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Kathleen at 23:28 Feb 5, 2009

Thanks for writing this up! Very interesting. There are good reasons to have guaranteed healthcare and I don't disagree with you, but...

I don't understand how your wait time to see a doctor or nurse would be improved if everyone gets healthcare. Wouldn't it take you ages to get an appointment? We don't have enough medical personnel as it is so I imagine it would be worse with (let's say) three times as many patients.

I could also argue that the quality of basic healthcare would go down as a result, but better something than nothing. I think. :-/

As a side note about liability, my father's job (as a doctor) has over the years become progressively less about caring for patients and more about filling out paperwork to either cover his butt legally or to satisfy byzantine coding requirements by the insurance companies just so he can get paid. His job satisfaction has decreased to the point that he is ready to quit if they introduce another new form. Anything that could reduce that obnoxious weed in an otherwise fulfilling career would be a good thing for doctors all around.

Aaron at 4:25 Feb 6, 2009

I don't think wait times would increase. Right now people pay two things for their health care: money for coverage and time required to go to the clinic. People who don't necessarily need to go will spend the time to do so to justify the money they paid, especially if the money is significant compared to their total income. I think if a visit only cost people time, then they would weigh that cost against the benefit of the health care.

Ironically, that's free market economics, just with time instead of money.

Ben at 21:08 Feb 6, 2009

Kat, it's not just your dad. NPR did an article talking about the stampede away from general practice. Partly it's the money (specialists are paid a lot more under various health insurance schemes), partly the challenge (you see more interesting cases if someone else has triaged for you), partly the bureaucracy.

I find it hard to believe that the cost of reducing fraud to the point we have is worth it. Presumably some beancounter somewhere has figured out the direct financial cost of fraud versus the direct financial cost of paperwork, just as hospitals have figured out the direct financial cost of paperwork versus the direct financial cost of lawsuits. But isn't there someone whose job it is to look at the mess and say we need to change course? Someone we've picked to preside over the country for a bit?

Health care costs too much. On average that's OK. I don't mind that people with millions to spend on health care can eke out a few more years of life - that doesn't strike me as a problem to really worry about, as long as it's not a cost borne by insurance. But everyone ought to have about the same chance of making it to 50, at least medically speaking. And yet my last two optometrist visits have been billed at close to $500/hr, with no particular infrastructure to warrant it. No wonder people don't get treatment for minor problems, even if they could be quite serious.

Alan De Smet at 0:05 Feb 7, 2009

The CDC tells me that as of 2006, about 15% of Americans lacked health insurance. At the very worst, we'll increase pressure on the system 15%. I think the system will bear that and will adjust. Furthermore, a lot of medical professional time is being tied in in emergency treatment, which tends to be more time consuming. If these people have access to health care in general, some will seek earlier, briefly, less expensive treatment, reducing the load.

Still, this may make getting non-emergency access to a doctor slower. It's hard to guess exactly how it will shake out. But I do believe it will make getting emergency treatment faster. I think that's a good trade off.

A post has been hidden because it's spam. This post was link spam. It's still available (just hidden), if you really want to see it..
Ben at 8:26 Feb 7, 2009

Alan, please delete that double-post. Reloading tabs and blindly resubmitting form data is sometimes bad:)

Alan De Smet at 11:42 Feb 12, 2009

Per Ben's request, and after checking with him by email, I've marked the double-post as spam. I'm not deleting it because I am really, really loathe to delete comments for any but legal reasons.

Eva at 13:05 Mar 23, 2009

I really think that people don't enjoy going to the doctor, even when it's cheap and not too slow. I think it's a fundamental fallacy to assume that everyone will just pop round to the doctor's office every couple days just because they can. Things like available nurse advice phone lines cut back on doctor visits even further, since they can give you immediate info and confirm that you do/don't need to take all that trouble.

Sure, maybe cautious folks will bring their kids in a bit more, but as a huge fan of preventative care, I think the decrease on emergency room load and the corresponding decrease in serious medical conditions those kids carry when they grow up will pay off. There are just too many unfortunate cases where an ear infection in a baby festers into something that requires multiple surgeries in an adult. It's completely unnecessary in both cost and pain.

David M at 3:45 Oct 1, 2009

Very good read. There is a big gap that people fail to realize and it is a major source of pain, discomfort, and illness. Dental care. Proper dental care can cost as much as a vehicle yet no where is someone really covered except for the extreme basics. Another issue I see with UHC is who is going to pay for it? Having a 40-50% tax rate for all Americans will devistate this country on an epic scale escecially since debt is increasing and wealth is going to other nations of the world. Our government can't properly take care of our veterans heath care or run the post office so my trust in them for healthcare is very poor. If we can get the same healthcare as the senate then I'm all for it.

Alan De Smet at 15:41 Oct 1, 2009

David M: "Another issue I see with UHC is who is going to pay for it?"

We already pay for it.

First, the elderly already have UHC. And we pay for it. Same for some young children and some mothers. Same for

Most Americans do have insurance through out employers. We pay for some ourselves, and employers pay some more. The part the employers pay represents lost pay. With UHC paid for by taxes (there are other options), pay will go up, but so will taxes. The effect will largely be a wash.

Now there is a concern about paying for coverage for people who are currently uninsured. But we're still already paying for them! If their health reaches an emergency they go to the Emergency Room, and hospitals will treat someone in an emergency. People without insurance typically can't afford to pay, so they don't. Many never recover more than half of their expenses. They run the ER at a loss! That cost gets passed on to you and me in the form of higher rates elsewhere. And since being treated in ER is typically more expensive that seeing a doctor when the problem is more mild, we're paying extra for this treatment.

Taking a longer view, America is less competitive as a whole because of a lack of UHC. People with great ideas but chronic conditions stay in safe, less productive jobs instead of taking risks to start new companies or join startups. It makes us stagnant. Fewer great ideas come from the US and we end up importing great ideas, the very outflow of wealth you're worried about!

I can't promise the UHC will end up being positive, or even neutral, for individual take up pay. But I believe the worst case will be a relatively modest decrease in take home pay with the tradeoff that the economy as a whole will be stronger.

"Our government can't properly take care of our veterans heath care or run the post office so my trust in them for healthcare is very poor."

In an especially strange decision, our post office is partially privatized, so it's not a great comparison. Still, I'll take it since we're lucky to have one of the most reliable, fastest, cheapest postal systems in the world! They'll ship stuff cheaper than any of the private carriers. They have better office hours than the private carriers. Sure, when you get a mangled letter it feels like it's a crap system, but by and large that is a rare exception. They sure as hell mangle my mail and packages less than UPS.

Veteran's health care has a lot of problems, but it has some strengths. A key weakness: the military tries to claim some injuries, particularly brain injuries, aren't so they don't have to pay for care and don't have to sent a soldier home. Of course, private insurance companies try to claim that illnesses and injuries are fake, are preexisting conditions, or are simply not covered. I don't like either one. On the strength side, the VA is arguably a shining example of how to run a pharmacy plan.

James Pannozzi at 7:40 Dec 29, 2009

As a former professional programmer (32 years) who later entered the medical field (Oriental medicine, Chinese Herbology, Acupuncture), I would agree with you completely on the need for a Government run universal health care plan. I am, in general, opposed to big government and expensive government projects with the potential for waste. But the inhuman and peremptory dismissal of 40 million people by the health "insurance" industry is simply beyond the bounds of any rational humanism and, what with corporations referring to their employees as "human resources", I think we've had enough dehumanization.

The resistance against the government plan has more to do with the understanding by the lobbyists and corporatistas that one reform will lead to many more - a correct idea, far beyond anything those poor bastards can imagine.

Ed Habowski at 3:11 Mar 1, 2010

Your premise is completely wrong. Universal health care is available, everybody just has to buy insurance, but they don't, mainly because they have other priorities. So we don't have universal health care. Unreasonable cancellation and rate hikes could be eliminated quickly and easily, if we wanted to do that but we don't.

Also for universal health care we need a specific population, not everyone who wanders across the border can be treated. The U.S. would have to have a no unhealthy newcomers policy, as they do in EVERY country that has universal health care. Radical border control is required for universal health care - see Australia

The way we do it now, we will provide free health care for anyone with AIDS (or ...) and they can come to the U.S. already sick. That estimated cost is $1 million each. We cannot provide a decent level of care for every poor person in the world (or even in Canada or Mexico). We do not have that much money. In fact we are already broke.

What we should have is universal payment. Everybody has to pay something whenever they go to a doctor or hospital. That would dramatically reduce over usage and direct people to cheaper venues. Sorry aliens you must pay for health care in the US or go back to Canada where it is free. Even small payments would cut costs dramatically as people go to Walmart nurses (or P.A.'s) for a cold, rather than an ER.

Sorry the lawyers have to get out of health care. The C.B.O. cannot estimate the cost savings (they say) but from personal experience I'd say we could save 20 - 40% on unneeded tests, exams, procedures and defensive medicine. Oh, and yes, reduce provider overhead.

If you want free health care for anyone, you will get what you pay for - nothing. Ask someone from the old Soviet Union, they will tell you what universal health care is like. Talk to sick people in counties with universal health care. They will admit it is universal, but NOT that is health care. Try Oregon and Massachusetts their programs base your health care on what they think you are worth. Suicide pills are not health care, and one way or another that is what universal health care involves.

Universal health care WILL NOT BE THE STANDARD OF HEALTH CARE WE CURRENTLY ENJOY, it is the standard of care "enjoyed" at the Cook County Hospital in Chicago - which is both extremely expensive (more than 1st rate hospitals) and in general extremely poor care - no one goes there unless they have no other choice. That is the reality of government health care - HIGH costs, LOW quality.

Effectively we do have universal health care, it is called Medicaid, and most doctors won't treat Medicaid patients. Now more doctors won't treat Medicare patients. Do you really believe universal health care will be better than Medicare, it won't. In fact, considering seniors voting power, universal health care will not be allowed to be better than Medicare. However, to pay for universal health care, the quality of Medicare is going down $500 Billion while the number of people covered is increasing dramatically. So right at the start the quality of health care is being reduced. Is that a good sign?

Wishing is great, but if you got that new Ferrari for free -- insurance gas, maintenance - repairs, parking etc., would bankrupt the average person, so within a few years that fantastic new car would turn to garbage. The same is true of universal health care.

ANONAMOUS at 15:32 Apr 5, 2010


ANONAMOUS at 15:32 Apr 5, 2010


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