Is this the future of USA healthcare?

[Rolfe]

A number of posters from the USA have argued vehemently against taxpayer-funded medical services in America. The concept of funding or even subsidising healthcare through taxes is described as theft, and "putting a gun to my head and taking my wallet". Posters talk about "taking the money that I need to get healthcare for my child, to pay for healthcare for someone else's child." It's big no-no for many people. Rather than countenance any "compulsion" to fund healthcare as a general good, they advocate charity. They'd be happy to contribute voluntarily, they say, and charity is the way to go.

We debate this, usually, by pointing out the unfairness of allowing the mean wealthy to avoid paying their share, and leaving it to the charitable to pick up the tab. We also point out the potential for discrimination in charity funding, where large donors may dictate who may and who may not benefit from their largesse. We also point out the improbability that sufficient funds could be raised in this way to provide quality, first-world 21st century healthcare to everyone.

However, we haven't really thought about what a mainly charity-funded healthcare system would look like. Would the charitable donations be going into big, high-tech hospitals with state-of-the-art facilities? Or somewhere else? This could be a very important consideration as more and more people lose employer-provided healthcare and are priced out of the private healthcare market. If charity is expected to pick up the slack, how might that work?

One name which has cropped up several times in the debate is the "Remote Area Medical Volunteer Corps (http://www.ramusa.org/about/mission.htm)".

The Remote Area Medical® (RAM) Volunteer Corps is a non-profit, volunteer, airborne relief corps dedicated to serving mankind by providing free health care, dental care, eye care, veterinary services, and technical and educational assistance to people in remote areas of the United States and the world.


The corps was founded in 1985 (http://www.ramusa.org/about/history.htm) with the aim of providing medical aid to Guyana, and other isolated, third-world communities.

The vision for Remote Area Medical® developed in the Amazon rain forest where founder Stan Brock spent 15 years with the Wapishana Indians. He lived with the pain and suffering created by isolation from medical care. He witnessed the near devastation of whole tribes by what would have been simple or minor illnesses to more advanced cultures. When he left South America to co-star in the television series "Wild Kingdom", he vowed to find a way to deliver basic medical aid to people in the world's inaccessible regions.


I found an interesting article about this (http://news.bbc.co.uk/1/hi/world/americas/7420744.stm) on the BBC web site, dating from May of last year (and yes, I have read to the end!).

He started a charity - Remote Area Medical (RAM) - more than 20 years ago to bring relief to those cut off from healthcare. Originally it was to help poor tribes in the former British colony of Guyana, South America.
That is where he lived after leaving Preston, Lancashire, more than half a century ago - he still is a British citizen. But now Stan spends most of his time bringing relief to the richest country in the world.

Some 60% of RAM's work is now carried out in the United States.


The corps appears to have been very active in the Appalachians for some time, and more recently, it was a RAM "expedition" to Tennessee that caused Wendell Potter's much-publicised change of heart (http://wallstreetpit.com/8311-health-care-industry-millions-people-uninsured) over the insurance system.

I just assumed that it would be, you know, like a health – booths set up and people just getting their blood pressure checked and things like that. But what I saw were doctors who were set up to provide care in animal stalls. Or they’d erected tents, to care for people. I mean, there was no privacy. In some cases – and I’ve got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee – all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. … And that made it real to me.

It was absolutely stunning. It was like being hit by lightning. It was almost – what country am I in? It just didn’t seem to be a possibility that I was in the United States.


Even more recently, an expedition to an urban area in Los Angeles has been hitting the headlines. "At free clinic, scenes from the Third World (http://www.latimes.com/news/la-me-lopez16-2009aug16,0,223974.column?track=rss)"

Stan Brock, who founded RAM in 1985 to bring medical care to Third World countries, told me that in 1992 he began getting requests to do the same work in the United States.


Much of the work seems to involve dentistry and optometry, but a lot of it doesn't. There are people there with breast lumps needing checking, with untreated diabetes, high blood pressure, asthma, the whole spectrum. And they're the the low paid, the unemployed and the uninsured. Some older people reported needing care that wasn't covered by Medicare.

Lacking an affordable route to healthcare for many Americans, with more apparently set to join their numbers, and in the absence of any public will to provide tax funding for healthcare, is this the shape of America's future?

Will more and more people be priced out of the big hospitals and the regular healthcare system, and will we see the result being more and more free, charity-funded clinics providing the absolute basics not just to the very poor, but to a significant proportion of the population?

If not, how else might the escalating cost of healthcare, which persistently outstrips inflation year on year, play out in future decades without some government intervention?

Rolfe.

[theprestige]

I don't object to "taxpayer-funded medical services" in principle... as a form of welfare for those citizens who can't provide for themselves.

A simple, straightforward government aid program along those lines would be agreeable to me.

I mean, it would still be bloated, inefficient, bureaucratic, and corrupt, just like every other government program. That's the price we pay for having government. It's usually cheaper than the price we'd pay for not having government.

And one big advantage to keeping the program simple and straightforward, focused on a specific objective, is that it's easier to audit it and correct flaws. The less tangled the web of regulations, rules, guidelines, entitlements, funding sources, etc., the easier it is to find and eliminate waste, corruption, and unnecessary bureaucracy.

Another advantage is that the bill proposing such a program would be much shorter. Legislators might actually have time to read it before trying to pass it. The President might actually be able to talk concretely about what the bill actually does, rather than having to oscillate between what he wishes and hopes the bill might do, and declaring what's not in "any of the bills" currently being considered. There'd also be a lot less room in the public debate for innuendo, rumor-mongering, and misrepresentations.

People need food to survive. Those who can provide for themselves, do so. Those who provide a little extra are taxed a little, to provide for those that can't provide for themselves. This kind of government welfare program is relatively simple, limited in scope, and largely unobjectionable in principle. For the vast majority of voters, regardless of ideology, the debate ends up being about the details of implementation: questions of efficiency, corruption, eligibility, etc.

People need "health" to live, too. Why can't government-sponsored healthcare be a similarly simple concept?

[Highly Selassie]

I saw these guys on a segment of Real Time with Bill Maher recently. What really irks me about this is that our poor health care system is now causing resources to be taken away from truly impoverished nations. I would hope this would be enough to make most opponents to public health care reconsider their stance, but if they aren't concerned about suffering in their own neighborhood, they obviously couldn't care less about suffering in the rest of the world.

[WildCat]

A simple, straightforward government aid program along those lines would be agreeable to me.
What would be simpler than mandating that everyone have private health insurance, subsidizing the premiums on a sliding scale according to income? After all, we're already subsidizing employer-provided health insurance in the form of tax breaks.

[Rolfe]

What you describe seems to work well in quite a number of other countries, so even though it's not within my experience, I'd assume it would be a reasonable way for the USA to go.

However, what I really meant by the thread was, if nothing is done and no healthcare reform is passed, is this the future? It seems to be in accord with the philosophy of those who believe that voluntary charitable contributions are the preferred way to fund healthcare for those who can't access insurance.

If not this, then what?

Rolfe.

[thaiboxerken]

People need "health" to live, too. Why can't government-sponsored healthcare be a similarly simple concept?

Health Insurance companies and the GOP, that's why.

[Highly Selassie]

I sure hope that's not the future. During economic recessions, people stop donating. The supply of health care to the most vulnerable segment of the population would be cut off at the worst time, possibly perpetuating the economic decline. At best, it is no better than the system we have now.

[Lothian]

What would be simpler than mandating that everyone have private health insurance, subsidizing the premiums on a sliding scale according to income? If you offered it free, paid for through tax systems already in place it would be far simpler than involving a third party (insurance)

[Rolfe]

At best, it is no better than the system we have now.


It's very, very much worse than what most people have now. I don't see anyone getting a hip replacement or a coronary bypass or even proper diabetic stabilisation and maintenance at one of these clinics.

I'd like to know how else the people who are for no tax funding or subsidy going into healthcare, and favour charity picking up the slack for all those who can't get insurance, think their method is actually going to pan out.

Healthcare costs are increasing at 10% a year, much greater than inflation. People are losing their jobs, and with them their insurance. Employers are cutting back on or eliminating health insurance as a benefit for employees. People relying on private insurance are either being refused a policy, or facing recission if they develop a high-cost illness.

If charity is the preferred means of looking after these people, is this what its advocates have in mind? Or something else?

Rolfe.

[WildCat]

However, what I really meant by the thread was, if nothing is done and no healthcare reform is passed, is this the future?
Future? It's already the present.

[Praktik]

Future? It's already the present.

Wait a minute though, we're at "now" now aren't we?

So isn't the "present" in your quote really the past?

http://img.photobucket.com/albums/v517/angry_in_t_o/now.jpg

[Darat]

It's very, very much worse than what most people have now. I don't see anyone getting a hip replacement or a coronary bypass or even proper diabetic stabilisation and maintenance at one of these clinics.

I'd like to know how else the people who are for no tax funding or subsidy going into healthcare, and favour charity picking up the slack for all those who can't get insurance, think their method is actually going to pan out.

...snip...

On one of the many websites that ran with the story of this clinic I read a couple of comments that this was in fact a good thing because companies would realise that this was an "untapped" market.....

[WildCat]

If you offered it free, paid for through tax systems already in place would be far simpler.
That would only work for a government-run system like the NHS in the UK. The Netherlands has a very similar syatem to what I proposed, IIRC about 30% of the population gets no subsidy and the rest get subsidies up to 100% of the cost depending on income. I would have thought this would be a much more natural fit for the US, but a shocking amount of people insist on having their health insurer get picked by their company and having it tied to their employment for reasons I cannot fathom. And apparently they're willing to accept lower pay for this privilege, and make our companies less competitive in the global marketplace.

But lacking any changes, yes what we see in the OP will become more and more common as we sink to 3rd-world status.

[WildCat]

On one of the many websites that ran with the story of this clinic I read a couple of comments that this was in fact a good thing because companies would realise that this was an "untapped" market.....
Of course, companies are bending over backwards to fill the niches in the free health care market. It's a simple 3-step model.

Step 1. Provide free health care.
Step 2. ?
Step 3. Profit!

[Darat]

Of course, companies are bending over backwards to fill the niches in the free health care market. It's a simple 3-step model.

Step 1. Provide free health care.
Step 2. ?
Step 3. Profit!

Damn I knew there was something wrong with their arguments but couldn't put my finger on it! :)

On your comment about "third world", do you really think it will get to that stage anytime in the near future?

[Toke]

I am trying to imagine setting up tents in a parking lot and declaring a free medical clinic. It fails at the patient part.

I am afraid that the US health care situation will descend to the point where the inconvenience to business/employers outweigh the profits of the drug/insurance industry. At that point the power/lobbyist balance will start to change and at some point reverse the direction.

It may end up with something like Wildcats UHC-light. (It sounds like a strange system but would clearly be an improvement)

[mortimer]

Health Insurance companies and the GOP, that's why.
Really? The Democrats could do this without involving either the insurance companies or the GOP (or at least could have, and will once again be able to, once Sen. Kennedy is replaced by another Dem). Why haven't they?

[thaiboxerken]

Really? The Democrats could do this without involving either the insurance companies or the GOP (or at least could have, and will once again be able to, once Sen. Kennedy is replaced by another Dem). Why haven't they?

Because of GOP interference and Health Insurance companies giving large contribution to "blue dogs."

[sugarb]

Put this in another thread, but it probably belongs here:

You know, Rolfe, I wonder...if some international groups were to step in and start drives and large donations for US medical charities, maybe that will shame our government into real action. I remember how people reacted when a few countries the administration didn't like so well offered aid during Katrina. No one in our country wants to think that we'll ever reach the point of being dependent on other nations...but let's face it: there are so many Americans in need of health care, were other nations to be more generous to them than our own government is willing to be...well, sometimes? A slap in the face helps wake someone up.

And to add to it a bit, if I may...

It's been a lot of years that me and people like myself have been saying that, for an example of the poverty that exists in the United States, all one has to do is travel through rural Appalachia. Yes, it's beautiful. But it is also very, very poor in the more remote areas.

Medicaid is a good program, but...in some parts of Appalachia, it is ineffective, because we're talking about the kind of poverty that involves having no transportation, no nearby towns with hospitals, emergency clinics, eye clinics, etc. People with no vehicles, no public transportation, in some cases no public water or sewage, for that matter. While the population isn't as large, the truth is that, for a long time, our rural volunteer medical services are the only care these people ever receive. And it is sad. True poverty. True poverty does exist in the good ole USofA. I've seen it. I can get in my air conditioned car and drive for about three or four hours and see some of the worst of it, and there are simply not enough volunteers with the ability/time/money to give these people what they truly need...which is more than just medical care. Sometimes it might be relocation, or a vehicle (but how can they afford gas and insurance?), better education, better infrastructure. Just so many things. Clean water, affordable electricity, donations of propane tanks for winter (and installing and keeping filled), so that they aren't relying solely on wood or coal.

The debate about health care is going to end up revealing a lot of dirty little secrets we prefer to keep our eyes shut to. There is simply NO excuse, in more populated areas, for people to have to rely on mobile units. And there is NO excuse for those mobile units to not be devoted to these rural areas until clinics, at least, can be built and some kind of regular transportation provided.

A lot of people tend to think that these people from rural Appalachia are just lazy, or third-fourth-fifth generation welfare, unmotivated, whatever...but the TRUTH is that, without better infrastructure, without real investment in those areas, or without help relocating and substantial assistance for a time, "third world" poverty will continue to exist in our nation. We're collecting food for children to take home from school on Fridays, for goodness sakes. It is a never-ending struggle, no matter how charitable and generous individuals and groups can be. Because nothing will really improve until the government gets involved.

I'm not "okay" with such poverty in our country. "Poor", yes. There will always be poor (and any of us could be that at any given time). But...eh, sometimes I just cry in frustration. So many wonderful people...just...ignored and forgotten about. And sadly, that seems to be becoming a trend in our country. *No one* should be forgotten. Not like that.

[WildCat]

On your comment about "third world", do you really think it will get to that stage anytime in the near future?
The current average health care cost for a family of 4 in the US last year was $15,609. But health care costs are increasing about 7% higher (conservatively) than the rate of inflation. So by 2019 we'd be looking at an average cost for a family of 4 of $30,705 in today's dollars. In 15 years it would be $43,065. I don't think the average family of 4 has that kind of dough laying around the house. Nor do I think that employers can absorb that kind of cost and stay viable. The feces is about to hit the fan.

[mortimer]

Because of GOP interference and Health Insurance companies giving large contribution to "blue dogs."
The GOP can't stop the Dems from passing anything, and the contributions to Dems don't force them to vote against anything. Why are you not placing blame on the Dems?

[WildCat]

Oh, and I think it goes without saying that costs need to be brought down dramatically, and both parties will have to piss off core constituencies to do so. Dems will have to tell the trial lawyers to take a hike, the GOP will have to admit that the "health care as a business" model is an abject failure (you don't want doctors and hospitals selling tests and procedures like a car salesman selling rustproofing), the AMA will have to increase the artificially low supply of doctors by opening more medical schools and (FSM forbid) learn to get by on a sub-$500,000 salary.

Of course, I'm not hopeful that any of this will get done. Too many ideologues digging in their heels on all sides of the political aisle.

[thaiboxerken]

The GOP can't stop the Dems from passing anything, and the contributions to Dems don't force them to vote against anything. Why are you not placing blame on the Dems?

Because they're the ones promoting health insurance reform.

[Toke]

Because they're the ones promoting health insurance reform.
They could just be making noises, while being just as much on the take as the GOP. Or maybe they just woke up and noticed the current situation of health care.
One party being bad does not mean that the others are good.

[Rolfe]

I wonder...if some international groups were to step in and start drives and large donations for US medical charities, maybe that will shame our government into real action.


I wonder too.

If anyone read to the bottom of the BBC piece, there is a suggestion there that RAM might come to England with some dental services. When I read all the reports of their expeditions in the USA, my first thought was that if this ever happened in Britain, we'd be so ashamed and absolutely mortified that Something Would Be Done. Indeed, apart from the dental aspect, if you sent RAM to Britain, maybe a handful of down-and-outs would show up but that would be it.

Then it occurred to me that dental services in England are poor enough that they might well get some takers for that. (Which seems already to have occurred to somebody.) I can flat guarantee that if that did happen, if they set up a clinic in a livestock market somewhere and were overwhelmed by the response, the public outcry would be so great that the dental problem would be addressed.

However, it's already happening in the USA. Given the size of the country I don't suppose the fraction of the population who have attended such a clinic would register on the radar, but the clinics themselves are quite prominent. We'd be mortified. We'd be deeply ashamed. It would probably topple any government that had let it happen. But it isn't doing that in the USA.

In spite of the poverty and the deprivation and the unmet need, US posters like easycruise still lecture us on how much better things are in the USA, how much richer you are and how much higher your standard of living is.

I totally don't get it. It's as if these people don't exist. The fact that RAM can show up anyplace they like and be inundated by people presenting health problems indistinguishable from those seen in third world countries isn't making a blind bit of difference. All the rhetoric is about "death panels".

So how big a proportion of the population would need to be relying on charity before the republicans would think again? Or would they not? Is RAM what they mean when they say that charity should pick up the care for the uninsured and uninsurable, and they're quite relaxed about it?

Rolfe.

[Darat]

...snip...

The debate about health care is going to end up revealing a lot of dirty little secrets we prefer to keep our eyes shut to. There is simply NO excuse, in more populated areas, for people to have to rely on mobile units. And there is NO excuse for those mobile units to not be devoted to these rural areas until clinics, at least, can be built and some kind of regular transportation provided.

...snip...

And this will probably be one of the major differences for any UHC in the USA compared to those in say the EU countries, how do you provide good health care to such rural communities. In the EU countries a remote community would probably mean one a hundred and fifty miles or so away from an excellent medical centre (ignoring some of the offshore places) but when you think that the UK, France and Germany could all fit into the single state of Texas it really helps to understand some of the real challenges a USA UHC would face.

But as someone has said a few times before - your government put a man on the bloody moon 40 years ago, and you don't get more remote than that! Ensuring good rural health-care can't be that taxing to such an ingenious society.

[Rolfe]

And the Australians could probably provide a few pointers (http://www.flyingdoctor.net/).

Rolfe.

[Darat]

How could I forget The Flying Doctors (http://en.wikipedia.org/wiki/The_Flying_Doctors)?

[thaiboxerken]

They could just be making noises, while being just as much on the take as the GOP. Or maybe they just woke up and noticed the current situation of health care.
One party being bad does not mean that the others are good.

I do blame the Democrats for not being united enough to simply vote the bill into existence, but that is only part of the blame. I think the blue-dogs are on the take, and that's a major part of the problem. When these a-holes speak out against health care, they should be wearing the patches of their corporate sponsors.

[Darat]

Folks there are plenty of other threads to discuss party politics and health care - please try to keep to the topic of the opening post.

[Rolfe]

Is it all this "self-reliance" and "stand on your own feet" stuff that allows the relatively affluent public to ignore the people showing up to the RAM clinics - and also allows the politicians to ignore them?

All we hear is petty squabbling among people who already have a great deal, about their (mostly groundless) fears that they might end up marginally worse off under a new regime. The ongoing discourse seems to be ignoring the profoundly disadvantaged as if they simply don't exist. Nobody is highlighting the queues for the RAM clinics. Nobody is talking about the rural Appalachian population. It's all about, oh yes, of course you'll still have $50,000 spent on you for a 50/50 shot at an extra month of life!

We're told how generous Republicans are, so of course charity provision is the best way to care for the poor and disadvantaged. But what are these Republicans (or anybody else) doing for the people queuing up at the free clinics? Is their own right to that final $50,000 month more important than basic standards of decency for those with nothing?

Why are the Democrats pandering to that agenda by spending time reassuring these selfish bastards about that final month, rather than screaming to the four winds about the people who aren't going to make it close to cancer chemotherapy of any kind? What sort of Christian values are these in this ostentatiously religious country, that these things aren't being cried with shame to the heavens?

How many people is it going to take in the queues outside the livestock markets before the privileged take off their blinkers?

Rolfe.

[Rolfe]

Folks there are plenty of other threads to discuss party politics and health care - please try to keep to the topic of the opening post.


Sorry Darat, didn't see the mod box before I posted.

I agree. Back to the topic.

If there is no reform, if charity provision is held to be the best "freedom" model for providing for the poor, and if healthcare cost inflation goes on the way it's heading, is this the future?

Or does anyone who favours no reform and a charity safety-net see it panning out differently?

Rolfe.

[theprestige]

What would be simpler than mandating that everyone have private health insurance, subsidizing the premiums on a sliding scale according to income? After all, we're already subsidizing employer-provided health insurance in the form of tax breaks.
About the only thing simpler than that would be not mandating it. We seem to be able to run a food assistance program for the destitute without a government mandate that everybody buy food insurance with premiums on a sliding scale.

And if the reform proposal really is that simple, why didn't it get passed before the August recess? Why was it, back in July, that we kept hearing about that the bill was so lengthy that legislators didn't even have time to read it before they were going to vote on it? If it's so simple, how come there are now multiple bills being considered?

You know what's a simple idea? Putting a man on the moon. John F. Kennedy was able to make the case (http://www.youtube.com/watch?v=ouRbkBAOGEw) for the Apollo Project in about 18 minutes. The what, the why, the how, and the when, all in under twenty minutes, and he even had time to work in a couple jokes about football and speechmaking. He even had time to give specific dollar figures for the project.

If the president's health care reform is so simple, and so important, why didn't he put the whole thing to rest in July with a twenty-minute speech that laid the whole thing out clearly for the American people?

[oldhat]

And if the reform proposal really is that simple, why didn't it get passed before the August recess?

Republican obstructionism plus millions and millions of dollars spent by the pharmaceutical, medical and insurance lobbies.

[Rolfe]

I'm not sure everyone posting in this thread has appreciated how basic the healthcare offered by RAM really is. They can't do major surgery. They can't give people long-term medication such as insulin or blood pressure tablets. They can't provide cancer chemotherapy. This is basic, poverty-spec, pull the rotten teeth and lance the abscesses territory.

What level of healthcare does the USA, the richest country in the world, the country that boasts about its standard of living and its cutting-edge medical facilities, believe should be provided to its least fortunate citizens?

And just how close to destitute do these citizens have to be, even to get that?

Rolfe.

[WildCat]

About the only thing simpler than that would be not mandating it.
It would absolutely have to be mandatory. If it isn't, it cannot work. Not at all. Because if it isn't mandatory people would just wait until they're sick to enroll.

[The Painter]

People need food to survive. Those who can provide for themselves, do so. Those who provide a little extra are taxed a little, to provide for those that can't provide for themselves. This kind of government welfare program is relatively simple, limited in scope, and largely unobjectionable in principle. For the vast majority of voters, regardless of ideology, the debate ends up being about the details of implementation: questions of efficiency, corruption, eligibility, etc.

And this would be fine. However that is NOT what is on the table. Providing for the 14% who don't have health insurance/care is fine. Leave the other 86% alone, they are happy. What is on the table is tearing the entire system down. That is not necessary. If you need to fix up 1 room in your house you don't raze the house and rebuild, you only fix the 1 room.

[Rolfe]

Look, Darat has already warned about posting off topic. The thread is about how healthcare provision will develop in the USA in the absence of any reform of the present system, and considering the rampant inflation of healthcare costs and the exclusion of ever-increasing numbers of citizens from insurance cover.

It is NOT about how to reform the present system.

Take your suggestions to another thread.

Now, in the absence of reform, what might happen?

Many people recommend reliance on charity contributions to fund the care of those who can't meet the cost from their own resources, in preference to any subsidy being provided from the tax system.

I'm asking how this might play out. Will future uninsured Americans be queueing up at RAM clinics for basic abscess-lancing? Or will the system stabilise so that everyone will avoid the death panels and get their $50,000 chance at an extra month of life somehow?

Rolfe.

[Tricky]

You know what's a simple idea? Putting a man on the moon. John F. Kennedy was able to make the case (http://www.youtube.com/watch?v=ouRbkBAOGEw) for the Apollo Project in about 18 minutes. The what, the why, the how, and the when, all in under twenty minutes, and he even had time to work in a couple jokes about football and speechmaking. He even had time to give specific dollar figures for the project.

If the president's health care reform is so simple, and so important, why didn't he put the whole thing to rest in July with a twenty-minute speech that laid the whole thing out clearly for the American people?

Two main reasons:
The American people were pretty much united in the fear that the USSR would control space before us. The overwhelming voice of the people was, "money is no object."
The space program did not threaten any wealthy, established businesses who would spend fortunes lobbying and advertising against it in order to protect their own interests.

[The Painter]

Tricky, you are off topic and Rolfe will yell at you.

Now, in the absence of reform, what might happen

Answer----Nothing

The system will go on just as before. And there are no people dying in the street for lack of healthcare. In fact you can not be refused healthcare even if you have no money.

Not like this;
The Horror (http://www.dailymail.co.uk/news/article-1209034/The-babies-born-hospital-corridors-Bed-shortage-forces-4-000-mothers-birth-lifts-offices-hospital-toilets.html)

Or this (http://www.independent.co.uk/opinion/commentators/ian-birrell-why-i-dont-believe-that-the-nhs-is-sacrosanct-1775088.html)

or even this (http://www.dailymail.co.uk/news/article-1208970/Man-collapses-ruptured-appendix--weeks-NHS-doctors-took-out.html)

[WildCat]

Tricky, you are off topic and Rolfe will yell at you.



Answer----Nothing

The system will go on just as before. And there are no people dying in the street for lack of healthcare. In fact you can not be refused healthcare even if you have no money.

Not like this;
The Horror (http://www.dailymail.co.uk/news/article-1209034/The-babies-born-hospital-corridors-Bed-shortage-forces-4-000-mothers-birth-lifts-offices-hospital-toilets.html)

Or this (http://www.independent.co.uk/opinion/commentators/ian-birrell-why-i-dont-believe-that-the-nhs-is-sacrosanct-1775088.html)

or even this (http://www.dailymail.co.uk/news/article-1208970/Man-collapses-ruptured-appendix--weeks-NHS-doctors-took-out.html)
You sure can be left to die, and you will.
Studying a national organ donation database, ethicists and cardiologists estimated 23 percent of donors who made their organs available for transplantation upon death were uninsured. The vast majority of those donors would not have been eligible to receive an organ, however, should they have needed one while alive. That's because under federal law a potential recipient must show the ability to pay for surgery, life-long follow-up care and anti-rejection medicines before he or she can be placed on the United Network of Organ Sharing's national wait list.
http://smu.edu/newsinfo/excerpts/cardiac-donation-ethics.html

Find any examples in the UK of an organ transplant being denied because of inability to pay The Painter? But here if you're a rich guy like Steve Jobs you can get on many transplant lists and be virtually guaranteed to get one. The uninsured? Those not rich? Fuhgetaboutit.

[The Painter]

Find any examples in the UK of an organ transplant being denied because of inability to pay The Painter?

Why would they pay me???

[WildCat]

Why would they pay me???
Don't joke your way out of it, answer the question. Find any examples? No? Do you really want to continue with your ridiculous claims that inability to pay doesn't mean you don't get health care?

[The Painter]

Federal law gives you the right to emergency care, regardless of your ability to pay.

The hospital must screen for the emergency and provide the care without inquiring about your ability to pay.

http://www.floridahealthinsurance.com/emtala.htm

What happens in the UK? Don't know and I don't care.

As for organ transplants. A friend of mine had a heart transplant. He was in his 40's and had virtually no money. He had minimal insurance left over from when he was a volunteer fireman. He died 2 years later. His body rejected the heart. The anti-rejection drugs just didn't work anymore.

I also had a customer whose heart was producing some kind of protein and the only solution was a transplant. He met all the requirements but one. He was over 60. 64 to be exact. No heart for him. He died because he was over 60 even though he had money.


Here is a big surprise.... Rich people live better, even in the UK. I''ll bet the Queen gets better care than some piss ant in a London ghetto.

[Molinaro]

I mean, it would still be bloated, inefficient, bureaucratic, and corrupt, just like every other government program.

Can you offer any evidence that this differs from how large corporations are run?

[WildCat]

http://www.floridahealthinsurance.com/emtala.htm

What happens in the UK? Don't know and I don't care.
Of course you wouldn't. You only care when something goes wrong with the NHS.

As for organ transplants. A friend of mine had a heart transplant. He was in his 40's and had virtually no money. He had minimal insurance left over from when he was a volunteer fireman.
He obviously had enough to pay for the $500,000 operation and to pay for the anti-rejection drugs the rest of his life or he never would have made it on the transplant list.

I also had a customer whose heart was producing some kind of protein and the only solution was a transplant. He met all the requirements but one. He was over 60. 64 to be exact. No heart for him. He died because he was over 60 even though he had money.
Maybe more people would donate organs if they felt they themselves might be able to get one some day if needed, and they wouldn't be so rare that had to be age limits.

[Rolfe]

The system will go on just as before. And there are no people dying in the street for lack of healthcare. In fact you can not be refused healthcare even if you have no money.


No, as I understand it, they don't usually die in the streets.

Dishonest arguing again, I note. You know as well as everyone else that you cannot simply show up anywhere and get medical treatment with no means of paying. You can and will be refused most healthcare if you have no means to pay. Only if your condition is deemed a lifethreatening emergency will you be given care you cannot pay for.

There are repeated stories of people who need long-term treatment for disease management, who are denied it because they can't afford it. They can only get care when their condition becomes critical, then they show up at the emergency room, the hospital is compelled to spend large amounts of money on them to stabilise their condition, then they're sent out again to face the same cycle.

Can you got chemotherapy for cancer if you can't pay for it? Can you get a hip replacement if you can't pay for it? Can you get any serious conditon treated in the early stages to prevent it becoming life-threatening, if you can't pay for it?

No.

Have you watched Sick Around America (http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view/)? Do you recall the story of Nikki, the girl with lupus? She had to give up her career plans to find a job with health coverage. OK, them's the breaks. However, her health deteriorated, and she lost the job, and the insurance. Neither she nor her parents could afford the medication she needed. At first she got the treatment from TennCare (some sort of Medicaid?) However, due to budget cutbacks (politicians refused to increase funding to Tenncare to cover all the people who needed treatment, because they believed the sick should take responsibility for themselves), she was REFUSED the treatment she needed to control her disease.

So much for "you can not be refused healthcare even if you have no money."

Eventually she deteriorated to the point where her life was in immediate danger, and she was admitted to hospital. Despite $600,000 being spent on her at that stage, she died.

Do you think this is a good use of resources? A fraction of that $600,000 spent on maintenance treatment could have kept her alive and contributing to society.

Now, you think this situation can go on as it is, indefinitely.

Are you considering the figures for health costs inflation, which are more than twice the normal rate of inflation? Nobody has identified any reason why these costs should not just go up and up. Thus pricing more and more Americans out of the market.

Are you considering the number of companies discontinuing the provision of health insurance for their employees completely, or cutting back to exclude family coverage? Are you considering the number who are loading more and more costs on to the patient, with higher contributions to premiums and high co-pays and deductibles? Are you considering the number of people losing their jobs in the recession?

Do you really think it can go on indefinitely?

What's likely to happen?

More and more people unable to afford the care they need to stay out of hospital. More and more people relying on free and charity clinics to deal with day-to-day needs. More and more people with conditions that have deteriorated to the point of being lifethreatening showing up at hosiptal emergency rooms to consume a big slice of resources.

And if they weren't bankrupt before that happened, they will be afterwards, because what you conveniently fail to mention every time you bring up the matter of compulsory provision of emergency care is that this is not free and the hospital will pursue the patient for the bill if they have any assets at all.

And if they don't have the assets, who pays? Those left in the system, the insured, who are presented with inflated bills to cover the money spent on the care of the destitute emergency admissions.

So the cost of insurance goes up even more, pricing more people out of the market....

Do you really think this is sustainable?

Rolfe.

[Darat]

If the current system remains pretty much as it is I can't see how the outcome can be anything but more and more people falling out of health-care, resulting in increased pressure on the "free emergency" care, which will push up the costs even more.

[Rolfe]

If the current system remains pretty much as it is I can't see how the outcome can be anything but more and more people falling out of health-care, resulting in increased pressure on the "free emergency" care, which will push up the costs even more.


What he said.

I seem to have taken about half an hour to say the same thing. tl;dr. Darat says it better!

Rolfe.

[ddt]

If the current system remains pretty much as it is I can't see how the outcome can be anything but more and more people falling out of health-care, resulting in increased pressure on the "free emergency" care, which will push up the costs even more.

Absolutely. And the hospitals that provide this "free emergency" care have to recoup the costs of that on their paying customers - which means that insurance premiums go up - and have to be spread over fewer and fewer policies. Fewer businesses will be inclined to offer the more expensive premiums as part of the salary package, meaning more and more people will decide not to insure themselves as the costs of paying it themselves are (nearly) prohibitive.

Moreover, it has been shown that this kind of care is actually more expensive than timely care, so costs will spiral even more.

From all sides, it goes out of control...

[The Painter]

Of course you wouldn't. You only care when something goes wrong with the NHS.


Are you kidding me???? I don't care one way of the other what happens in the UK. If it goes right, 3 cheers, if it goes wrong, who cares.


They can do what they want and we will do what we want.

[WildCat]

Are you kidding me???? I don't care one way of the other what happens in the UK. If it goes right, 3 cheers, if it goes wrong, who cares.


They can do what they want and we will do what we want.
So it wasn't you who posted this?
Not like this;
The Horror (http://www.dailymail.co.uk/news/article-1209034/The-babies-born-hospital-corridors-Bed-shortage-forces-4-000-mothers-birth-lifts-offices-hospital-toilets.html)

Or this (http://www.independent.co.uk/opinion/commentators/ian-birrell-why-i-dont-believe-that-the-nhs-is-sacrosanct-1775088.html)

or even this (http://www.dailymail.co.uk/news/article-1208970/Man-collapses-ruptured-appendix--weeks-NHS-doctors-took-out.html)

[The Painter]

So it wasn't you who posted this?


of course it was. Just to show them that their system is not the be all and end all of health care. That's all,

[WildCat]

of course it was. Just to show them that their system is not the be all and end all of health care. That's all,
Like I said, you care about it when it suits your needs.

[Rolfe]

of course it was. Just to show them that their system is not the be all and end all of health care. That's all,


Good Lord, did everyone ever say it was?

But you know what? The horror stories you find from the NHS have one thing in common. They involve people who were not given what they were entitled to get. They have redress. People within the system are working to see they get what they ought to get. Politicians get VOTES by taking note of these concerns and promising to fix them.

When the British complain about the NHS, they are asking for MORE of it. Suggest that the country should revert to every-man-for-himself, let-them-eat-cake - well, try running for office on that and see how far you get.

In contrast, in the far more broken US system, the horror stories are about the excluded, the unentitled, the marginalised. And nobody is working to get them care. Politicians play vicious fencing matches over the exact extent of the high-cost care that may or may not be given to one of the elite to extend their dying process for a few weeks, while people queue up at free clinics run by charities set up to provide care to impoverished third world countries.

Look at the OP for a minute, and digest what that's showing, before you get all superior about a crowded maternity ward or someone having to wait a couple of months for non-emergency surgery.

Rolfe.

[jimbob]

This might be OT, but should put some of the Painter's examples in context:

The patient's association (http://www.patients-association.org.uk/) is a UK charity "to promote the voice of patients in healthcare".

They perform an annual survey of people's experience s of the NHS.

There are a lot of shocking stories in this, which *do* make me angry, due to the failure of the system to do what it should do.

However, when we get to numbers, this is 2% of the users of the NHS. (Which is too many but significantly better than the users of the current US system.

Here (http://www.patients-association.org.uk/DBIMGS/file/Patients%20not%20numbers,%20people%20not%20statist ics.pdf) is there full report (PDF)

Sometimes these figures might represent a small proportion of patients. The national inpatient survey results from 2008 state that the number of patients that rated the care they received as excellent had increased from 38% in 2002 to 43% in 2008. The NHS should be applauded on this achievement. But the same survey also showed that the percentage of patients that rated their care as poor had not changed from 2002 to 2008, staying at 2%. Over the years of the survey this represents approximately 10,000 patients who personally rated their care as poor.

If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over 1 million patients.


And their statment about their report:


It is very clear, that whilst still representing a small proportion of the care being given by the NHS the numbers of people receiving substandard care are not small. The NHS treats millions of patients each year. Even if 2% of these are given substandard care this equates to tens of thousands of people.

We feel the immense response we have had from the public is the best answer to continual rebuttals by NHS leaders and the Department of Health as they insist on ignoring the scale of the problem.

We do not wish to attack the nursing profession as a whole and we know the vast majority of nurses do an excellent job but this doesn’t mean incidences of appalling treatment can be ignored or treated as one-offs. Those nurses lacking the caring attitude vital to their role should not be allowed to undermine the work of the rest. We are pleased to see nursing leaders acknowledge this today.

And their view of the US system:

http://www.patients-association.org.uk/News/288 (http://www.patients-association.org.uk/News/288)

[jimbob]

And back on topic:

If nothing changes, I guess that US costs will keep rising, until the healthcare equivalent of the Shoe event horizion (http://en.wikipedia.org/wiki/Places_in_The_Hitchhiker's_Guide_to_the_Galaxy#Bro ntitall) is reached

[WildCat]

A tragic local news story (http://www.chicagotribune.com/news/local/chi-fox-lake-girl-31-aug31,0,7595377.story) in these parts this week:
The driver whose car struck a 3-year-old girl and dragged her 200 feet in Fox (http://forums.randi.org/topic/economy-business-finance/media/television-industry/fox-ORCRP000008831.topic) Lake last week did not have a valid driver's license because it was revoked in 2005, secretary of state records show.

...Skiler remained in critical but stable condition Sunday in Lutheran General Hospital in Park Ridge (http://forums.randi.org/topic/us/illinois/cook-county/park-ridge-PLGEO1001005011130000.topic), where she is expected to recover, but she could suffer from seizures (http://forums.randi.org/topic/health/symptoms/seizures-HEISY000027.topic) due to brain trauma and will need extensive reconstructive surgery, said her parents, Raymond and Crystal Wright. She also may have a fractured jaw, her father said. Doctors are slowly trying to wean her from some of the pain medication.

...After being airlifted to the hospital, Skiler had immediate brain surgery to remove gravel that had penetrated her brain, Raymond Wright said.

On Monday, doctors plan to evaluate the reconstructive surgery she will need on her head, shoulder and possibly right pinky finger (http://forums.randi.org/topic/health/human-body/fingers-HHA000022.topic), he said.
That's bad enough. And then you get to the very last line of the news story:
Donations to help cover medical bills can be made at any National City Bank (http://forums.randi.org/topic/economy-business-finance/city-bank-ORCRP003362.topic) branch in the name of Skiler Anne Grace Wright.
Yep, the future of US health care right here. After a tragic accident, you are forced to beg for donations from strangers to pay medical bills and avoid bankruptcy. At least this family got lots of publicity from the local news media, but what of the 99% of people who aren't lucky enough to get their plight in the papers?

[ponderingturtle]

I don't object to "taxpayer-funded medical services" in principle... as a form of welfare for those citizens who can't provide for themselves.

A simple, straightforward government aid program along those lines would be agreeable to me.

I mean, it would still be bloated, inefficient, bureaucratic, and corrupt, just like every other government program. That's the price we pay for having government. It's usually cheaper than the price we'd pay for not having government.

BUt think about how less Bloated, inefficient, bureaucratic and corrupt it would be than the current health insurance industry?

[Darat]

A tragic local news story (http://www.chicagotribune.com/news/local/chi-fox-lake-girl-31-aug31,0,7595377.story) in these parts this week:

That's bad enough. And then you get to the very last line of the news story:

Yep, the future of US health care right here. After a tragic accident, you are forced to beg for donations from strangers to pay medical bills and avoid bankruptcy. At least this family got lots of publicity from the local news media, but what of the 99% of people who aren't lucky enough to get their plight in the papers?

What I think astonishes folk with UHC is that such a line is simply tagged onto the bottom, as if there is anything out of the ordinary for such a request to be made. (A request to help raise funds for something that would be 100% covered in pretty much any UHC system I am aware of.)

[ponderingturtle]

Really? The Democrats could do this without involving either the insurance companies or the GOP (or at least could have, and will once again be able to, once Sen. Kennedy is replaced by another Dem). Why haven't they?

Several reasons.

1. they are democrats, they suck at party unity.
2. You honnestly think that they are immune to all the lobby money being spent? It is tens of millions a month by just the drug industry.

[ponderingturtle]

Oh, and I think it goes without saying that costs need to be brought down dramatically, and both parties will have to piss off core constituencies to do so. Dems will have to tell the trial lawyers to take a hike

So you buy that lie as well? Malpractice insurance and related costs has been a stable 1% of health care costs for a long time. It just makes an easy target.

If you want savings look at the difference between the 5% overhead of a goverment plan and the 30% overhead of private insurance. That is the efficeincy of the free market right there.

[ponderingturtle]

But as someone has said a few times before - your government put a man on the bloody moon 40 years ago, and you don't get more remote than that! Ensuring good rural health-care can't be that taxing to such an ingenious society.

I use this argument in reverse questioning how much credit we deserve for that. It seems americans are too dumb to do that.

[ponderingturtle]

And this would be fine. However that is NOT what is on the table. Providing for the 14% who don't have health insurance/care is fine. Leave the other 86% alone, they are happy. .

Funnily enough those on medicare and medicaid have higher satisfaction ratings and so are happier than those in private health care. But actual happyness is not relevent right?

[ponderingturtle]

No, as I understand it, they don't usually die in the streets.

They don't die in the streets in the US, that is what hospital waiting rooms are for.

[WildCat]

So you buy that lie as well? Malpractice insurance and related costs has been a stable 1% of health care costs for a long time. It just makes an easy target.
It's not just malpractice insurance, it's the defensive medicine nearly all doctors must practice out of fear of lawsuits. Some estimates put this figure at 25% of the cost of health care. Just compare/contrast caesarean section births in the US compared to elsewhere.

[Undesired Walrus]

WildCat, would that story mean the girl in question is uninsured?

[ponderingturtle]

It's not just malpractice insurance, it's the defensive medicine nearly all doctors must practice out of fear of lawsuits. Some estimates put this figure at 25% of the cost of health care. Just compare/contrast caesarean section births in the US compared to elsewhere.

Other estimates put it at maybe 5% at most.

How much is defensive medicine and how much is people demanding an MRI for a sprained ankle?

[ponderingturtle]

WildCat, would that story mean the girl in question is uninsured?

Nothing in the actical indicates that. Of course insurance does not mean that you will not be driven to bankruptcy through health care costs.

Of course if the driver was uninsured it means that they can not get much money from suing the driver.

[Undesired Walrus]

When you are insured and injured, does your premium go up?

[ponderingturtle]

When you are insured and injured, does your premium go up?

Not in the short term. But having insurance does not mean that all the bills are covered.

[sugarb]

When you are insured and injured, does your premium go up?

No, but your ten or twenty or more percent of costs can get really high really fast. Also, if your insurance company believes the fault lies with someone else, then they can place the burden of payment on someone else...leaving you with the bills to manage while all that gets straightened out (assuming it ever does).

Now, I've had auto insurance premiums go up...because things happen that I pay the insurance for in the first place. But that's to be expected, for whatever reason. In one case we had our premiums increase when the fault of the accident was entirely the other party's. Something about if we hadn't been there, we wouldn't have been hit...(?)