

I agree that's wrong. In the clinic I work at the doctors often waive the copays of repeat visits if they're for the same problem. So that doesn't happen. And if we have to send them on the the emergency room, the copay is also waived.

Same doctor for about 20 years, now. Since there's one insurance system and it pays for any doctor and any doctor takes it, I can stick with the same doctor if I want. I really don't understand how some people would think it acceptable that if you changed insurance coverage or got a new job or whatever you would end up having to change doctors.

Again, I work at a clinic in Alabama (not the most progressive state) and your statement has nothing to do with us. We take all insurances, including medicaid, and the patients see the same doctor, if they choose, from a pre-birth conference until they turn 21.

Changing insurance means nothing more than letting us know. And we know many patients by name. If we don't, it's because we have so many patients.

Many of our patients are medicaid patients. They pay nothing, but get the same care. If you're over qualified for medicaid, but still need help, we have AllKids.

Chanachie, I won't say more because this isn't the blue so it would best if I didn't debate, but when you ask the question you have to remember where you asked it. Metafilter leans (hard) to the left, and the views will also.
I'm not saying I wouldn't enjoy national healthcare, but it's not as simple as people make it out to be. Free healthcare sounds great, free crappy healthcare sounds bad.

Do a google search for canada health care problems and you'll find quite different views than you see here, if you actually want to hear both sides.
posted by justgary at 8:21 PM on February 2, 2005

National healthcare is the difference between the comfort of knowing that if you get seriously ill, you will get care, at minimal financial cost; and the comfort of knowing that if you get seriously ill, you may get care (if insured), as well as bankrupted.

Study: Health costs spur bankruptcy - CNN
More ...

I live in Australia, and I think the system here is much as described above: if you need medical care, you'll get it, and it will be of an excellent standard; if you need elective surgery (or surgery that can be postponed), you'll have to wait a while. Like I said, it's comforting to know.
posted by bright cold day at 8:22 PM on February 2, 2005

Justgary: I didn't mean to imply that Canadian healthcare has no problems, only that I think they're less serious than a system where some people have trouble getting health care at all, where people don't have completely free choice of what doctors they go to and what care you get, and different people have different things covered (which is just another way of saying "some people don't get things covered).

I'm glad to hear the patients at your clinic don't have to switch doctors when they switch insurance providers. I never claimed that people in the US can't ever keep their doctors. Just that people (meaning some people) do have to change docs just because they change doctors or employers. I know if I were to choose to stay in the US (and healthcare is one reason I lean towards not staying), I would have to change when I left the insurance I have now. I don't think its acceptable that people *ever* have to change.

And I wonder if all of those patients can go to any doctor in the state and know that that visit will be covered. Can they go to any other doctor in the state and expect the same hassle-free treatement they get from you? And can they get that same hassle free treatment from you if they have no insurance no medicaid and no way of paying? That's what I think the standard should be (when I say standard I mean "lowest acceptable level of service"). I place a huge premium on choice. I like being able to go to any doctor I want and know that what health care I get is up to me and my doctor and not anyone else.

It's also important to me that people be treated the same regardless of their insurance I don't know how you're clinic works, but when I was in hospitals I found that even when people got the same medical care, they weren't treated the same: "Oh sure you can get X,Y,Z...but first you'll have to fill out all these forms." Argh...I've never had to fill out a form to get my healthcare in Canada (meaning a form dealing with insurance or finance or anything of the sort -- obviously when you see a new doc you do fill out your family and personal medical history). The forms are needless hassling of patients, and they require administrative employees to process them (which means money is going t administration rather than health care).

As for copays, I remember reading once that they discourage even people who do have legitimate needs to see doctors (some study). I think the problem is that often you don't know if you needed a doctor until after you saw a doctor. The people co-pays discourage the most of course, are the poor. And you don't need to discourage there are already plenty of disincentives to keep them from seeing doctors -- like the hourly pay many people lose if they take a few hours off to see a doctor.

Oh..and my several different appointments to get diagnosed were each with different doctors, so waiving co-pays for subsequent visits wouldn't have applied to me.

I am aware that there are problems with Canadian health care and I've read about it a fair bit...If you feel like I'm not giving the problems their air time: there's a shortage of doctors, particularly in rural and northern areas.

There are some surgeries that are extremely necessary, but not so urgent that some people end up waiting way too long for. (there are no "waiting lists" .. you pick your doctor and make an appointment for the surgery with your doc. There are no centralized lists, which is good because you choose your doctor, but bad because people with some doctors will have their surgery sooner than people with other doctors... of course you can shop around to find a doc who will do it sooner). Things like cataract surgery or hip replacements. This is a huge problem, though IMO not as huge a problem as having people who don't get surgeries at all because they have no coverage.

In Ontario there is no prescription coverage (at least for regular stuff...I think if you spend a couple of thousand on drugs a year, or if you are poor there's some sort of coverage that kicks in, but I don't know about that). This is a big problem.

Homecare needs to be expanded. We have it already...I had some surgery a few years back and it was high-risk for infection so a nurse came to my house every day to check it and to change my dressing (this wasn't a standard/simple dressing change and needed to be done by someone who knew what she was doing). I know elderly people who have a nurse come to their home every day to help family members with bathing them. Stuff like that... I'm not sure what additional homecare they're looking to add, but it's my understanding that there are people who could use more homecare, and it's a problem that they're not getting it.

There are definitely problems, but the bottom line is that when we need healthcare we can go out and get it. Every single one of us. And every single one of us is motivated to fix the problems that do exist, because none of us gets to "opt-out" of them just because we have money.
posted by duck at 8:54 PM on February 2, 2005

And while I'm pointing out the cons of the Canadian system, I should also give the other side on the US system: I really like my doctor's in the US. They're good people. I know they care. They're friendly (though the system they work in isn't friendly, as I've mentioned) and they do know my name and they do remember me.

One doctor in particular has always been very kind to me. After I was ill, when I was paranoid about every little thing (remember, my red eye ended up being serious...if that could be serious, then surely this strange pain in my back will kill me!) and if he'd gotten impatient with me and told me to stop bugging him about every little thing, he would have been well within his rights. But instead he reassured me each time that I wasn't dying and that my health problems weren't coming back, and he just kept being kind and reassuring until the paranoia passed. I am very grateful to him, and man was I mad when I saw him on Fox News and some reporter implied that he (and doctors more generally) were trying to cover up the cure for cancer because doctors make money off of cancer. ARGH! He's such a sweet man, why would anyone slander him like that???
posted by duck at 9:12 PM on February 2, 2005

And they should. The system already gets abused, without a copay, I can't imagine. If ten bucks makes someone hesitate about going to the doctor, they don't need to go.

The system already gets abused, yes. But a huge majority of the abuse is from HMOs and hospitals fraudulently billing each other and Medicare; it's not from patients. Patients who abuse the system are called hypochondriacs, or have ficticious disorder, and they require treatment, not condemnation. For-profit hospitals, on the other hand, do unnecessary heart bypass operations to increase their bottom line.

And let's try flipping the above statement around. If most people (insured, middle class) are sick enough to think they need to see a doctor, 10 dollars isn't going to prevent them from going to see a doctor, nor will 20 or 30. But for someone that's uninsured, or insured with enormous copays or deductibles, or just low-income, it just might make a difference. The question is, does it make more sense for them to see a doctor when their infection is easily treatable, or wait until it gets more complicated?

Like it or not, we're all in this together. My health affects you, your health affects me, and if I require more expensive treatment, it costs the whole health care system more, making your premiums higher next year. It's time that we have a rational health care financing scheme in this country, and quit wasting billions of dollars on administrative paper-pushing, denial of care, and pre-existing conditions.

Canada's not perfect. The Romanow Report addresses the imperfections, but by-and-large, Canadians support their health care system, and value it highly. Yes, there are waits for elective procedures, but Canada still uses triage; if you need to go to the cath lab immediately, you go immediately.
posted by gramcracker at 10:19 PM on February 2, 2005

What duck said, in spades. That's all exactly how my experience in Canada has gone.

And to add a bit more, I can expect the same no matter where I am. If there is a doctor within shouting distance, I'm covered. If I'm in Tuktoyaktut and get chomped by a polar bear, I'll be flown out to the hospital in Inuvik; if it turns out to be worse than they can handle there, they'll lift me to Whitehorse; still no good, then it's off to Edmonton. It's just not a problem.

I guess that's what it boils down to: in Canada, problematic healthcare is the exception, not the norm. Almost all of us almost all the time get excellent healthcare with no hassles and no worries.

And to boot, it costs less than in the USA. On a per-capita basis, healthcare in Canada is one-third (one-quarter?) the cost as it is in the USA.
posted by five fresh fish at 11:01 PM on February 2, 2005

the truth resides in the almost 50 million Americans (and growing each year) without healthcare

Firstly, there are NOT 50 million Americans without healthcare. There maybe 50 million Americans with out health insurance. Not the same thing.

The # of uninsured Americans is batted around quite often... now you are saying 50 mil, last I heard it was 40 mil... but what it over looks is the millions of young people like me who do not WANT Health Insurance. What I want is Catastrophic coverage, but I can't get just that.

My car insurance does not pay for oil changes, it only pays out if I total the car. Why should my health insurance pay for routine doctor visits? If people actually thought about the price of a doctor visit as something they were paying for with their money, opposed to someone else's, they might 'shop around' like everything else they buy, and the price of visiting a doctor would drop. This is the reasoning behind a co-pay to some extent.
posted by Steve_at_Linnwood at 11:15 PM on February 2, 2005

40 million, 50 million...pretty soon you're going to be talking about real people.

If people actually thought about the price of a doctor visit as something they were paying for with their money

That'd work great, as long as they had money.

I honestly believe that a major obstacle to the US getting national healthcare goes like this: national healthcare > socialized medicine > socialist > Communist > no way, Godless commies!
posted by kirkaracha at 12:10 AM on February 3, 2005

I think you're right, kirkaracha. There seems to be a great fear of 'socialized' anything. In Belgium (and the rest of Europe, more or less), I can go to any doctor I want, any specialist I want, and the 'socialized' RIZIV (national, mandatory health insurance) will cover it. It costs of course (I would say about 16 % of your gross income), but when someone gets cancer, they can afford treatment and meds and home care worker, etc. etc. To remind people that medical treatment costs money, they do have to pay a (smallish) part of the treatment (remgeld).

It's mandatory, which means that you can't opt out and it's a pseudo-tax (your premiums are linked to your income), but it also means that you can't not be covered when disaster strikes. No bullshit about pre-existing conditions (what a ludicrous idea, by the way). Premiums do not rise when you get ill (another strange idea), because they are always calculated on your gross income.

Recently the system was refined with a 'maximumfactuur', a maximum healthcare bill per family. If a family spends more than 450 € per year in remgeld, they get the amount they spent over and above that 450 € back.

It's an expensive system, but that's because (gasp!) medical care is expensive: that's the whole point of an insurance. If medical care was cheap, nobody would need an insurance. In all, I believe Belgium spends roughly 10 % of its BNP on medical care (with everybody covered), while the USA spends about 14 % (with lots of people not covered). I'm sure universal health insurance is the most fair system available, because everybody pays for everybody else's risks.
posted by NekulturnY at 3:50 AM on February 3, 2005

Thanks, trharlan....we were pretty long on personal experience and short on research (I just skimmed the first few paragraphs and don't have time to read now, but I'm assuming it's research). Another good source pointing out the problems with national health care (this one in Canada specifically) is the Romanow Report.

I would actually like to see some report that does a point by point comparison of single-payer vs. US style on a bunch of different things, but I'm not sure if such a report exists (not sure who the audience for such a thing would be, so probably nobody has produced it).

I do take issue with your suggesting that nobody here would like to answer the question honestly. While obviously you think our answers are wrong/misguided/uninformed or whatever, I don't see any reason to think that anyone here has been less than honest.
posted by duck at 6:27 AM on February 3, 2005

From CATO's 'About Us':

The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace.

Hardly surprising that they would 'debunk myths' about 'socialized' healthcare. If 'honest' means 'not biased', I think the answers here in AskMe are actually more 'honest'.
posted by NekulturnY at 6:49 AM on February 3, 2005

From The World Bank:

2002 Per Capita HC Spending, in US Dollars:
Canada: $2163
US: $4887
France: $2109

2002 Child Mortality at Birth (per 1000 births):
Canada: 5
US: 7
France: 4

2002 Life expectancy at Birth:
Canada: 79
US: 77
France: 79
posted by bonecrusher at 7:22 AM on February 3, 2005

to counter trharlan's anti-national health CATO thing, here's Physicians for a National Health Program (there are many other orgs online too)
posted by amberglow at 7:26 AM on February 3, 2005

what it over looks is the millions of young people like me who do not WANT Health Insurance.

I know I should just ignore it but... are you kidding? Why would you possibly not want health insurance? I'm 25 and I live in near constant fear that something will happen that will require me to seek health care. I haven't seen a doctor or dentist in years except for Planned Parenthood. My vagina is in tip-top health.

Not having health care really cuts into my quality of life, I'm in a near state of panic when I participate in sports.
posted by palegirl at 7:34 AM on February 3, 2005

NekulturnY, the study has 115 footnotes. I humbly suggest that someone looking for truth should find a scholarly paper supporting socialized/nationalized/single-payer and compare it to the one I have cited.

trharlan, I'm sorry, but that sounds like debating Ann Coulter ("read my footnotes!"). The people at Cato are giving us their bias right upfront, I see no reason not to take their own word for it. All I'm saying is that, given this bias, it's probably not a good source of 'truth'.

There is nothing "anecdotical" about the answer I gave: it is a rough overview of how the system in my country works, of which I have a good understanding, from living in it and having specialized in Social Security at my alma mater. I can give you a dozen of scholarly works, but unfortunately, I don't think you or the original poster read Dutch. So yes, you can probably find more "scholarly" position papers by free market think tanks with a lot of footnotes.

FWIW, just the first page of that CATO report is already full of sneering language like:

Single-payer systems tend to leave rationing choices up to local bureaucracies that, for example, fill hospital beds with chronic patients, while acute patients wait for care.

That is simply not true. In Belgium and France there are virtually no waiting lists, and certainly not for life threatening procedures. Also, if a certain hospital does have a waiting list for some procedure that is not urgent and you don't want to wait, you can always consult another specialist at another hospital.

There are certainly no waiting lists assembled by "local bureaucrats" (btw I thought CATO was against centralized government and would prefer local bureaucrats over 'Washington insiders'?): any waiting list there is, is managed by the medical staff of the hospital. No bureaucrats there.

Yes, there are in Great Britain, and in the UK the single payer system "tends to leave rationing choices up to local bureaucracies", but that's because the NHS was "restyled" to be more "efficient", more or less along the lines of what Cato likes: free market initiative. And boy, is the NHS a mess. BTW, if you look at the footnotes, most of their data and "scholarly" works (like Reuters Health...) deal with the situation in Great Britain, which is, as I said, dramatic.

On preview, thank you bonecrusher, that makes the point quite clearly.
posted by NekulturnY at 7:40 AM on February 3, 2005

Blatant self-link: I put together a chart of some facts comparing the US and Canada on health care. (from my single-payer site that is always never finished)
posted by gramcracker at 7:43 AM on February 3, 2005

More info on Belgian social security: here.
posted by NekulturnY at 7:56 AM on February 3, 2005

If 'honest' means 'not biased',

If wishes were horses, beggars would ride. "Honest" means "truthful." It doesn't mean "not biased." It's possible to be simultaneously honest and biased.

This is not a comment on whether the Cato report is honest or not, just against the general statement that "biased" necessarily implies "dishonest."
posted by DevilsAdvocate at 8:01 AM on February 3, 2005

Well, as I showed, it is both biased and not truthful.
posted by NekulturnY at 8:06 AM on February 3, 2005

Since the original question concerns the US: Regardless of lessons learned from other countries, a national system of healthcare begins with Congress, and many americans doubt the government's ability to build a healthcare system from scratch, especially given the government's inability to regulate what already exists. (Yeah, I know, same thing I said in the blue.)
posted by mischief at 8:20 AM on February 3, 2005

Firstly, there are NOT 50 million Americans without healthcare. There maybe 50 million Americans with out health insurance. Not the same thing.

Having gone without health insurance during a time when I very much wanted health care, I can tell you it's pretty damn close.

The # of uninsured Americans is batted around quite often... now you are saying 50 mil, last I heard it was 40 mil... but what it over looks is the millions of young people like me who do not WANT Health Insurance. What I want is Catastrophic coverage, but I can't get just that.

Maybe you're looking for somethign *really* catastrophic (very low premiums, coverage only kicks in at $50,000 of expenses), but catastrophic-like coverage is in fact available. I have a major medical plan right now that isn't much on covering the "maintenance" you're talking about -- no doctor visits are covered. Drugs aren't covered, though you are offered a 25% discount from their mail order pharmacy. It does have an ambulatory care rider that I invoked that gives me a $500 yearly deductible for things like tests, but mostly, it's a catastrophic plan for if something comes up that would more than clean out my savings account ($3000-$5000). But I will grant you this is pretty hard to find -- I looked for 9 months before I found these people.

I also have a "normal" health plan through my employer which does cover drugs and doctor visits. Theoretically, at least. In reality, they like to fight with me about whether or not they're the "primary" insurer and have to pay for anything at all, making their coverage nearly an automatic negative-value proposition for me. Like ROU_Xenophobe, for me the biggest benefit of moving to single payer would be watching these clowns squirm.
posted by weston at 8:25 AM on February 3, 2005

I have only had experience with US healthcare, apart from one visit to Ireland, where I contracted a nasty sinus infection, went to the doctor, paid 10 pounds & got antibiotics - easy and simple and cheap.

That has never been my experience here; right now, although I have insurance for me and my son, which I pay for to the tune of some $250 per month out of my paycheck - and my employer kicks in another $200 or so - I am looking at catastrophically huge healthcare bills for the mental health stuff I have been going through with my son. The total will end up being nearly $1000. Not to mention the $150 over and above insurance that his skateboarding broken arm is costing me - and the $20 copay per doctor visit minimum ($75 for urgent care) plus anything that isn't covered, which last year included a TB test for him ($50) and a thin-prep Pap smear for me ($125) and I won't even start on the dental bills.

As far as Medicaid being available for all children, well, I don't know about Alabama, but in North Carolina there is currently a 3 year waiting list for the children's health program. And in Maryland, where I did eventually get on Medicaid (pregnant, they did cover that, although not birth control,) my 8 year old daughter was refused on the grounds that she was too old and would have to have her own case opened and then was refused due to the waiting list, which ended up with me owing $2000, yes $2000, for her broken arm from a bike accident.

I also want to leave my job and have been offered a better one, making substantially more money, but I'm afraid that the cost of health insurance at the new job will be beyond my reach, since it may well eat up more than the extra money I'd be making. I don't particularly like feeling trapped in my job because of health insurance but here I am. COBRA would cost me over $500 a month, and I don't have that.

So yes, this is anecdotal, and I'm sorry about that, but anecdotes are people, and the US health care "system" sucks brutally from my perspective. It isn't as simple as a $10 copay, far from it, and it isn't easy to get Medicaid, and once you have children the whole thing gets exponentially worse.
posted by mygothlaundry at 8:31 AM on February 3, 2005

And boy, is the NHS a mess

It is? I've had very positive experiences with the NHS. True, there can be long waiting lists for non-essential procedures but if anything catastrophic happens, the care you will receive is as good as anywhere. For those non-essential procedures, you can always pay to go private, but then you're back in the realm of the US system.

There will be problems with every country's health system if you look for them. The question is how they compare. All I can say is that with my wife's various health issues, the American system would likely have bankrupted us. I can't imagine living in a place without an NHS-like system.
posted by salmacis at 10:38 AM on February 3, 2005

Steve, what do you mean by "catastrophic coverage?" Something like broken bones or traumatic accidents? Is cancer covered under something like that, or disease? Your car insurance analogy sucks. If I refuse to get the oil changed in my car and the engine seizes up and dies as a result, insurance isn't going to cover it. Are you advocating that people are refused treatment for cancer because they didn't detect it until it was very advanced because they never made any appointments for medical screenings?

I'm in a very similar position to you in that I'm young, have a history of good health, and am fairly conscientious in my decisions. On the other hand, I feel fairly strongly that keeping health insurance coverage and keeping regular appointments ("preventative maintenance," which I've been fairly lax in lately) is going to be a lot more effective in the long run than hoping that a catastrophe isn't going to happen. Anything I fail to detect personally might get tagged as a pre-existing condition if I go off insurance.

Pointing out the failures of other countries with socialized medicine is ridiculous. We're the damned USA, we're supposed to do things better. I think we should be able to guarantee food, shelter, and medical care for every person, with the last being consistent in quality for everyone.
posted by mikeh at 10:51 AM on February 3, 2005

There was a recent smoking thread where someone was hoping to lean the monopoly of socialized medicine and the forced/shared burden into controlling individual people's behavior. I do not favor national healthcare, so I tend to collect and remember instances where it fails, causes death, or removes choice, but that is no real measure of how well it works. I don't want it because I do not want to socialize risk, it is not for me. I held this view when I was freelancing without insurance and have learned anything that has come close to changing my mind.

If US healthcare were made federal, I would be freed to do several things immediately that I am currently struggling to do years from now, because I am now in a position where I need to maintain insurance coverage, but that freedom is not so attractive that I am willing to betray my basic notions of liberty.
posted by thirteen at 1:58 PM on February 3, 2005

Ah. One of those "cut of my nose in spite of my face" sorts, eh?
posted by five fresh fish at 2:30 PM on February 3, 2005

I think that we're going to see the healthcare debate open up in the U.S. in the next few years.

What's kept reform off the table has been a collective action problem -- those with something to gain are disorganized and powerless, and those with something lose are highly organized and highly powerful.

That's starting to change: employers increasingly regard the U.S. healthcare system as a terrible burden on them. They either have to shoulder ever-increasing costs of care themselves, or accept the poor quality of workers one can hire if one doesn't offer health care benefits.

They're going to prompt government action in one of two ways. Either they'll lobby for it, or they'll simply drop the coverage in large enough numbers that workers won't quit (because other employers will be doing the same). The latter occuring will force Congress's hand, because it will brin the middle class into the political game, as well as doctors and hospitals who suddenly have lost a lot of their customer base.

I personally think that the ideal system is basically a federally-managed catastrophic plan: families 100% responsible for their own health care up to a certain dollar amount, some form of national insurance paying 90% thereafter. All doctors and hospitals remain in private hands, with the 100%/10% system of patient keeping competition, economization and prevention economically viable.

I'd probably want to soften the impact of the patient's 100%/10% liability by having a credit system, with debit balances reclaimed out of tax refunds, public benefits, and other assets/income if the bill's not paid in reasonable time.
posted by MattD at 2:45 PM on February 3, 2005

I am a citizen of both Canada and the US, but I only have experience with US healthcare. But anecdotal evidence from my relatives in countries with national healthcare backs up what duck, fivefreshfish and nekulturny (don't be so hard on yourself, you seem very cultured) have said.

In my own experience, American healthcare can be fantastic. Can be. On a Blue Cross PPO plan paid for by my company, I could go to any doc I wanted, and most everything would be covered. On this plan, I never understood why some people were so angry about health insurance here. There were never any headaches.

Then my company was sold. The health plans all changed to a primary-physician-based system (HMO-style). The dermatologist I had been seeing for more than three years was no longer on the approved list, so I had to find a new one. First, I had to get a referral from my primary physician, which had to be on record with the insurer. After being referred to a dermatologist, it took over two months to get an appointment.

After the first visit, I received a bill in the mail for the visit which was supposed to be covered by insurance. Apparently the insurer never got the referral, so the entire bill was my responsibility - no chance of getting a referral after the fact. Because somebody had lost a piece of paper, I had to pay for what I was already paying them to cover. Wasted a few days fighting that one. After the next visit, they arbitrarily decided not to cover the full cost of the visit, and billed me the remainder again. That one got fixed, but only after a few days of back and forth on the phone.

No, this isn't a horror story or anything. But it's a pretty standard frustrating experience with a lot of the health plans companies are offering lately, for my friends and coworkers I've talked to at least. I can't imagine a system with more bureaucracy and slower movement than the average private insurer in the US.
posted by chundo at 3:02 PM on February 3, 2005

Ah. One of those "cut of my nose in spite of my face" sorts, eh?

Not so much. I don't like the trade off, and I don't like probable loss of autonomy.
posted by thirteen at 3:34 PM on February 3, 2005

I'm an Aussie, who has lived with and used the NHS in the UK.
In both countries acute medical care is handled very well, as is serious medical complaints that cannot be delayed (example being obstetrics).
Less urgent complaints sometimes are triaged.
For example, I broke an ankle. My local free hospital had me wait around 45 minutes while they checked on some other cases where the diagnosis indicated actual or potential urgent treatment was required. An example was a toddler in distress with a rash, who was feared to have meningococcal.
No problems with this type of wait, although it was a bit uncomfortable.
My mother in law was diagnosed with cancer in the UK and had the doctor call to our house at 7pm to advise her of the diagnosis when her blood tests were returned. She was then admitted to hospital immediately.
For fairly excellent care all tax payers are forced to contribute.
Additionally, in both countries there is the option of private care. This allows you to have the procedures/specialists visits etc. of your choosing, but you pay market rates (think around $800 for an anesthetist, $1000 for a surgeon, $150 for a specialists appointment) which can sometimes be high. So you have choice.
Those that would like private care can also insure for it, and indeed the conservative government in Australia has effectively made this insurance compulsory for high income earners (largely for ideological reasons, as it appears to benefit few but the private doctors, as there is no lesser tax burden and emergency care is still almost exclusively done by the state).
Under this system, the choices available with the US system are maintained, with the exception of the choice to pay for no cover whatsoever.
While I respect that choice, such as Steve_at_Linnwood would make for routine healthcare, most arguments against universal healthcare tend to come from the camp that sees it as limiting individual choice, when this is clearly not true.
posted by bystander at 4:04 PM on February 3, 2005

I don't like probable loss of autonomy.

I guess I don't see how you'd lose autonomy, besides paying a tax?
posted by gramcracker at 5:22 PM on February 3, 2005

I guess I don't see how you'd lose autonomy, besides paying a tax?

I was referring to the increasingly common idea that when the risk is shared, the public has a right to have some say in what have been traditionally personal decisions. Talking about making smoking illegal, based on the cost of treatment, when people do not have any choice for opting out of that system is a mean Catch-22. It is not hard to imagine that fast food and sodomy are unacceptably risky to the scolds who are sharing the bill with you either. I don't smoke or love tigers, or really do anything that should cause people to want to limit my behavior right now, but I do oppose the idea of anyone being force to live their life according to the greater good. I don't want to pay for the stick that will be used to hit me.
posted by thirteen at 7:54 PM on February 3, 2005

Er... the truth of the matter is that with the current private healthcare system, what you fear is exactly what is happening.

Did you miss the MeFi thread on the company that is firing employees who smoke at home, because those employees are at higher risk of requiring insurance coverage?

Have you missed all the comments where people are being denied coverage on the basis of flimsy "pre-existing condition" excuses?

Surely you're aware that private insurers are continually weaseling out of paying claims.

If there are any sticks involved, it's the one that private insurers are shoving up the ass of their clients.
posted by five fresh fish at 8:18 PM on February 3, 2005

I was thinking of that thread in fact. People are freaking out about it, and I do not expect it to stand. One of the people who thought it was a great idea was one of your countrymen, and frankly I think that sort of thing has a greater chance of getting a toe hold up North.

Don't get upset, you have a system you are happy with, and I am trying to preserve a system that I approve of.
posted by thirteen at 8:35 PM on February 3, 2005

I guess I'd tend to use examples of other developed nations--ones that are arguably more "socialist" than the US, with national health plans or national health insurance, and smoking or other "unhealthy" beaviors haven't been outlawed there. The UK, France, Germany, Taiwan, Japan, Australia... unless I'm mistaken.
posted by gramcracker at 8:43 PM on February 3, 2005

These smoking restrictions ar only now coming into vogue in some of the places you mentioned. I would wait a bit before deciding if there is a trend.
posted by thirteen at 9:11 PM on February 3, 2005

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