So with all the talk about healthcare, what is your ideal?

[Jane in NC]

Everyone complains about the cost of healthcare; many complain about the way healthcare works here in the US.  My friend the doctor complains that many of the conditions for which she sees patients come about through lifestyle and she thinks that a lot of people prefer to take medicines then change how they live.

 

I know that much of the increase that we have seen in the cost of delivering healthcare is due to technology.  For better or for worse, I suppose.  Personally I like old fashioned "hands on" doctors but not everyone operates that way.

 

I am grateful for technology.  My son at age four weeks had a microsurgery from which he recovered almost immediately.  Invasive surgeries of old often introduced infection.  I guess the question we must all answer is how much technology and at what price to ourselves and to society.  These are hard questions and I certainly don't have the answers.

 

So...what would you like in your ideal health care world?  I think a visiting nurse to answer questions for new mothers would be a wonderful addition to our system.  Visiting nurses who cared for my Mom through hospice allowed her to remain at home until the end.  Palliative care for the aged is on my list.

 

What would you like to see?  Does your community or your doctor offer something that is just a little different that you think could be replicated by others?  Admittedly, my healthcare begins with me.  But I do see a gynecologist, dermatologist and eye doctor annually, my dentist twice a year with dental cleanings. I like my doctors and feel good about their advice. Or do you prefer alternative routes?

 

I saw in another thread that there is a difference in the amount of risk people can tolerate with regard to insurance.  It occurred to me that perhaps we are also using the healthcare system differently.  Perhaps what you do now is not your ideal but I am curious to hear what that might be.

[PinkyandtheBrains.]

Universal Healthcare, with encouragement towards preventative care.

 

 

I think this might lead to more nurse practitioners and P.A.s that do the basic care, and doctors perhaps being more specialized. I am okay with that.

 

My experience with nurse practitioners and physicians assistants is that they take more time, have more time, to listen to what is going on.

[EKS]

Agreeing with Mama-san.2, universal healthcare.

[Laura Corin]

I'm pretty happy with what I have.  Being made up of people, it's not perfect, but it works pretty well.  

 

After I gave birth to Calvin, I had a midwife visit every day for about ten days.  I had to reassure her that I was doing fine and she did not have to come on Christmas day!  After the ten days, she handed over to a health visitor, who could have come to my home had I needed her, but was based in a public health clinic where I took Calvin to be weighed and tested for things like hearing.

 

Long term monitoring of chronic diseases is largely done by specialist nurse practitioners.  My colleagues have, between them, asthma, liver damage and diabetes.  They are each called in for periodic testing and monitoring appointments.

 

How do I use the system?  I have dental check ups twice a year, cholesterol/general health appointments with a nurse once a year.  At my age I also get called in for smear, mammograms and bowel cancer screening ..... Otherwise I see doctors rarely.  In the past year I've seen my GP once and was referred to a gynaecologist; Hobbes has seen the GP once and has been referred to a paediatric physio.  Calvin has not been to the doctor in the last year.  Husband has gone in for flu jabs, cholesterol/general health and asthma monitoring.

 

L

[Mrs Mungo]

Universal Healthcare, with encouragement towards preventative care.

 

 

I think this might lead to more nurse practitioners and P.A.s that do the basic care, and doctors perhaps being more specialized. I am okay with that.

 

My experience with nurse practitioners and physicians assistants is that they take more time, have more time, to listen to what is going on.

 

I pretty much agree with this.

 

 

I think this is a huge factor.  Although I get the impression from doctors that I can't be healthy without them.  That in order to be healthy I have to visit them regularly and take drugs...for every piddly thing.  So that is why I basically never go to the doctor's.  I don't want to be treated for anything.

Do you think this would remain true under a single payer system? I can tell you that being in the government health care system, I haven't experienced this. In fact, it has taken some pushing and jumping through hoops to get certain things approved.

[Laura Corin]

 

What would be my ideal?  I guess honesty.  There are drugs out there that can treat lots of things, but how much do they REALLY improve my life.  How much longer do they REALLY let me live?  

 

When I lived in Hong Kong (with private insurance) I was discovered to have high cholesterol.  They took a family history and marked my file with 'family high cholesterol'.  I reported this when I reached the UK and my statins were continued.  I didn't have any side effects, but I wasn't happy with taking a drug for the rest of my life.

 

So I sent my original Hong Kong test results to my doctor and she called me back in.  I was armed with the knowledge (gleaned from reading 'Bad Pharma') that statins halve your risk of health problems, so if your risk is already low, they have a proportionately small effect.  Even before I got that far, the doctor said, 'Your Hong Kong results were high but not very high.  There's no way that they indicate a genetic issue.'  She went on to delineate the reasons why I was overall low risk (normal weight, low blood pressure, no blood sugar issues, habitually active - walking almost every day) and took me off the statins.

 

Since then I've worked to lose 10 pounds in weight.  I'm looking forward to getting tested in November to see what my stats are.

 

ETA: I forgot to mention that what she actually said was, 'In fact, you are probably one of the few people your age in this country who should not be on statins.'  So she's not anti-drug, but just able to look at the whole picture.

 

 

L

[Jane in NC]

 

What would be my ideal?  I guess honesty.  There are drugs out there that can treat lots of things, but how much do they REALLY improve my life.  How much longer do they REALLY let me live?  

 

But no one can really answer that for you since everyone is different.  And it is not just drugs but certain surgical treatments that may enhance quality of life but may not.  When we examine the effects of drugs or treatments statistically, some people are offended and bring up the issue of "death panels". Personally I like to know where I stand with the odds.

 

[Laura Corin]

But no one can really answer that for you since everyone is different.  And it is not just drugs but certain surgical treatments that may enhance quality of life but may not.  When we examine the effects of drugs or treatments statistically, some people are offended and bring up the issue of "death panels". Personally I like to know where I stand with the odds.

 

 

I think that the odds of a good quality of life after a procedure are also important.  My FIL had a heart valve replaced when he was in very poor health and aged almost 80.  The operation completely destroyed what was left of his health, as well as deepening his pre-existing depression.  I think that his life would have had a happier end if he had not had the operation.  The only statistics he was given before the op. were about the risks of dying under the knife and his likely life expectancy afterwards.  No-one expressed to him how debilitating the op. would be to someone in his poor health.

 

L

[Jane in NC]

I'm pretty happy with what I have.  Being made up of people, it's not perfect, but it works pretty well.  

 

After I gave birth to Calvin, I had a midwife visit every day for about ten days.  I had to reassure her that I was doing fine and she did not have to come on Christmas day!  After the ten days, she handed over to a health visitor, who could have come to my home had I needed her, but was based in a public health clinic where I took Calvin to be weighed and tested for things like hearing.

 

Long term monitoring of chronic diseases is largely done by specialist nurse practitioners.  My colleagues have, between them, asthma, liver damage and diabetes.  They are each called in for periodic testing and monitoring appointments.

 

How do I use the system?  I have dental check ups twice a year, cholesterol/general health appointments with a nurse once a year.  At my age I also get called in for smear, mammograms and bowel cancer screening ..... Otherwise I see doctors rarely.  In the past year I've seen my GP once and was referred to a gynaecologist; Hobbes has seen the GP once and has been referred to a paediatric physio.  Calvin has not been to the doctor in the last year.  Husband has gone in for flu jabs, cholesterol/general health and asthma monitoring.

 

L

 

Laura, your doctors and nurses are National Health employees, right?  But not all countries with universal health hire the medical people directly.  The Japanese system is quite different, I believe.  What does France do?

 

[Laura Corin]

Laura, your doctors and nurses are National Health employees, right?  But not all countries with universal health hire the medical people directly.  The Japanese system is quite different, I believe.  What does France do?

 

 

As far as I remember, France has a universal insurance system, rather than hiring employees directly.

 

L

[Jane in NC]

As far as I remember, France has a universal insurance system, rather than hiring employees directly.

 

L

 

That is what I was thinking.  It might be a more comfortable model for some Americans--or maybe not as we are seeing with the ACA.

[Laura Corin]

That is what I was thinking.  It might be a more comfortable model for some Americans--or maybe not as we are seeing with the ACA.

 

I don't know though if it's a government health insurance company or if it's made up of a consortium of private insurers.  You would think I would know, as I worked there for two years, but I can't remember.

 

L

[Laura Corin]

If you look at many of the drug studies where they claim one's life was prolonged, sometimes the average prolonging is a matter of weeks or months.  Really...a person needs to endure side affects from a drug that lets them live for a few weeks or months more?  And of course that seems rather speculative anyway.  I feel like they aren't totally honest.  Unless I feel ill and a drug I take makes me feel less ill, I don't necessarily see the point.

 

It's important also to know that drug companies do not publish studies that show negative effects (unless they are dangerous) or negligible benefits.  They only publish the positive studies.  New protocols to combat this intrinsic bias are often mooted for new drugs, but for many of the drugs that are in current use, there might have been six studies, two of which showed that the drug was worse than existing treatments, two of which showed that it equalled a placebo, one of which showed a minor benefit and one of which showed an appreciable benefit.  Only one will be published.

 

L

[Laura Corin]

 

 

What is the answer???  I don't know!!!  We want the best healthcare in the world, but we don't want to pay for it either... 

 

It is a really complicated issue.

 

It's important to define 'best health care' too.  According to this chart, Britain spends less than half of US spending on health care but we live a little longer.  Everyone is covered but not all procedures are available.

 

You can buy top-up insurance in the UK to pay for things that the NHS doesn't provide - and many middle class people do.  You can also pay out of pocket for treatments that are outside of the NHS.  But in general, people are happy to go with the programme that benefits the majority of the people, even if it means that the most last-ditch treatments may not be available to the few who might just possibly benefit from them.

 

Choosing a health system is a matter of national culture as much as an issue of medicine or economics.

 

L

[Kim in Appalachia]

I think the ideal would be universal healthcare with incentives (or "punishments, such as higher co-pays) for preventative care/ patient self-care (such as weight loss, quick smoking, etc...)

[Laura Corin]

I think the ideal would be universal healthcare with incentives (or "punishments, such as higher co-pays) for preventative care/ patient self-care (such as weight loss, quick smoking, etc...)

 

This kind of thing has been mooted in Britain, but it's always dropped.  If you take it to a logical conclusion, someone who dove into a lake without checking the depth would have to pay for their entire treatment for being an idiot.  And that's not a direction that people have been willing to go.

 

L

[regentrude]

I think the single payer system would improve the problem.  Not that I want to make people have to jump through hoops if they really need something, but stop treating stuff that doesn't need to be treated.  My husband went to the doctor because he complained of dizziness.  Now that IS a very vague symptom so not so easy to figure out, but wow they must have done every single test known to man on him.  And it was EXPENSIVE.  In the end they still did not know what it was.  It just went away.  Not that I wouldn't want them to do SOMETHING, but really some of the testing was ridiculous.  We had good insurance...so why not..right?  Ugh.

 

Actually, that would be one instance where I, as the patient or family of the patient, would insist on the whole battery of testing, because the causes are so difficult to diagnose: blood sugar, blood pressure, vision problems, upper spine issues, ear issues... to brain tumor. Even back home in Germany, where doctors do not fear law suits as they do in the US and are much more reluctant to run you through tests, my doctor ran every possible test from blood work to ophtalmologist to brain scan.Some people with those symptoms have a life threatening condition, while others have a benign misalignment of crystals in their ear - but there is no easy way to find out.

Your doctor was prudent. And yes, in the majority of cases they never find the cause. But if they did not look, they might also miss something deadly.

[regentrude]

I think one reason for the high health care costs in this country is not the existence of technology per se, but the litigious society with people so eager to sue their doctors. Doctors have to order unreasonable tests because they can not afford the minute chance of missing something, and doctors have outrageous liability insurance premiums. I know obstetricians who are on the verge of stopping their practice because their liability insurance is so ridiculously high (several $100,000 per year; cost that has to be recovered from the patients before the practice sees any profit). Pediatric neurosurgeons are becoming rare because of the very high risk of law suits. I think this is a unique facet of the

 

[Lisbeth]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others.  Via my own free agency, I will choose what charities to support.  Being forced to "do good" or "be charitable" robs me of the spirit to do it voluntarily.  I wish they would do that for social security, too.  I would rather have that money back to invest as I see fit...instead of giving into it and watching them squander it and hint that I'll probably never see that money again. 

Let me decide just how many preventive measures I'd like to take to make my healthcare more in my budget.  Treat me like an adult, not a child who needs a nanny to oversee my consumption and behaviors, and what I purchase to cover my needs.

I would like a system that did not reward bad choices, and that did not create learned helplessness.  There's no dignity in it.

Government hands off for another reason:  their power and reach should be limited.  Too much power, well, we know what that does.  It doesn't end well for the people.

Government should also have a VERY limited capacity for promising people other people's earnings in exchange for votes.  Healthcare is another aspect of this.  "Vote for us, and we will let you keep your current free stuff/care and give you more FREE STUFF!"  This should be gone, yesterday.  It completely messes with our system of government.

And in the process, I promise you it will completely mess up our healthcare system.

 

 

 

 

[fairfarmhand]

I'm pretty happy with what I have.  Being made up of people, it's not perfect, but it works pretty well.  

 

After I gave birth to Calvin, I had a midwife visit every day for about ten days.  I had to reassure her that I was doing fine and she did not have to come on Christmas day!  After the ten days, she handed over to a health visitor, who could have come to my home had I needed her, but was based in a public health clinic where I took Calvin to be weighed and tested for things like hearing.

 

L

that sounds wonderful!

[Laura Corin]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others.  

 

Are you prepared to see people die in the street after car accidents?  I saw people just left by the road in China.  I'm sure that there would be some charitable care, but given the cost of health care, would charity go far enough for your peace of mind?

 

This is not an attack.  Your point of view is so far from mine, I'm trying to understand how it looks to you.

 

L

[Jane in NC]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others.  Via my own free agency, I will choose what charities to support.  Being forced to "do good" or "be charitable" robs me of the spirit to do it voluntarily.  I wish they would do that for social security, too.  I would rather have that money back to invest as I see fit...instead of giving into it and watching them squander it and hint that I'll probably never see that money again. 

Let me decide just how many preventive measures I'd like to take to make my healthcare more in my budget.  Treat me like an adult, not a child who needs a nanny to oversee my consumption and behaviors, and what I purchase to cover my needs.

I would like a system that did not reward bad choices, and that did not create learned helplessness.  There's no dignity in it.

Government hands off for another reason:  their power and reach should be limited.  Too much power, well, we know what that does.  It doesn't end well for the people.

Government should also have a VERY limited capacity for promising people other people's earnings in exchange for votes.  Healthcare is another aspect of this.  "Vote for us, and we will let you keep your current free stuff/care and give you more FREE STUFF!"  This should be gone, yesterday.  It completely messes with our system of government.

And in the process, I promise you it will completely mess up our healthcare system.

 

Since you are a free market gal, may I ask you a question? There is no profit to be had in certain basic immunizations.  What if no company chooses to manufacture them.  Do you think government needs to take a public health role in this case?

 

I don't know your age so I don't know if you knew anyone who had polio.  I feel that the government played a valid role in combating a childhood epidemic in funding immunization research.  Do you believe that all medical research should be funded by corporations or individuals--not government?

 

[mom2samlibby]

No profit with vaccinations? I don't think so. That's huge business. $39 billion for 2013 http://www.timesdispatch.com/entertainment-life/drug-companies-see-big-potential-profit-in-vaccines/article_0040ef18-882f-5a94-9308-3b3788e8ed85.html?mode=jqm

 

Ack, I typed million, but it is Billion!

[abacus2]

I can't figure out why dental and eye care are separated from normal health insurance. Eyes and teeth are very important parts of my health. Medical insurance doesn't pay for cosmetic surgery so I don't see why it should skip covering eyes/teeth at all in order to avoid covering cosmetic procedures.

[justasque]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others.  

 

I'm uncomfortable with this, as it would mean that some people would suffer horribly and often die from treatable conditions - car crashes, "random" non-lifestyle illnesses like leukemia, etc.  People who are mentally ill, the elderly, the addicted, those who are cognitively challenged, and the children of these folks would have a very hard time.  I don't think it's good for our country to overlook these folks, and, pessimistically I suppose, I don't think that charity giving would come close to meeting the need.  Some hard-hit communities simply don't have anyone who can carry that load.

 

I think there is a moral imperative to do what we can to help those who are less fortunate.  I like that the UK system serves everyone, but those who wish to "go private" can do so if they can afford it.

[regentrude]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others. 

So what do you propose should be done when an uninsured poor person shows up at the ER? Turn them away and let them die? That would certainly be the free market solution.

If that is considered unethical and they are being treated, somebody has to pay. Right now, it is the people who have insurance who pay for this. There are good reasons to spread this burden across all of society.

 

Btw, in my home country, nobody loses their house because they get sick. Very nice. And good for society as a whole, too. Medical cost is the leading cause for bankruptcy in the US. That's free market, too.

 

ETA: there are other issues where we, as a society, consider it unethical to let free market principles operate: what about organ donations for money? or babies? I don't want to go there.

[regentrude]

Laura, your doctors and nurses are National Health employees, right?  But not all countries with universal health hire the medical people directly. 

 

In Germany, doctors are either self-employed, have an independent practice and hire their nurses, or they are employed by hospitals, clinics, etc. Those are not government run.

The mandatory health insurance is through private insurance companies, not tax funded as in the UK.

Germany spends a little more than half of what the US spend on health per capita in absolute $; in GDP percentage 11.6% vs 17.6%.

 

ETA: The mandatory insurance overs all important things, but not certain things deemed luxuries. If you want a guaranteed private room in the hospital or be seen by the chief doctor instead of some other doctor, you can purchase additional coverage.

[Eagle]

I live in Canada where we have universal healthcare. I would like to see improvements so people could optionally pay for private medical procedures in order to reduce wait times. But overall, I am very happy with the system we have.

 

I read posts here where people are debating whether or not to go to Emergency at the hospital and deciding if the risk is worth the cost. We never have to do that. If any of us get sick we don't have to wonder if we can afford medical care. We didn't pay for the hospital stays when we had our children, or when we had to go to emergency when my son had an asthma attack. A health nurse visited our home when we had our first baby to provide support with nursing and answer any questions we had about baby care.

 

I hear stories of people in the US paying $1000 for an emergency visit or having to refinance their home because they had a heart bypass. I think it must be scary to have monetary stress added to the equation when you are ill.

[ktgrok]

Every time I see a coin collection jar at a check out register, with some kid's picture on it, who needs chemo or a transplant or whatever, I want to scream. How can anyone think the best, most efficient, most humane approach to health care is to collect loose change at the gas station? Cause that is what "charity" looks like for medical care. And heaven forbid you aren't a cute kid. I don't think the ugly get as many donations somehow. 

[Mrs Mungo]

ETA: The mandatory insurance overs all important things, but not certain things deemed luxuries. If you want a guaranteed private room in the hospital or be seen by the chief doctor instead of some other doctor, you can purchase additional coverage.

In my experience (and you can speak to this too, I'm sure)? This actually leads to *some* better practices. For example, a uncomplicated childbirth in Germany is attended by a midwife, not a doctor. These mid-level health practitioners (like PAs, Nurse Practitioners and the such) allow for less expensive care for uncomplicated matters. It employs more people. It allows more people to be triaged and treated. 

 

Not to regentrude:

I completely disagree with the idea of the free market running health care. Honestly, it seems completely contrary to American values. What happened to, "give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!" Do you really want consumerism to drive medical care? 

[HRAAB]

Universal Healthcare, with encouragement towards preventative care.

 

 

I think this might lead to more nurse practitioners and P.A.s that do the basic care, and doctors perhaps being more specialized. I am okay with that.

 

My experience with nurse practitioners and physicians assistants is that they take more time, have more time, to listen to what is going on.

 

What she said.

[Frances]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others.  Via my own free agency, I will choose what charities to support.  Being forced to "do good" or "be charitable" robs me of the spirit to do it voluntarily.  I wish they would do that for social security, too.  I would rather have that money back to invest as I see fit...instead of giving into it and watching them squander it and hint that I'll probably never see that money again. 

Let me decide just how many preventive measures I'd like to take to make my healthcare more in my budget.  Treat me like an adult, not a child who needs a nanny to oversee my consumption and behaviors, and what I purchase to cover my needs.

I would like a system that did not reward bad choices, and that did not create learned helplessness.  There's no dignity in it.

Government hands off for another reason:  their power and reach should be limited.  Too much power, well, we know what that does.  It doesn't end well for the people.

Government should also have a VERY limited capacity for promising people other people's earnings in exchange for votes.  Healthcare is another aspect of this.  "Vote for us, and we will let you keep your current free stuff/care and give you more FREE STUFF!"  This should be gone, yesterday.  It completely messes with our system of government.

And in the process, I promise you it will completely mess up our healthcare system.

 

But what happens under this system when you have a child born with a serious medical condition or someone in your family develops a serious medical condition and you have independent health insurance (not group coverage through a job) or no insurance at all?. What possible incentive would any insurance company have to provide coverage for your family? As an economist, I simply don't think free market principles can be easily applied to healthcare.

 

While I don't think there is any perfect solution, the experience of every other industrialized nation in the world has shown us that some form of universal healthcare is effective at both containing costs and improving health outcomes.

[regentrude]

In my experience (and you can speak to this too, I'm sure)? This actually leads to *some* better practices. For example, a uncomplicated childbirth in Germany is attended by a midwife, not a doctor. These mid-level health practitioners (like PAs, Nurse Practitioners and the such) allow for less expensive care for uncomplicated matters. It employs more people. It allows more people to be triaged and treated. 

 

 

Births are attended by midwives, that is true, and a doctor is only consulted if there is a medical necessity to have one. With an uncomplicated birth, the doctor would typically pop in for a few minutes when the baby is born, have a look at baby and mother, and disappear again; the entire birth is under a midwife's care, even when it happens at the hospital.

 

But  I have never come across PAs or Nurse practitioners in Germany. I am not sure they exist.

[Kim in Appalachia]

This kind of thing has been mooted in Britain, but it's always dropped.  If you take it to a logical conclusion, someone who dove into a lake without checking the depth would have to pay for their entire treatment for being an idiot.  And that's not a direction that people have been willing to go.

 

L

 

 

Yeah, there could be abuse.  There would have to be strick regulations about it, only pertaining to certain choices.  But if there was no patient check there would need to be some sort of other regulations to limit use.  The culture here is not the same as in Europe, and there would have to be a huge cultural shift in what people expected from the healthcare system before this country to go to Universal coverage. 

 

I really would love to see universal health care.  I think what we have now is a nightmare and far more expensive to our overall economy then a universal plan would be.  But we also have unrealistic expectations, as well as existing laws and regulations that would make it impossible to have a viable universal system.  But maybe when the current mess implodes will get something decent. 

[Murphy101]

I want Universal Care. I think anything less is unethical.

 

As for medicating vs treating. I agree many, most, patients want that. But let's be honest, it's faster and cheaper to the economy to many people. In America we treat illness as character weakness and that's reflected in how our schools and employers treat students and employees. Compare how little sick or maternity or vacation time Americans get to other first world countries. And many 2nd world countries too for that matter. It's awful. It's not fair to put all the blame on want to just take a pill and get back to work on the employees.

 

But I think universal care would be a huge step in the right direction. I would hope anyways.

[Mommyfaithe]

Universal Healthcare, with encouragement towards preventative care.

 

 

I think this might lead to more nurse practitioners and P.A.s that do the basic care, and doctors perhaps being more specialized. I am okay with that.

 

My experience with nurse practitioners and physicians assistants is that they take more time, have more time, to listen to what is going on.

This!! We pay so much in insurance, co-pays and pharmaceuticals....we have no dental, eyeglass or mental health coverage. I would be happy to pay into a single payer universal health care system. What we have now is not working for anyone except insurance company CEOs . The doctors hate it, the patients hate it....medicare works beautifully....no reason it couldn't extend to all Americans and be based upon income level. A tax for this would be FINE with me. A fine for NOT purchasing healthcare is NOT ok with me.

[Kim in Appalachia]

My ideal is not surprising.  Government hands off.  Free market insurance, free market doctor practices.  Let ME decide what to spend MY money on. Don't insist that I pay for others.  

 

While this kind of statement sounds good on the surface, it wouldn't work.  We would end up with a society that looks like something out of a Dickens novel, with the sick and poor getting sicker and poorer.  Illness and disease create a terrible downward spiral that has effects on the rest of society, as well as on that individual and family. 

 

Our current high standards of healthcare came about because of our mixture of government support as well as pooled resources from the insurance industry.  Left to itself the insurance industry alone (pure free market) would fleece us.  You may think that in a free market alternatives would spring up, but honestly they would not be able to do that.  It wouldn't take long for monoplies to occur.  Currently Medicare and Medicaid help regulate the market (not always well, but they do contain some costs).

 

A universal system would deliver overall savings from the rest of society to help pay for it (such as decrease in disability and higher productivity).

 

You may only want to care about you (or those you deem worthy), but that doesn't make for a good society on the whole.   

[Mrs Mungo]

Births are attended by midwives, that is true, and a doctor is only consulted if there is a medical necessity to have one. With an uncomplicated birth, the doctor would typically pop in for a few minutes when the baby is born, have a look at baby and mother, and disappear again; the entire birth is under a midwife's care, even when it happens at the hospital.

For the record (for anyone following along), I had one baby in a US hospital and two babies in (two different) German hospitals. I LOVED the German hospital so much more that I can't even express how much better it was.

 

Now, I will say, when my son was born? They thought I was in false labor (I was only 2 cm when I got there), so they put me in a room and didn't check on me for an hour. She came in, said, "how are you doing?" I said "I'm ready to push." She checked me and I was 10 cm. She went and got the other midwife at that point. A doctor came in, tried to give me a heplock while I was pushing. He gave up after it squirted blood all over him and I was yelling at him that it was too late. That's not a usual circumstance, lol. My son was sunny side up. The midwives *really* worked with me, turning me, having me push in different positions until he finally turned. I don't think an American doctor would have worked with me like that.

 

 

But  I have never come across PAs or Nurse practitioners in Germany. I am not sure they exist.

Part of the difference too is that our educational system is totally different. There are more doctors available because the schooling is so inexpensive compared to the US. The immigration system is also easier for medical professionals in Germany. It's faster and cheaper to become a PA or Nurse Practitioner here. In Germany, the people with the knowledge, drive and education to do those programs would just become doctors.

[IHaveNoIdeawhatIAmDoing]

Free market healthcare system. And yes, I think it's ethical. 

[Mrs Mungo]

One of the statistics I read in Betsey McCaughey's book "Beating Obamacare.." was that 5% of the population is consuming 50% of the medical care in terms of cost.  I'd like a group of brainiacs to get together and find some cost savings there and some lines of research that will be helpful.

I don't doubt that is true. But...I'm not sure how statistics would help find cost savings? That five percent likely includes kids with Cystic Fibrosis, adults with complicated cancers, the elderly, etc. My two daughters rarely see a doctor. My son? His medical costs would have bankrupted us by now. Ultimately? It was probably *the* primary reason we've stayed in the military for so long rather than moving to the private sector like so many of dh's friends.

[Mrs Mungo]

Free market healthcare system. And yes, I think it's ethical.

So, my son would die because we couldn't pay cash for his medical care? You find that ethical? How?

[Frances]

I don't want to derail this thread, but I'd like to hear what others think about this question. What makes the US so different from other first world countries (particularly our neighbor to the north, Canada) that a significant portion of our citizens are opposed to some type of universal healthcare?

[LucyStoner]

The inelastic nature of demand for crucial healthcare services makes costs soar under a strictly free market system.  In the US we  are choking our businesses by making this primarily an employer function.  That is a huge drag on the free market and on new businesses.  There's a lot of irony in that.  

 

 

[IHaveNoIdeawhatIAmDoing]

So, my son would die because we couldn't pay cash for his medical care? You find that ethical? How?

 

It's not that simple. We all pay for healthcare now, we just doing it through a  middleman. That's never made anything cheaper. And I never said anything about a denial of care. I've seen how the government runs things. When I want the healthcare system to end up like the post office, I'll be all about government-run healthcare. 

[Mrs Mungo]

I don't want to derail this thread, but I'd like to hear what others think about this question. What makes the US so different from other first world countries (particularly our neighbor to the north, Canada) that a significant portion of our citizens are opposed to some type of universal healthcare?

 

I think people are being fed lies about what it means. 

[Mrs Mungo]

It's not that simple. We all pay for healthcare now, we just doing it through a  middleman. That's never made anything cheaper. And I never said anything about a denial of care. I've seen how the government runs things. When I want the healthcare system to end up like the post office, I'll be all about government-run healthcare. 

 

I HAVE government health care. We're a military family. We don't generally pay anything for health care. My son has had hospital stays that cost over $10k, and that's not even counting the one where his lung collapsed. We never had to pay anything for them. We've paid occasional co-pays when we chose to pick meds up from a pharmacy instead of a military facility (for convenience), have chosen a brand name drug over the generic or have seen a doctor out of network. But, even those instances are few and far between over the last 20 years. 

 

edited for clarity

[IHaveNoIdeawhatIAmDoing]

I HAVE government health care. We're a military family. We don't generally pay anything for health care. My son has had hospital stays that cost over $10k, and that's not even counting the one where his lung collapsed.

 

You still pay into the health care system with your taxes. I have government health care too. That doesn't make it my ideal system. Far from it. 

[ChocolateReignRemix]

But what happens under this system when you have a child born with a serious medical condition or someone in your family develops a serious medical condition and you have independent health insurance (not group coverage through a job) or no insurance at all?. What possible incentive would any insurance company have to provide coverage for your family? As an economist, I simply don't think free market principles can be easily applied to healthcare.

 

While I don't think there is any perfect solution, the experience of every other industrialized nation in the world has shown us that some form of universal healthcare is effective at both containing costs and improving health outcomes.

 

This.

A free market system for something with a fairly inelastic demand curve (healthcare qualifies) will often lead to inefficient outcomes.

[LucyStoner]

 

[Mrs Mungo]

You still pay into the health care system with your taxes. I have government health care too. That doesn't make it my ideal system. Far from it. 

 

You haven't answered any of the questions asked about what makes it *ethical.* 

 

Let me give you an example. I have a good friend who has a cousin with Cystic Fibrosis. He's college age, but doesn't attend college (mostly due to his health issues). Before the changes in the law, he couldn't be on his parents' insurance. Nobody would give him medical insurance. He would get extremely sick, go to the ER, they would stabilize him and boot him out. Without regular medical care, he will *unquestionably* die sooner rather than later. His parents were so happy when the law changed and they were able to put him on their insurance. Will he outlive that? Hard to say, but at least he has options now. Granted, we didn't have a completely free market system before, but it was "free" enough to turn away someone not in need of *critical* care.