Tuesday Sober Thread

Currently, I have government healthcare. The idea of having this system across the country scares the shit out of me.

A few months ago, they got rid of sick call. If you're sick or whatever, you cannot just show up to the clinic; you will be denied treatment. You have to set up an appointment. And this applies to everything. Break your ankle? Set up an appointment. Have a 103 degree fever? Set up an appointment.

If you're in serious trouble, you're supposed to go to the emergency room. You then get to wait several months for TRICARE to pay your claim. In the meantime, you get to deal with their faggot bureaucrats who yell at you for not going to the clinic first (even though you can't walk in anymore) and getting a referral to the ER. Oh, and you usually get hounded by the hospital for money while this is going on.

Not to mention that the medical staff aren't very good. I like corpsmen; they're nice guys, and most of them are decent at their jobs. Unfortunately, they do not have the experience to deal with anything that's not a minor issue. They're great for prescribing painkillers and telling you to ice a joint, (we joke that HM stands for Here's Motrin) but they aren't good at the real medicine - diagnosing serious issues that need to be dealt with quickly before permanent damage is done. Several of my coworkers have to get surgery because of wrong diagnoses by the fearless medical staff at our BHC.

I think that we should have private insurance. However, I also think that said insurance needs to be catastrophic-coverage only. You don't submit an insurance claim when you change your brake pads or oil. Why do people do this for a routine checkup?

If the government wants to do a single-payer healthcare fund, I think the same thing should apply. Catastrophic coverage only. Break your leg and spend a month in the hospital? Insurance / the government should fund it. Have the sniffles and go to the clinic? You're paying for that yourself.

 

I'm a pretty big fan of how it works in Australia. Which is to say government cover for almost everything. But the quality isn't great.

You get hit by a bus, or have a heart attack and no insurance? Fuck it - you can go see a doctor. You can get into hospital. You don't ever get denied minimum essential care because you can't afford it. The doctor may not be very nice to you. But fuck it, you'll probably live. Emergency care is never denied to you because you can't pay. Worst case you get a bill after the fact, but that's rare and usually gets refunded as soon as you show up to the govt office with a reciept. Prescription medication is covered so that it's basically fuck all and if you're on government benefits for being poor - all your medical costs go down further. If you go above a threshold in a year because you're really fucking sick - you get a pretty big tax break because clearly you were really fucking ill.

If you have enough money to want more than minimum essential care, then you can get private. And go see a good doctor in a nice hospital who'll be nice to you. And if you pay for private, your tax chunk for public gets reduced.

It's not perfect, but I'm generally pretty comfortable with it. Mostly because I can afford private.

 

Helloooooooooooo thread right up my alley.

Public. Public. Public. Public. Public. Public. Public. Public. Public.

Did I say public?

Look, both systems are deeply deeply flawed, I'll be the first to admit that. But, having experienced both systems over a number of years, I think I can say that a public system has more overall benefits to society. Sure, if you have money, a private system is great. You'll get treated like a fucking king, but the reality of the situation is that, in a capitalistic society, there will always be people that don't have the money to pay for their healthcare. Why this is doesn't matter. The fact is that they can't pay and, ultimately, the cost falls right back to society. Now you have someone that's too sick to work and you have the public paying for it anyway. So why not give people that option to get taken care of from the very beginning?

Yes, that means higher taxes. However, nothing good ever comes without some sort of sacrifice.

 

A combination system where you can choose whether or not to participate in the public program. If you do not participate in the public healthcare program you do not pay into the public health program. Everyone who opts in pays the same rate, and if you have dependents you have to pay for them too.

I absolutely refuse to pay for smokers, fatties, and people who do retarded and unsafe things to survive. Natural selection at work, bitch. Seriously though, America is disgustingly unhealthy. Not just food and exercise habits, but some people live in complete filth, and then there is the utterly horrifying practice of where people don't finish their prescribed antibiotics, save them, and whenever they feel sick they take some left over pills to make themselves feel better. I'm more than willing to chip into a system that I don't take part in but provides healthcare to people who did not bring their medical condition upon themselves or at least took reasonable safety precautions, but you can kiss my ass if you think I'm going to help pay for chemo for smoker with lung cancer, a bypass for some fatty who eats at McDonalds every day, or life support for the guy who got in a crash on his motorcycle and wasn't wearing a helmet.

 

I second the praise for the Australian two-tier system. There is a very decent public health system where most things are covered, but also a large private health sector for those who can afford (or prioritize) it.

For my money, this is the best of both worlds. If you are poor, or willing to wait for a while, you can get free healthcare. If you have private health insurance, or need something done as soon as possible and are willing to pay, you have that option. I have at times been very poor, but still forked up for important health services so they can be done within days, as opposed to weeks or months. The upper middle class attending private hospitals also takes off some of the pressure on the public health system, reducing waiting time for the poor.

Compare this with the system in my home country, where there is tremendous cultural resistance to the very idea that somebody should be "better off" or have "better access to services" than others. Some private hospitals exist, but they are few, and they do not make it easy for them. For this reason, you have to wait months and months even for important procedures. I am reminded of the quip that the inherent vice of capitalism is the uneven distribution of blessings, while the inherent virtue of socialism is the equal sharing of misery.

 

Couldn't have said it better myself so I won't.

In my mind, with tangential experience in healthcare, the only no cost good thing that would come out of public health would be not having to deal with claims departments, that shit is a nightmare and one clerical error can cost individuals thousands of dollars.

 

I am in the US and I'm uninsured. If (When) I get a job, my insurance will be private and likely awful.

I can say that the US system damages the quality of life in weird ways. Since going to a hospital or doctor will likely impoverish me, I avoid activities that would greatly improve my quality of life in other circumstances. For example, I am not lifting anything heavier than 135 at the gym for fear of an injury and my motorcycle is collecting dust until I get some coverage. I know how ridiculous that sounds, but I am in no debt and the last time I was in the hospital overnight the bill (covered by insurance) was around $21,000 for a serious bout of pneumonia.

I know a lot of friends who were not allowed to play sports or do certain activities because of the tremendous costs of getting them to doctors.

For me, I would happily pay 3-5% of my check to not have to deal with the US system. I think part of the problem is the blank check private insurance writes to some of the medical facilities that enables them to run up a tremendous bill, effectively pricing out a single-payer. I also think that the US system lacks a lot in terms of prevention, education and general scientific health knowledge. My .02 plus this: you Aussies and Canadians are lucky to have the systems you do.

 

You've obviously never dealt with Medicaid or Medicare.

 

Milton Friedman, patron saint of conservatives everywhere, had two ideas for government healthcare that I thought were good, and surprisingly left-wing given his status:

Pick a high-but-not-crazy number, say $30,000. We can move it up or down later, but it's got to be steep, but affordable. In any 12-month period, any health costs below this amount are your responsibility, and anything above this is publicly-funded.(1)

Pick a high-but-not-crazy age, say 82. Again, we can argue over the exact age, but apply the same principle of old, but not ancient. On your 83th birthday, you're officially playing with house money and the public no longer pays for your healthcare costs.

It'll never happen, because the old fucks vote, but it's simple, fair, and not as budget-busting as the current US-ian setup.

(1). Yeah, that's a lot of money. But the average household income in the US is about 46K, and you should be willing to spend a lot of money to stay/get healthy - what better use of $ is there? "High, but manageable" is the guidepost. And the risk-averse could supplement with cat health, etc. insurance.

PS. This obviously doesn't cover military pensions, and other programs that don't apply to the whole citizenry.

PPS. I'd love for someone to point out the flaws in this, 'cause I'm sure there are some, but I can't see them right now.

 

A family of 4 is in an automobile accident, and all of them are seriously injured. So, under this plan, they're responsible for a $120,000 nut before any coverage kicks in. Have you looked at healthcare costs lately? When I broke my wrist a few years ago, the total cost (ambulance--because it was on campus--ER, temporary reset, surgery the next day to implant a stainless steel plate which, with screws, was over $10k alone, x-rays, drugs, anesthesia and 2 months of physical therapy) amounted to nearly $40k. And I didn't spend a night in the hospital. I left the night of the accident and returned the next day for surgery and went home a few hours after it was over.

Based on the average HHI you cited, 65% of it just went to treat two broken bones.

 

I'd call that a flaw.

 

So, at an age where, in the modern society, your chance of having several very expensive diseases is pretty high and you don't have the money from a regular salary, you're supposed to pay everything yourself?
Nope, can't find any flaws.

In Germany we have sort of both systems.
The problem with the system here is, that there are fixed rates a doctor gets for patients in public health care.
I think a GP gets about 19 $ dollars/3 months for any patient, it doesn't matte if he comes in 1 time or a 100 times in that time span.
Hospitals get payed fixed rates for a certain disease.
This led to drastic cuts in treatment quality, because the longer the patient stays/the more often he comes in, the less profitable it is for the hospital/doctor.
The patients with private insurance are what keeps some doctors out of the red numbers, so they sometimes get more treatment/procedures than necessary just to make money.

As of right now, we already have less hospitals than a few years ago, because many smaller houses can't keep up in the competition, they simply don't get the necessary number of patients, so the trend goes toward less but bigger hospitals in bigger cities.

 

US health costs are ridiculously inflated precisely because it has pretty much been obligatory for employers to pay for health insurance over the last 50 years. This leaves people with no incentive for choosing affordable health care, so they tend to go for the Rolls Royce model every time. It also allows for providers to inflate costs, and obviously removes their incentive to innovate to bring down costs.

In addition, US citizens are in effect subsidizing the rest of the world's health care. Most research and development in medicine happens in the US, but since IP protection in many countries are awful, the companies have to take in a disproportional amount of their R&D costs back home. So, thanks yanks.

As somebody else pointed out, veterinary services and LASEK surgery are affordable precisely because the government doesn't get their ten thumbs involved in it. If you want affordable health care, deregulate and privatize it, or at least allow for a two-tier system.

 

I don't think he's saying you CAN'T have private insurance on top of the governmental policy, just that if you make it that far it's on your dime (be it out of pocket or through insurance) if you want treatment.

I think the reason Friedman went the high deductible route is because if we have a governmental health plan with a five dollar co-pay people are going to abuse the shit out of it and costs will go through the roof.

 

You can't really stop how much health care needs to be given. People will get sick, etc. There are exceptions - not providing care to those that need it, and public campaigns to stop unhealthy behavior.

So in the example where you had to pay $40k of your own bills, it's not like that money isn't going to get paid somehow. Either it's coming out of your own pocket, or it's coming out of your own pocket via taxes. Or, if you're poor, you're just sucking that money out of someone that's more wealthy.

As someone that is healthy and pays a shitload in taxes, privatize that shit. I don't like broke motherfuckers abusing the system. There are exceptions, but it's a generalization.

On top of that, if people had to make decisions on healthcare with money out of their own pocket, you'd see actual motivation to change the laws and innovate the industry. Vote with dollars, turn the whole thing upside down.

Between health insurance, HSA's, employer paid health care, medicare, and medicaid, nobody actually knows how much anything costs. That's only good for the people collecting money.

 

Because deregulation has worked out so well for us in the past.

I'd be fine with a two tiered system, actually.

 

Except no, not really.

 

Maybe. It seems high, to be honest. A lot depends on what time horizon one is looking at. It's strikes me as really hard for the median American family to spend less than $30K. I did some calculations using median _____ expenses in the U.S., focusing on the sort of things we typically allow for (rent, food, education) and not even including frivolities:

-Using the rates in the median state (Oregon), they make $33K after state and federal taxes. Maybe that's unfair (after all, high tax areas like New York tend to be also high income), so let's say $35K.
-They pay something like $800 in housing costs a month (median rent is about $650, median mortgage is $1250, obviously some pay no mortgage).
-$250 for utilities a month
-Using US government numbers (in the middle of their ranges, and which assume all meals are consumed at home), add in roughly $200 a week to feed a family. That's for four people, though. That's above median family size, so let's scale it back to $120 for 2.5 people.
-They probably own a car, which adds another $800 in payments, gas, insurance.
-One wants to save a bit for college, right? And even including interest/returns on the money, paying for even a reasonably priced college for a kid means $2000 a year. If you have two kids, it'll be $4000.

Somehow we've already arrived at over $30K in expenses. And we haven't even accounted for saving for retirement, basic necessities such as toiletries, furniture, clothing. I'm not sure that the median family is going to be able to stomach $30,000 absent long term loans. And most "big bills" are going to be multi-year and run a high risk of inhibiting your ability to work, so there goes that median income...

And if you get cancer? No one cures cancer in one year, or returns to work immediately. So we're talking what? $60K plus lost earnings?

My point isn't that you couldn't reduce your expenditures to say, $20K by moving into a one-bedroom place for all three of you, eating very cheaply, etc. It's obviously possible. I'm just trying to point out how little wiggle room there is within normal expenditure patterns for an extra $30K expense. I presume you didn't intend for your system to mean a big bill means no college for their kids or Ramen for the family's dinner, but it's hard to see how they'd pay this.

The only way I can see it working is a very large industry in health-care loans. Like we don't have enough debt.