Our rules have been updated and given
their own forum. Go and look at them! They are nice, and there may be new ones that you didn't know about! Hooray for rules! Hooray for The System! Hooray for Conforming!
Our new Indie Games subforum is now open for business in G&T. Go and check it out, you might land a code for a free game. If you're developing an indie game and want to post about it,
follow these directions. If you don't, he'll break your legs! Hahaha! Seriously though.
American health care vs the world!
Posts
Most of the people I know in my personal life are surviving off the anecdote of "there's waiting lists to get elective surgery" and "taxes!" with a few smattering of "I lived in Europe, it was terrible because of XYZ niche that wouldn't have happened in the US because the doctors there have a fucking brain."
All of mine are from Norway and have been edited to show this.
The elective surgery issue is tough in the US. Given how political we make a lot of health care matters (especially w/r/t women's health) I would be terrified to have a republican administration determining what "non-necessary" procedures would be covered. . .
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Its a bad tendency with american policy in general. You have to build anything with the assumption that one party wants to burn everything to the ground and will do so the second they get in power. Main reason we can't fix Medicare or SS is they're designed to be insulated from Congress fucking with them or the president putting a shlub in charge to destroy the system from the inside.
How are you defining superior? "Superior care" is a thing that means different things to different people, which is problematic when it's used in policy discussions. The right wing in the UK are hell-bent on privatising the NHS, and when they make that argument it tends to involve things like private rooms instead of wards, or the provision of TVs.
Also worth mentioning that in the UK, there aren't many ways in which politics can interfere in the provision of care. The decisions about the treatments available are made by the individual trusts with guidance provided by NICE. Some of the decisions NICE makes have the force of law, since NHS trusts cannot refuse to provide a treatment that NICE has approved.
And as I said earlier, the fact that they can initiate care sooner than the Public system almost guarantees them better results. This is the case in Norway, and I suspect the case everywhere else with private health care in addition to UHC.
I'm in an area with an overabundance of extremely qualified doctors and medical systems, and have pretty much the best insurance you can get. If I have something urgent, I can see my doctor or another doctor in her office the same day. If I'm just calling for a normal annual checkup, I usually have to schedule ~3 months out.
I could easily conflate 'come in immediately, we have an opening in an hour' with my 'We've got an opening in August', but that's being dishonest and disingenuous.
Now, we've got friends that live in a rural part of Tennessee, and they either need to wait two - three weeks to get in for anything, or they need to go to the ER / urgent care. No middle ground. And when they complained and said they shouldn't have to wait so long? Their doctor dropped them so now they need to go to a doctor that's two hours away.
I'm in the UK - NHS FTW!
Again, it depends what kind of treatment you're talking about. I don't know of any private hospital that has an Accident & Emergency department (the ER). Even if there were, my parents could not have afforded to keep their children alive even though they were both working. If we'd received treatment and then been stuck with the bill afterwards, it would have crippled us financially with all the knock effects on future health and education opportunities that entails.
Don't take this the wrong way, but I'd love you to visit England and get hit by a car.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Pretty much what we've got now
trouble is such a system is both extremely expensive and more or less guarantees significant numbers of people get no care at all outside of the ER.
In a socialized system you can still ahve all that if you want to pay but everyone gets an acceptable baseline of csare
Counterpoint: last week I had a nasty case of bronchitis. Since it didn't get better after 3 days like I usually do when I'm ill, I just went to my local GP and asked to see a doctor. I had to wait about 20 minutes for a walk in appointment. He diagnosed me, wrote a prescription, gave me some good advice and I went to the pharmacy and paid my £7.85 prescription fee and picked up my medication.
Now I am better.
This is my experience of the NHS in the UK: When I'm genuinely ill, I can see a doctor for free. My medication will cost me £7.85, regardless of what it is. I will get better. I don't have to pay any more than that.
I can cycle to work without worrying that if I fall off and break a leg or something that I'll be financially ruined.
My father was treated for cancer last year (he's fine now). He went to an NHS hospital in Middlesborough (one of the poorest areas in England) and his exact words were "I can't imagine how the treatment I received would have been any better if I'd gone private". The hospital would probably have been in a nicer building, and the nurses prettier, but the core fact is that he got the treatment he needed because it was the treatment that was best for him, not the one that made the hospital the most money, and I get to have a father instead of a funeral.
Rich people who want to disband the NHS (or avert UHC in the USA) are sociopathic shitballs. I literally spit on them. They don't give a shit about the consitution, They don't give a shit about "freedom". They don't even really care about "socialism". They just want poor people who are ill to shut the fuck up and die quietly and cheaply so that the rich can pay even less tax.
If you're not rich and you buy their ridiculous propaganda, then you're a gullible goose. No wait, you're not even a goose - You're a thanksgiving turkey arguing that "freedom" means being forced to pay for its own stuffing.
Which is exactly what I think we should be providing, but also why private care will generally still be superior, imo. UHC is much better for a society, but for those who can afford it, private care will generally be better than UHC for an individual.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Similarly, there aren't many instances where a treatment absolutely will not be provided by the NHS. If you need it, you'll pretty much get it. The edge cases tend to be treatments for terminally ill patients that extend life, but at very low quality of life, or provide minimal improvement in quality of life for an extended period at very high cost.
EDIT: for the purposes of discussion "very high cost" under the NICE guidelines is generally more than £40,000 per quality adjusted life year, bearing in mind that is the cost of the treatment alone, not what you would be billed for under a private system.
That is a big difference vs the US, where the top hospitals are teaching hospitals (for the most part), but the top doctors often do not participate in many insurance plans. Also, medicare/medicaid billing is the scourge of US hospitals. Changes in reimbursement rates can literally drive hospitals into bankruptcy.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
bitter pill appears to have been taken off of the interwebs
has this ever actually happened?
The biggest correlation is that hospitals that receive a large amount of Federal Medicare / Medicaid money tend to be in places - such as inner cities or rural areas where there are also a large percentage of uninsured patients. Remove those uninsured patients, and Medicare / Medicaid may not be AS lucrative as private insurance, but it's plenty profitable to sustain any health system that isn't fundamentally rotten to the core or has no business existing anyway.
There is A LOT of money in health care. My employer just built a brand new Women's and Children's hospital - $1 billion - and paid with cash. Barely put a dent in the cash on hand.
I would argue that private healthcare being better is a consequence of UHC setting a certain standard. Private providers have to provide better care, or else nobody would pay for it. You get a more or less fair market where people choose between healthcare providers based on price and quality. Here in the Socialist Utopia of Finland it works basically* like this: if you get sick, you can either seek public healthcare which is competent and affordable (but can involve long queues depending on where you live and the kind of care you need), or you can go to the private sector, in which case the government reimburses part (or all) of your bill.
* It can get a bit more complicated, but this is the basic idea.
I think it's Obama's birthplace, a town named Benghazi.
All these buzzwords are appropriate.
But the point of the UK comparison is UHC and a robust private health care system are not mutually exclusive.
gut guess is that Time wants you to buy the magazine issue, or use their paysite. I'd have good money on being able to access it in a slightly less legitimate way, and I'm just not capable of digging for it where I'm at.
I'm actually in favor of that type of system. I don't think there is any disagreement here.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
I know of hospitals that were literally about to go bankrupt in connection with medicare changes which were later postponed by congress, or even seen hospitals flirt with bankruptcy due to the timing of medicare reimbursements. They are not typically in great shape to begin with, obviously (typically they are local hospitals that have lost most of their patients to larger conglomerate hospital groups, and have tons of empty beds now while most people just use the emergency room and imaging equipment). There is a real question about whether it makes sense to keep some of these hospitals open anyway though.
Also, hospitals are run in a very strange way in the US, and are highly dependent on debt financing, which they pay off over the course of the year as they collect billings. A small dip below projected billings can cause the hospital to default on the loans. It is not a great system.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Pretty much my only memory of the 1990s so far as NZ UHC reform goes is various marketisation attempts at various levels and regular horror stories relating to hospitals/regions going bust or closing down. It was pretty much one of the top 3 political issues for a decade or so, if not longer.
You will be able to read the full rule in the May 15 Federal Register. I can't share my advanced copy.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Austerity's a bitch.
Yeah US drug prices are too expensive, but when a full third of the world population(India & China alone), will use the drug but contribute $0 to the development, that skews the shit out of things. How many Billions in USD is China holding in reserve?
1. PHARMAC - Unitary pharmaceutical purchasing group for the national health system. Basically this organisation assesses and then buys almost all medications dispensed through the system. Whether not a single buyer for medication is ideologically or practically your thing, it does seem to mean http://www.oecd-ilibrary.org/social-issues-migration-health/pharmaceutical-expenditure-per-capita_pharmexpcap-table-en. This kind of operation may only work well in a small, out of the way country. It also is a periodic issue between NZ and the US, when we debate trade liberalisation.
2. ACC - Unitary and mandatory national insurance corporation that covers all injuries caused by accident, from workplace to well, outside of work. The Corporation will pay for most or all of the costs of healthcare and sometimes loss of income. The downside is that by law, your right to sue for personal injury has been removed. This was a design feature.
It is doubtful that either of these could be easily replicated at a national level by a large country, especially #2
Right. A hospital that relies on Medicare and Medicaid for a large chunk of its income is one that's serving a poor and/or elderly population; it's likely going to suffer from overuse of its emergency department and existing problems collecting on bills.
It's already going to be on precarious financial territory to begin with; anything that disrupts cash flow from Medicare is going to be a huge problem.
Sure, your states are probably not too dissimilar in size/administrative capacity (NZ is about 4.5m). I would think the lobbying would rather awful though.
NZ is a place where if you can convince the governing party that it is a good idea then it will be made into law and there isn't really much one can do about it - no constitutional challenges. Barring the right to sue for personal injury is a pretty key part to ACC and one that angered a lot of people, who would have taken steps if they could have.
Out of all the first world countries, the United States healthcare reform bill most closely resembles Switzerland - a basic health care package, provided by either the government (if you qualify based on income or age) or private insurers, with significant regulation at the state/province level.
In the Swiss system, there's a government entity that negotiates with pharma manufacturers on reimbursement rates for covered drugs.
This is exactly what the US should be able to do with Medicare, but can't, because the 2003 Medicare Modernization Act explicitly forbids it.
Which, as we know from prior threads, was a moment of astounding stupidity in the recent history of the US.
Most first-world countries have hybrid systems where basic coverage is provided by the government; meanwhile those who can afford it can solicit private insurers for premium supplemental coverage.
That seems to work out pretty well; it gives people the best mix of not being fucked by a catastrophe if you're poor while letting the rich have options.
Honestly, I think that the best roadmap to UHC in the US is just stepwise gradual expansion of our existing social coverage systems (Medicare, Medicaid, Veteran's Administration, and the patchwork of state & local programs) and better interoperability between these systems (widespread adoption of electronic medical records is the keystone here) until these programs together form a functional health network.
But I've been saying that for years now.
I think all we need to do is
(1) eliminate the exclusion from income for employer paid premiums,
(2) permit an exclusion for employer paid subsidies for employees who go into the exchanges, and three
(3) have the government pay the full premiums for people who are medicare/medicaid eligible to participate on the exchanges.
If we did this and basically turned every US state into a single risk pool, we'd be in fantastic shape, while still maintaining the private insurance plans people know and (seemingly) love.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
That's what happens when the GOP gets control of all 3 Houses.
Private care also have to be better* than public in a UHC system, or it won't exist.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious