The Health Care Crisis

[ClarionCall]

The U.S. is the only industrialized country in the world that lacks universal health care, and this leaves at least forty-two million Americans seriously at risk nationwide because they have no health insurance.

For those who DO have insurance, premiums for health care coverage in the U.S. nearly doubled just between 1998 and 2002, and out-of-pocket costs that are in addition to premiums almost more than doubled. And that trend continues.

In 2002 Americans spent $1.55 TRILLION for healthcare – an average of $5,440 per person, which means that the average for those who were actually able to get care was much, much higher.

For all that money spent, do we have better health care than countries with Universal Healthcare?

The answer is a resounding NO. The World Health Organization ranked the U.S. only 37th in the overall quality of health care that it provides. Not only that, The Commonwealth Fund surveyed people in the U.S., Canada, the UK, Australia, and New Zealand, and they ranked the U.S. as follows:

* Last in patient safety because of the highest level of medication errors and medical mistakes.

* Second-to-last in patient-centered care, and last in doctors not listening to patient concerns.

* Second-to-last in timeliness, unable to see doctor in five days or less when needing medical attention.

* Last in healthcare efficiency, with duplicate tests and unavailability of records and test results at scheduled appointments.

* Last in healthcare effectiveness, with failures to get recommended tests, and unaffordable treatment and prescriptions.

This is a sad state we are in, and unaffordable, inefficient and ineffective healthcare is merely one among many symptoms. The question is, what is the cure?

Will a Republican provide a cure? Certainly not. And neither will a Democrat. They benefit far too much financially from the status quo.

I am of the belief that a realistic and practical cure has been suggested in a book series entitled Real Prophecy Unveiled. The author submits that our partisan political-economic system will become obsolete and will be replaced by one that is far more reasonable, equitable and fair. And he also makes a very good case for public, non-profit Universal Healthcare, among many other solutions to our many problems.

Just a word to the wise who have an ear.

[Cleita]

1. Your preaching to the choir here, but I just returned from a

meeting of Democrats in my county and an AARP representative (a total sell out) and the conclusion was that we are going to have to organize at a grass roots level to reverse what this government is doing to us. I say we start shaking up our elected representatives and make it very clear to them that if they don't start reversing this trend of screwing over the elderly and infirm that they can be replaced with more activist politicians.

[salin]

2. May I suggest, you all start also talking with small businesses?

This is also really hard on them. Find allies.

I have long believed that when enough businesses realize that they can not keep paying the huge annual increases - and that paying a little more in taxes for some sort of external (to the business) universal plan than it costs them to provide healthcare - they will mount enough pressure on congress to counter the pressure from the healthcare industries.

But why wait? Find grops - nonprofit organizations (though they can't lobby - but there employees can write letters as individuals), small businesses, others to whom to costs of healthcare are devastating. Create a critical mass across organizations.

[NC_Nurse]

3. I can tell you

from the front lines of hospital care that it's a mess!

Unfortunately, there's a lot of companies making big bucks from the mess it's in, and they have the $ and the lobbies to keep it that way.

[Malva Zebrina]

6. Been that way for a long time

and I can tell you that I retired after thiry five years in the field because I could not stand it any longer.

It went completely against all that I ever believed I was doing in the health care field.

I once advised a young, bright eyed student nurse to be, ot not pursue this nursing career but to be a doctor instead and was severly accosted for being "bitter"

Well, that may be so, but however, a doctor has a much better chance than a nurse these days. I would recommend a career in medicince but only if it is not nursing--there is still no organized union that would defend a nurse's postion. A nurse is till under the thumb of the institution. Become a doctor--it only takes a few more years--and it affords a much more independant career .

After I finally left the field, I actually made more money more per hour cleaning summer cottages than I did working in the local hospital. Yup, that is the truth. By that time, idiology and sainthood did not make much an appeal to me, And I was independant also, had no responsibility actually and no ethics to consider, and established very good rapport with the customers. I had so much business that I could not schedule it all.

[bj_liberal22]

4. health care problems

The problems in our healthcare system happen not to be technology and availability, it is totally about insurance and access to the system.

We have the most technologically advanced healthcare system in the world, we just have a backwards insurance system that does not adequately address access to the system.

The best way to fix this is to open up a single-payer insurance program and simple cost controls. However, it would be a mistake to convert it entirely to a public system - there does need to be private innovations along side government ran institutions.

But the key is price control... In Canada, for example, they have a patent review board which sets a price ceiling for what they charge for a given medicine. It can rise every year along with inflation, and it allows for profits - but not outright price gouging.

A simple single measure like that here would work wonders!

However a failure with the Canadian system can easily be seen with waiting lists for simple procedures like MRI readings. This is because its against the law to pay out of pocket or have a private insurance supplement which you could pay for this, you must be limited. So an entirely socialized system is definately not the answer.

Hopefully we'll be able to have a legitimate debate on this and combine the best of both types of healthcare to come out with a superior system to all in the near future!

[bj_liberal22]

5. so complicated

Healthcare is so complicated... Just one problem with our current insurance system is that we pay such a huge amount into health insurance and the insurance programs don't even pay proper amounts out when you go to a hospital that isn't on their special list..

What makes me sick about Republicans is they won't even address simple issues within the system we have that are relatively simple. Federal law should mandate that people should be able to get insurance that pays at every hospital and pays at least a certain amount at a minimum.

There are a few insurance policies that you can choose which allow you to go anywhere, but their costs are sky high as well.

Of course, a single payer program would be far superior.

[iverglas]

7. let me recommend my favourite resource for USAmerican readers

http://www.newrules.org/equity/CNhealthcare.html

The New Rules Project is in the US, and that site is a collection of information about the Canadian health care system, written for people reading from a USAmerican perspective.

A previous poster noted that the problem in the US system is not technology or availability, it is the insurance companies.

Let me point out that problems in the Canadian system are attributable not to the universality/exclusivity of the system, but to chronic and deliberate underfunding by right-wing governments for a decade.

(It's also factually incorrect to refer to the Cdn system as "socialized"; all health care providers in the system are private entrepreneurs, but their services are paid for by the general public. It doesn't help advocates of universal single-payer health care to use the right wing's misnomers for the system.)

I don't doubt that a single-payer system in the US could never be introduced without allowing for some sort of parallel/supplemental private system, for purely ideological reasons.

Nonetheless, the fact is that allowing such a private system will ultimately doom the public system. Try visiting a National Health Service hospital in the UK in an emergency, as I did 10 years ago, and see how the quality of care suffered once those with the means "went private", and public engagement with, and commitment to, the public system began to dissipate. It will be left underfunded and its users underserved, as the wealthier increasingly refuse to pay the taxes needed to provide services to the less advantaged while the wealthier pay out of pocket (or through private insurance) for their own.

I got better care at an emergency room in Havana ten years earlier than my mother did in the NHS hospital in North London where we couldn't get ice for her head injury during the 5 hours we waited to see a resident -- while at the same time, my London friend's partner was in a West End hospital, on private insurance, ordering her meals from a room service menu and having every test known to woman for her condition.

Parallel public/private systems don't work. That's why Canada gradually abandoned the aspects of the parallel systems that it had initially retained (e.g. "extra-billing", co-payments to providers) and instituted an exclusively public system -- which, if properly funded, would be expected not to have the isolated problems that it is now experiencing to the same degree.

By the way, when my father was in hospital in Ontario with late-diagnosed terminal metastacized melanoma (he died a year ago tomorrow, 6 weeks after his initial visit to an emergency room with pain), he didn't wait for an MRI, or bone scan, or biopsy, or x-rays, or radiation therapy, or surgery, any longer than it took to schedule the treatments (i.e. within 2 days in all instances).

Situations vary from province to province and region to region within provinces -- but it simply is not true that there is some giant waiting room up here where we all go when we want medical care. And people advocating for a decent health care system in the US need to be as informed about how things do work elsewhere in the world as possible.

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[bj_liberal22]

8. sorry

I was under the impression that the Canadian system was government ran from insurance to the individual hospitals and doctors offices.. If that is not the case, then that is not the problem with their system.

[iverglas]

10. how it works

It's "universal single-public-payer". The provincial governments (with funding from the feds under the federal spending power in areas of provincial jurisdiction) are the "insurer". They pay for the services.

Hospitals are almost all public in the sense that they are operated by non-profit ("private") community foundations with elected boards, and funded by taxes and their own fundraising drives and foundation grants etc. There are a few grandfathered private and religious hospitals around from before the health plan was instituted, and the religious ones can be problematic as in the US. (Ten years ago, the right-wing Ontario government committed a round of hospital closings, and in some cases left the RC hospital as the only one in a small community.)

Doctors in private practice -- family practitioners, yer ob/gyns and other specialists -- are private businesses. They perform whatever services are "medically necessary" and listed on the plan's fee schedules, and bill the government. Absolutely NO prior approval for providing any service that a doctor deems necessary is required. Once in a while there's a doctor who bills for 48-hour days and the like, but because the system is centralized, they get caught and charged with fraud.

There are other private entrepreneurs in the system, like x-ray facilities and other labs and physiotherapists. Their services, if provided on referral from a doctor, are also billed directly to the plan and paid (within scheduled limits, like "x" number of physiotherapy visits) directly to the provider.

The administrative costs in the Canadian system are just over half of the costs in the US system -- something like 16.7% to 31% of total costs, if I recall correctly.

But you were right that the system is universal and exclusive -- no parallel private insurance or out-of-pocket payment for any medically necessary service covered by the plans is allowed.

As we speak, a case is on its way to the Supreme Court of Canada challenging the system (specifically Quebec's laws) as a violation of constitutional rights to life, liberty, security of the person, blah blah. The challengers lost in the trial court and the appeal court, and the Supreme Court agreed to hear it.

The expert opinions in the case (I've had the good fortune of reading most of what the parties have submitted to the Court so far) are overwhelmingly that experience shows that allowing a private system to drain resources, from the fixed pool of healthcare resources within the overall health services system, will necessarily lead to the deterioriation of services within the public plan.

Like I said, it's unlikely that a Cdn-style, in the sense of exclusive, system would be approved in the US to begin with, no matter what philosophical or economic arguments were made for it -- but hell, pretty much anything would be better than what you've got!

.

[iverglas]

9. another interesting resource

This one might get a tad esoteric for USAmericans:

http://www.healthcoalition.ca/

It's critical of the Canadian health care system from a progressive perspective -- people fighting to preserve and protect that system against marauding right-wingers bent on tearing it down for ideological reasons.

One of the personalities involved in it is Shirley Douglas, daughter of the CCF (forerunner of today's social democrat NDP) Premier of Saskatchewan who introduced North America's first public health care plan (and mother of Kiefer Sutherland, for 24 fans like myself).

For people seriously interested in getting a decent healthcare system in the US -- given how that effort involves a constant battle against right-wing/corporate disinformation -- it's worth knowing what the left in Canada says.

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