Author Topic: Universal Health Care Practicalities  (Read 8010 times)

gentmach

  • Bristles
  • ***
  • Posts: 269
Universal Health Care Practicalities
« on: January 30, 2019, 08:48:08 AM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

ncornilsen

  • Pencil Stache
  • ****
  • Posts: 836
Re: Universal Health Care Practicalities
« Reply #1 on: January 30, 2019, 09:26:55 AM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

I don't know how you can exclude morality from the debate when your questions are about the morality of forcing people to behave in a particular way. Were you to enact laws and such to address the issues you mention, you would be fulfilling the wildest nightmares of some people who think socialized healthcare is a way to control how we live.


Kris

  • Magnum Stache
  • ******
  • Posts: 3614
Re: Universal Health Care Practicalities
« Reply #2 on: January 30, 2019, 09:39:54 AM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

TrMama

  • Magnum Stache
  • ******
  • Posts: 2718
Re: Universal Health Care Practicalities
« Reply #3 on: January 30, 2019, 09:48:15 AM »
I don't have answers to any of your questions. However, I can tell you how these things work in Canada (specifically BC, because "Universal healthcare" is run provincially). Most of the answers boil down to the fact that universal health care doesn't replace personal responsibility or personal agency. No morality is attached to any health issue.

1. No morality or extra tax is attached to being overweight. If you have medical problems that stem for being overweight, they'll get treated, but otherwise it's up to you to lose weight; if you want. Surgical procedures like lap band, stomach stapling, etc are extremely hard to get. You must have a very high BMI and then wait years for the actual procedure. This is because OR and hospital time is prioritized for life saving procedures like cancer surgeries, cardiac issues, etc.

2. No one makes sure you take your meds properly. If you have medical issues stemming from improper use of meds, they'll get treated.

3. Addiction treatment is in extremely short supply. Addicts are lucky if they can get into a treatment program at all. Google "BC fentanyl crisis" for a graphic look at how this is a big issue here.

Universal health care doesn't solve all problems. It doesn't make for some kind of utopian paradise. All it does is make basic health care affordable for the masses. It also means that everyone deserves health care and very, very few people go bankrupt due to medical expenses. However, they may still go bankrupt if they're not able to work because they're too sick.

Blueberries

  • Stubble
  • **
  • Posts: 128
Re: Universal Health Care Practicalities
« Reply #4 on: January 30, 2019, 10:46:49 AM »
Doesn't group insurance work similarly when you get down to it?  I understand group insurance is voluntary, but I don't really understand how the argument changes when it becomes universal healthcare.  Life isn't fair, no system is perfect, and ultimately, we do have Medicare which is working, even if imperfectly. 

I have to point out that there's a fucking problem when I walk into a doctor's office lined in marble and filled with iPads but 20%+ of the population can't even get a checkup.

Barbaebigode

  • Stubble
  • **
  • Posts: 145
Re: Universal Health Care Practicalities
« Reply #5 on: January 30, 2019, 11:02:05 AM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

That's what death panels are for.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #6 on: January 30, 2019, 11:11:43 AM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Kris

  • Magnum Stache
  • ******
  • Posts: 3614
Re: Universal Health Care Practicalities
« Reply #7 on: January 30, 2019, 11:18:46 AM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.

That is not an evidence-based statement. It's a preconceived notion, based on a moral stance. I'll repeat, creating a system that functions on reality and evidence, not on people's preconceptions, is the key.

FIRE@50

  • Bristles
  • ***
  • Posts: 390
  • Age: 41
  • Location: Maryland
Re: Universal Health Care Practicalities
« Reply #8 on: January 30, 2019, 11:31:40 AM »
I'm not concerned about the truly sick people getting treatment. I'm concerned about the hypochondriacs bogging down the system. I guess they would get mental health treatment for that too, though.

bacchi

  • Magnum Stache
  • ******
  • Posts: 3306
Re: Universal Health Care Practicalities
« Reply #9 on: January 30, 2019, 11:37:54 AM »
I'm not concerned about the truly sick people getting treatment. I'm concerned about the hypochondriacs bogging down the system. I guess they would get mental health treatment for that too, though.

How do we in America handle hypochondriacs right now? If they don't have coverage, they go to the ER. Is that better or worse than in a universal care system?

How do the many universal care systems around the world handle hypochondriacs?

Does the US have more hypochondriacs than, say, France or Germany?


RetiredAt63

  • Senior Mustachian
  • ********
  • Posts: 10063
  • Location: Eastern Ontario, Canada
Re: Universal Health Care Practicalities
« Reply #10 on: January 30, 2019, 12:12:56 PM »
TrMama's reply would be pretty much the same for Ontario.  There are walk-in clinics (helpful if you are away from home), clinics (for your GP and specialties like sports medicine), medical centers (for tests) and ERs for crises.  And of course hospitals if you are really sick  If you go to the ER for something trivial you will be referred to a clinic. If you really need an ER the ER will not turn you away.  If you are sick you will be treated, urgent cases quickly, non-urgent cases not as quickly.  But you will be looked after, and your OHIP will cover it.  "Extras" (like prescription drugs, physiotherapy) get covered by personal insurance.  People do fall through cracks, I have no idea how someone who is homeless gets an OHIP card.  But getting that is a matter of residency, not money.  We all pay for it, through our taxes (I am sure every Canadian will be happy to point out that this is not "free" health care, the cost is simply distributed over the whole population).  Some years an individual may not need the system at all, other years they may use it a lot.  Mental health care is not as good as physical health care, and addiction health care is in really short supply. Sadly, dental care is not covered, except for some dental surgeries done in a hospital.

There are 2 3 obvious advantages to this: 1.  People are more likely to see a doctor before something gets so serious they are really sick and need hospitalization, and 2.  they are not held hostage by an employer because how will they get insurance coverage otherwise? and I remembered 3. People get their immunizations easily - flu shots are provided at clinics and pharmacies, all children's immunizations are covered, most adult immunizations are covered.


skp

  • 5 O'Clock Shadow
  • *
  • Posts: 70
  • Location: oh
Re: Universal Health Care Practicalities
« Reply #11 on: January 30, 2019, 01:09:28 PM »
 S That's what death panels are for.
[/quote]

I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.

I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.

Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost.  I routinely care for morbidly obese patients.  We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient.   As far as I can see under the current system there is no penalty for non compliance.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #12 on: January 30, 2019, 02:41:21 PM »
S That's what death panels are for.

I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.

I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.

Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost.  I routinely care for morbidly obese patients.  We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient.   As far as I can see under the current system there is no penalty for non compliance.
[/quote]

Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #13 on: January 30, 2019, 02:43:38 PM »
I'm not concerned about the truly sick people getting treatment. I'm concerned about the hypochondriacs bogging down the system. I guess they would get mental health treatment for that too, though.

I had a relative go to the emergency room too many times in a certain time period with nothing wrong with him. The hospital wound up sending him to the psych ward involuntarily.

So the system does have methods available.

skp

  • 5 O'Clock Shadow
  • *
  • Posts: 70
  • Location: oh
Re: Universal Health Care Practicalities
« Reply #14 on: January 30, 2019, 02:56:18 PM »
S That's what death panels are for.

I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.

I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.

Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost.  I routinely care for morbidly obese patients.  We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient.   As far as I can see under the current system there is no penalty for non compliance.

Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
[/quote]
I don't understand your question.  99% of the patients in the hospital are on at least low dose blood thinners.  I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify.   We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday.  She had only 3 months to go.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #15 on: January 30, 2019, 03:03:00 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.

That is not an evidence-based statement. It's a preconceived notion, based on a moral stance. I'll repeat, creating a system that functions on reality and evidence, not on people's preconceptions, is the key.

My brother had a girlfriend who was a heroin addict. Her mother died of a heroin overdose. One year later the daughter was dead of a heroin overdose.

The particular heroin addict I was talking about has been doing heroin for 12 years at this point. She gets arrested. They kick her to "drug court." Drug court sends her to rehab. After rehab she moves in with her mother who is toxic and the whole process starts over again.

Fun fact, that addict owes me 1365 dollars. And that is never coming back.

So I have "walked the walk" that you are asking me to do with helping people. I have found that people will strip you to the bone if you allow them. Jamming the government into these people's self destructive cycles seems like a bad idea.

To be clear, I agree that we need to find systems that work. Problem is the system needs to be more comprehensive (job training, life skills and keeping them away from the wrong people).

Kris

  • Magnum Stache
  • ******
  • Posts: 3614
Re: Universal Health Care Practicalities
« Reply #16 on: January 30, 2019, 03:06:11 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.

That is not an evidence-based statement. It's a preconceived notion, based on a moral stance. I'll repeat, creating a system that functions on reality and evidence, not on people's preconceptions, is the key.

My brother had a girlfriend who was a heroin addict. Her mother died of a heroin overdose. One year later the daughter was dead of a heroin overdose.

The particular heroin addict I was talking about has been doing heroin for 12 years at this point. She gets arrested. They kick her to "drug court." Drug court sends her to rehab. After rehab she moves in with her mother who is toxic and the whole process starts over again.

Fun fact, that addict owes me 1365 dollars. And that is never coming back.

So I have "walked the walk" that you are asking me to do with helping people. I have found that people will strip you to the bone if you allow them. Jamming the government into these people's self destructive cycles seems like a bad idea.

To be clear, I agree that we need to find systems that work. Problem is the system needs to be more comprehensive (job training, life skills and keeping them away from the wrong people).

I literally donít know what youíre talkng about when you say Iím asking you to walk some sort of walk. Iím not. I donítcare, for the purposes of this conversation, about helping people put of anything.

I am saying, if we want to construct a universal health care system that actually works, we have to start with evidence based studies of what actually works. Not, ďI knew a heroin addict once and she just kept relapsing until she died.Ē

Sailor Sam

  • Magnum Stache
  • ******
  • Posts: 4250
  • Age: 38
  • Location: Steel Beach
  • Semper...something
Re: Universal Health Care Practicalities
« Reply #17 on: January 30, 2019, 03:06:30 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

@gentmach, I think your wording might be throwing the debate off.

If you're asking for the actual mechanism of making decisions on who receives treatment, and the level of treatment they receive, then 'panels' are the correct answer. Somewhere, probably at multiple levels - federal, state, center - groups would get together and make standards. People do tend to get histrionic over the idea, but such decision making groups already exist. Transplant boards, premie care teams, oncologists; they're already holding such decision making panels.

If you're asking for how those groups would reach agreement on standards, that's definitely morality. Since you said you're now sold on universal healthcare, I'm guessing what you'd really prefer is for everyone to avoid rehashing the morality argument against universal healthcare.

Do I have it correct?

bluebelle

  • Stubble
  • **
  • Posts: 247
  • Location: Toronto
Re: Universal Health Care Practicalities
« Reply #18 on: January 30, 2019, 03:16:34 PM »
I don't understand your question.  99% of the patients in the hospital are on at least low dose blood thinners.  I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify.   We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday.  She had only 3 months to go.
That is so sad.  Unless she still had a great quality of life, too many families keep their loved ones alive because they don't want to let go....I knew my brother would have trouble, so we had the conversation with my mother about a DNR when she was very healthy and in her early 90s.  When she got really sick last summer, he knew what her wishes were and was comforted by that.  I'm happy to say she rallied (3 times), and we had her 97th birthday party a few weeks ago.


Back to universal health care - as some else said, it isn't free, we're still paying for it.  And because I'm a higher income worker, I get to pay 'extra' for that free health care.  What I've always seen as a huge short-coming of health care in general, whether it's my 'free' provincial health care, or employer offered health care, they will spend thousands on the disease, but little to nothing on prevention.  ie $1000s on bypass surgery or prescription drugs, but nothing on cease smoking or heart healthy eating or exercise plans.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #19 on: January 30, 2019, 03:17:27 PM »
S That's what death panels are for.

I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.

I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.

Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost.  I routinely care for morbidly obese patients.  We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient.   As far as I can see under the current system there is no penalty for non compliance.

Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
I don't understand your question.  99% of the patients in the hospital are on at least low dose blood thinners.  I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify.   We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday.  She had only 3 months to go.
[/quote]

You got it right. What is the work load treating the 900 pound patient versus an "average" adult? Do you require a lifting machine (https://medmartonline.com/advance-e-340-portable?utm_source=google_shopping&gclid=EAIaIQobChMIy_jGlcOW4AIVV_7jBx1aCAsjEAQYASABEgJcp_D_BwE) or do you assist them?

My dad had one knee replaced and the other should have been done. Unfortunately his weight has probably done no favors to that device so it's lifetime has probably been shortened significantly.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #20 on: January 30, 2019, 03:27:48 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

@gentmach, I think your wording might be throwing the debate off.

If you're asking for the actual mechanism of making decisions on who receives treatment, and the level of treatment they receive, then 'panels' are the correct answer. Somewhere, probably at multiple levels - federal, state, center - groups would get together and make standards. People do tend to get histrionic over the idea, but such decision making groups already exist. Transplant boards, premie care teams, oncologists; they're already holding such decision making panels.

If you're asking for how those groups would reach agreement on standards, that's definitely morality. Since you said you're now sold on universal healthcare, I'm guessing what you'd really prefer is for everyone to avoid rehashing the morality argument against universal healthcare.

Do I have it correct?

Yes. I wanted to get beyond the "universal health Care is bad" debate. I wanted to know how the system would actually run.

And it didn't occur to me that those would be called "panels".   Thank you.

Scortius

  • Bristles
  • ***
  • Posts: 446
Re: Universal Health Care Practicalities
« Reply #21 on: January 30, 2019, 03:34:05 PM »
Quote from: gentmach
S That's what death panels are for.

I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.

I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

Your questions are all about morality.

Looking at solutions that work, rather than who "deserves" health care, should be the focus.

I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.

Right.

You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.

Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost.  I routinely care for morbidly obese patients.  We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient.   As far as I can see under the current system there is no penalty for non compliance.

Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
I don't understand your question.  99% of the patients in the hospital are on at least low dose blood thinners.  I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify.   We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday.  She had only 3 months to go.

You got it right. What is the work load treating the 900 pound patient versus an "average" adult? Do you require a lifting machine (https://medmartonline.com/advance-e-340-portable?utm_source=google_shopping&gclid=EAIaIQobChMIy_jGlcOW4AIVV_7jBx1aCAsjEAQYASABEgJcp_D_BwE) or do you assist them?

My dad had one knee replaced and the other should have been done. Unfortunately his weight has probably done no favors to that device so it's lifetime has probably been shortened significantly.

It may be a bit of a diversion, but my understanding was that morbidly obese patients and others who refuse to be responsible for their own care outside of in-patient facilities end up costing the system the least, mostly because they die quickly and early before expensive long-term geriatric care is required. Now whether or not that's relevant to any discussion regarding universal health care is debatable.

FIPurpose

  • Pencil Stache
  • ****
  • Posts: 846
  • Location: ME
    • FI With Purpose
Re: Universal Health Care Practicalities
« Reply #22 on: January 30, 2019, 03:44:02 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

1. There is an argument out there that the obese actually end up consuming less healthcare on average due to shortened life span. People with a BMI >30 live 3 years shorter, people with BMI >40 live 10 years shorter. That difference tends to balance out the lifetime costs. So I don't think it's obese adults we'd need to worry about, it's the growing epidemic of obese children. So what are some major policy changes that should happen:
  • End sugar subsidies/ tax sugar - sugar is probably the single biggest driver of obesity. It needs to stop being added to absolutely every single product. Add taxes on sugar until manufacturers find it a better choice to remove it from their products. (ie people will prefer to pay less, rather than buy the sweeter product)
  • Provide good SNAP benefits and end food deserts. - A lot of obesity is in poor rural areas. Access to good nutritional food is low. People need a grocer that can supply them the products and benefits that will allow them to afford it.

2. You can't. Sounds like he's on the wrong anti-depressants. With universal healthcare, maybe he'd feel more able to get a second opinion.

3. I don't think heroin addicts choose to go to therapy willy-nilly. Usually they have to be pressured and incentivized by their family to go in the first place. Not because they're bad people, just because that's the power of the addiction. I think rehab done right does not have to be an expensive operation. And the government is going to have to come to terms with this in the current opioid epidemic. We need a top-down clear manual on how to operate and fund these facilities. As far as I know, there are no guidelines that lawmakers can follow. It's still the wildwest out there on what constitutes a reasonable rehab facility.


Overall though the major benefit of universal healthcare is that it creates a driving force for us to collectively improve how our communities function. Remove major waste in the system. Rethink some of our current policies. (Like why are we subsidizing sugar when it's part of what's driving our insane healthcare costs.) It simplifies health care administration, source of funding, medical debt management and losses, buy batch amounts of pharmaceuticals, have a huge risk pool, removes a need for profit, reduces hospital admin complexity, and can possibly lead to some other potential health improvements such as community analyses that are difficult to implement without a central system/database.
 

Sailor Sam

  • Magnum Stache
  • ******
  • Posts: 4250
  • Age: 38
  • Location: Steel Beach
  • Semper...something
Re: Universal Health Care Practicalities
« Reply #23 on: January 30, 2019, 03:59:02 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

My opinions:

1. Mantadory service for everyone from age 18-21. Minimum 2 years for military, and 3 years for civilian service. Both routes will have exercise requirements, inside which slacking is highly and deeply discouraged. It won't fully fix the problem, but it will instill discipline, as well as a national identity as fit and sporty people. Or, at the very least it will delay the inevitable slide into massive weight gain by a few years. If people become obese, despite this excellent societal shift towards exercise, they should continue to be provided care. Weight doesn't reduce someone's humanity.

2. There's possibly no solving for this one. Though, making sure children are raised in loving and protective environments will probably save a great portion of the next generation. It would probably also help if we could get over our societal squeamishness about sexuality and identity.

3. Intransigent recidivists should be shunted towards houses in which their basic needs are provided for. Three hots, and a cot in which to safely shoot up. They could be staffed by such 18-21 year olds that score high on empathy, and low on abusing the desperate. Given such succor, some might choose to return to rehab, and have a better chance of success. Research the "Rat Park Studies." Of course, some will still overdose and die, and we as society should grieve our failure of anyone in that much pain. Particularly if their doctors are the ones that hooked them in the first place. Heroin often comes once someone can no longer afford oxy...

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #24 on: January 30, 2019, 04:17:26 PM »
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.

I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.

It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.

Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?

Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?

Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?

What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?

1. There is an argument out there that the obese actually end up consuming less healthcare on average due to shortened life span. People with a BMI >30 live 3 years shorter, people with BMI >40 live 10 years shorter. That difference tends to balance out the lifetime costs. So I don't think it's obese adults we'd need to worry about, it's the growing epidemic of obese children. So what are some major policy changes that should happen:
  • End sugar subsidies/ tax sugar - sugar is probably the single biggest driver of obesity. It needs to stop being added to absolutely every single product. Add taxes on sugar until manufacturers find it a better choice to remove it from their products. (ie people will prefer to pay less, rather than buy the sweeter product)
  • Provide good SNAP benefits and end food deserts. - A lot of obesity is in poor rural areas. Access to good nutritional food is low. People need a grocer that can supply them the products and benefits that will allow them to afford it.

2. You can't. Sounds like he's on the wrong anti-depressants. With universal healthcare, maybe he'd feel more able to get a second opinion.

3. I don't think heroin addicts choose to go to therapy willy-nilly. Usually they have to be pressured and incentivized by their family to go in the first place. Not because they're bad people, just because that's the power of the addiction. I think rehab done right does not have to be an expensive operation. And the government is going to have to come to terms with this in the current opioid epidemic. We need a top-down clear manual on how to operate and fund these facilities. As far as I know, there are no guidelines that lawmakers can follow. It's still the wildwest out there on what constitutes a reasonable rehab facility.


Overall though the major benefit of universal healthcare is that it creates a driving force for us to collectively improve how our communities function. Remove major waste in the system. Rethink some of our current policies. (Like why are we subsidizing sugar when it's part of what's driving our insane healthcare costs.) It simplifies health care administration, source of funding, medical debt management and losses, buy batch amounts of pharmaceuticals, have a huge risk pool, removes a need for profit, reduces hospital admin complexity, and can possibly lead to some other potential health improvements such as community analyses that are difficult to implement without a central system/database.

1. That's interesting.

2. Actually he said "the anti-depressants leave me with fucked up thoughts." It sounds like he gets trapped obsessing over the bad things in his life. So the anti-depressants are working properly, he may need to see a therapist to work out some of his issues.

3. The heroin problem is people are fine as long as they are within the system. However upon release from the system they are often put in the same environment that caused them to pick up the needle in the first place. Thus begins a cycle of relapse and rehab.

The system would have to be expanded to provide skills training and allow new habits to form. But if someone keeps returning to a bad environment then we need to have an option to say stop.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #25 on: January 30, 2019, 04:20:46 PM »


3. Intransigent recidivists should be shunted towards houses in which their basic needs are provided for. Three hots, and a cot in which to safely shoot up. They could be staffed by such 18-21 year olds that score high on empathy, and low on abusing the desperate. Given such succor, some might choose to return to rehab, and have a better chance of success. Research the "Rat Park Studies." Of course, some will still overdose and die, and we as society should grieve our failure of anyone in that much pain. Particularly if their doctors are the ones that hooked them in the first place. Heroin often comes once someone can no longer afford oxy...

This actually sounds like a solution.

gaja

  • Handlebar Stache
  • *****
  • Posts: 1142
Re: Universal Health Care Practicalities
« Reply #26 on: January 30, 2019, 04:23:16 PM »
The Scandinavian model is to treat healthcare as a part of the larger picture. We don't address the obesity issue by denying/increasing the co-pay of healthcare, but by taxing unhealthy choices and making it easier to choose to live healthy. The same goes for tobacco and alcohol (yes, the expensive alcohol in Norway is a feature, not a bug). We spend state money on electric cars partly because bad air quality is very expensive for the healthcare budget.

As for the hypochondriachs and people misusing their medication; everyone has a "house doctor", the one that you book your regular appointments with, and who receives all your papers. If you choose to go to a different doctor, or the ER, they will send you back to the house doctor. The house doctors are quite strict, and will often tell people to take a paracetamol and see if gets better, if not; come back in two weeks. There is no system for sueing doctors. If things go seriously wrong, you might get a compensation from the state. But it is very rarely blamed on individual doctors. Due to this, the system as a whole saves a shitload of money on unnecessary tests, medication, and operations. We have some of the lowest use of antibiotics in the world (and do not have a lot of multi-resistant bacteria).

My kid has Erb's palsy. In the facebook groups about the diagnosis, it looks like most of the US kids with this diagnosis (who have insurance) have several operations before they are 5, and often need to re-operate later in life. Long term physical therapy is rarely covered by the insurance. My kid only had physical therapy and training (swimming lessons paid by the state) until the age of 8. By then we had been able to retrain 90 % of the muscles, but one movement was still missing. So she got an operation for that, before going back to physical therapy. Her arm and shoulder blade moves a bit differently, and they told us there is a possibility to operate to make it look more normal, but they recommended not to do it since it was purely cosmetical and could cause other problems. If everything continues as now, and she keeps up the stretching and training, she won't need any more operations. Better life for her, cheaper for the state.

We have a panel for medicines, where the recommended limit is 275 000 NOK/extra year of life, adjusted for quality. That means that some of the more expensive treatments available in the US for well insured people, are not offered by the state universal health care here. Now and then the panel gets a lot of heat in the media for "denying people life saving treatment", and sometimes the politicians give new orders based on the outrage. But usually, the decisions by the panel make sense.

But: our system is built on an acceptance of a strong state, that tells us what is best for us.

Kris

  • Magnum Stache
  • ******
  • Posts: 3614
Re: Universal Health Care Practicalities
« Reply #27 on: January 30, 2019, 04:32:48 PM »

But: our system is built on an acceptance of a strong state, that tells us what is best for us.

Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.

pecunia

  • Pencil Stache
  • ****
  • Posts: 749
Re: Universal Health Care Practicalities
« Reply #28 on: January 30, 2019, 08:29:59 PM »
"But: our system is built on an acceptance of a strong state, that tells us what is best for us"

Wow - Kris is right.  We have two generations now brainwashed on Ronald Reagan stuff:

"The most terrifying words in the English language are: I'm from the government and I'm here to help."

"In this present crisis, government is not the solution to our problem; government is the problem.Ē

Lots of hypochondriacs out there who go to the doctor for every little ache and pain.  They will cost a public healthcare system money.  There's got to be a minimum charge per visit say twenty dollars.  If you can't afford the twenty dollars, then you are really hard up and I guess you'll get in free.

FIPurpose

  • Pencil Stache
  • ****
  • Posts: 846
  • Location: ME
    • FI With Purpose
Re: Universal Health Care Practicalities
« Reply #29 on: January 30, 2019, 09:18:48 PM »
"But: our system is built on an acceptance of a strong state, that tells us what is best for us"

Wow - Kris is right.  We have two generations now brainwashed on Ronald Reagan stuff:

"The most terrifying words in the English language are: I'm from the government and I'm here to help."

"In this present crisis, government is not the solution to our problem; government is the problem.Ē

Lots of hypochondriacs out there who go to the doctor for every little ache and pain.  They will cost a public healthcare system money.  There's got to be a minimum charge per visit say twenty dollars.  If you can't afford the twenty dollars, then you are really hard up and I guess you'll get in free.

Or their medical history states that they're likely a hypochondriac, doctor perscribes a placebo and we all move on...

marty998

  • Walrus Stache
  • *******
  • Posts: 5988
  • Location: Sydney, Oz
Re: Universal Health Care Practicalities
« Reply #30 on: January 30, 2019, 11:51:57 PM »
For all its faults the Australian universal healthcare system works well too, much the same as Canada.

Two points I'd make:

1) We don't have the culture of popping pills and drugs for everything under the sun. Partly because pharmaceutical companies cannot by law advertise to the general public.

This is interesting reading:
https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/

An incredibly large proportion of America is on prescription medication, which generally leads to more medication to treat the side effects of the initial pills.

2) People accept their taxes will be a little bit higher than otherwise. In return, we know that we won't die or suffer major life setbacks due to minor health issues for want of being poor.

Barbaebigode

  • Stubble
  • **
  • Posts: 145
Re: Universal Health Care Practicalities
« Reply #31 on: January 31, 2019, 06:49:05 AM »
Declaring that a healthcare system has failed and should be shut down sounds like something possible only in a society that does not view healthcare as a human right. I am guessing that in places with public HC, obesity, hypochondria and addictions (to cite your examples) tend to be considered more like diseases to be treated than bad personal choices.

gentmach

  • Bristles
  • ***
  • Posts: 269
Re: Universal Health Care Practicalities
« Reply #32 on: January 31, 2019, 08:42:50 AM »
Declaring that a healthcare system has failed and should be shut down sounds like something possible only in a society that does not view healthcare as a human right. I am guessing that in places with public HC, obesity, hypochondria and addictions (to cite your examples) tend to be considered more like diseases to be treated than bad personal choices.

I consider whatever system we put in place an experiment. As such we should have metrics to compare to see if it doing better or worse.

I would have preferred to have each state to its own system so we would have a set of data to compare and contrast. But we will go national and see what happens.

It has nothing to do with it being a human right. If a system is not living up to its promises then it should be abandoned.

PoutineLover

  • Handlebar Stache
  • *****
  • Posts: 1047
Re: Universal Health Care Practicalities
« Reply #33 on: January 31, 2019, 09:24:57 AM »
Personally, the health care system in Canada works very well for me and I am very grateful for our system that doesn't cost an arm and a leg to each user, but may cost a bit more in taxes. Overall, we spend way less per capita on health care than the US does, and we have better outcomes (longer lifespan at least, I'd have to research other metrics). Since the taxes are progressive, people who can afford to pay more do so, and people who can't afford to pay still get access.
Fundamentally, I believe that all people should have access to health care, and that access should not rely on how much money that person has.
Our system does have some flaws, but for the most part, people who need health care can receive it without risking their financial future, going bankrupt or having to choose to postpone or discontinue care because they can't afford it. The exceptions here are eye care, dentists, and prescription meds, and personally I would love to see an all-encompassing system, but we aren't there yet.
Honestly, I am willing to accept that there are a few people who might abuse the system or not do all they can to live as healthily as possible, as long as the vast majority of people who get sick for reasons beyond their control can still be cared for. The extra cost and effort of trying to deny care to some people isn't worth it, in human or monetary cost. I don't think it's useful to judge whether a person is truly "deserving" of care, because
1. Fat is not necessarily automatically unhealthy, and BMI is a poor indicator of overall health
2. Even if fat does cause a health problem, doesn't make someone unworthy of health care
3. Fat people already get discriminated against and judged by the health care system, so any attempt to deny them care on that basis is wrong.
4. Until all people have equal access to education, money, healthy food, and the ability and time to live the most healthy life possible, we cannot fault people for ending up with less than optimal health.
5. Nobody judges skinny or rich people for eating the "wrong" foods or drinking and smoking too much, so lets just not judge people when it has almost no impact on our own lives.


Barbaebigode

  • Stubble
  • **
  • Posts: 145
Re: Universal Health Care Practicalities
« Reply #34 on: January 31, 2019, 09:25:36 AM »
Declaring that a healthcare system has failed and should be shut down sounds like something possible only in a society that does not view healthcare as a human right. I am guessing that in places with public HC, obesity, hypochondria and addictions (to cite your examples) tend to be considered more like diseases to be treated than bad personal choices.

I consider whatever system we put in place an experiment. As such we should have metrics to compare to see if it doing better or worse.

I would have preferred to have each state to its own system so we would have a set of data to compare and contrast. But we will go national and see what happens.

It has nothing to do with it being a human right. If a system is not living up to its promises then it should be abandoned.

Well, I made assumptions. I meant the human right thing in the context of the US, where leaving a large part of the population without access to healthcare seems to be a realistic alternative to a system "not living up to its promises".

TrMama

  • Magnum Stache
  • ******
  • Posts: 2718
Re: Universal Health Care Practicalities
« Reply #35 on: January 31, 2019, 11:05:43 AM »

But: our system is built on an acceptance of a strong state, that tells us what is best for us.

Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.

The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.

I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.

Kris

  • Magnum Stache
  • ******
  • Posts: 3614
Re: Universal Health Care Practicalities
« Reply #36 on: January 31, 2019, 11:20:56 AM »

But: our system is built on an acceptance of a strong state, that tells us what is best for us.

Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.

The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.

I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.

I agree. There's a fundamentally barbaric mindset in this country that is prevalent enough to make me sick to my stomach pretty often.

RetiredAt63

  • Senior Mustachian
  • ********
  • Posts: 10063
  • Location: Eastern Ontario, Canada
Re: Universal Health Care Practicalities
« Reply #37 on: January 31, 2019, 11:49:56 AM »
Here is an interesting article on health care costs in Canada.  Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal.  The Feds basically coordinate and subsidize.

https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends


Hula Hoop

  • Pencil Stache
  • ****
  • Posts: 826
  • Location: Italy
Re: Universal Health Care Practicalities
« Reply #38 on: January 31, 2019, 12:06:34 PM »
In my region of Italy, they recently brought in a system in the ER where if you go there for something which is not an emergency you have to pay a (small) fee.  I think that's fair. 

Plenty of people here eat junk, use drugs, don't comply with doctor's orders etc and they are treated just the same by hospitals and doctors.  I don't think there is any other moral way of doing it and universal healthcare doesn't effect this morality.

PoutineLover

  • Handlebar Stache
  • *****
  • Posts: 1047
Re: Universal Health Care Practicalities
« Reply #39 on: January 31, 2019, 12:16:45 PM »
Here is an interesting article on health care costs in Canada.  Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal.  The Feds basically coordinate and subsidize.

https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
That's actually super interesting. Clicking through, it looks like the US actually has a higher share of public spending (82%) than canada (70%). I didn't expect that.

RetiredAt63

  • Senior Mustachian
  • ********
  • Posts: 10063
  • Location: Eastern Ontario, Canada
Re: Universal Health Care Practicalities
« Reply #40 on: January 31, 2019, 01:20:17 PM »
Here is an interesting article on health care costs in Canada.  Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal.  The Feds basically coordinate and subsidize.

https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
That's actually super interesting. Clicking through, it looks like the US actually has a higher share of public spending (82%) than canada (70%). I didn't expect that.

From what I understand (could easily be off), the cost savings by provinces buying in bulk for hospitals, and the savings in paperwork because OHIP (or other provincial equivalents) paperwork is much less time-consuming than dealing with insurance companies at both the hospital and doctor's clinic (and therefore less staff time used) both add up to a lot of savings.  I would guess good vaccination programs help too, although not everyone uses them - I know seniors who have not had their flu shots this year, for example, and they are free. 

PoutineLover

  • Handlebar Stache
  • *****
  • Posts: 1047
Re: Universal Health Care Practicalities
« Reply #41 on: January 31, 2019, 01:28:03 PM »
Here is an interesting article on health care costs in Canada.  Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal.  The Feds basically coordinate and subsidize.

https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
That's actually super interesting. Clicking through, it looks like the US actually has a higher share of public spending (82%) than canada (70%). I didn't expect that.

From what I understand (could easily be off), the cost savings by provinces buying in bulk for hospitals, and the savings in paperwork because OHIP (or other provincial equivalents) paperwork is much less time-consuming than dealing with insurance companies at both the hospital and doctor's clinic (and therefore less staff time used) both add up to a lot of savings.  I would guess good vaccination programs help too, although not everyone uses them - I know seniors who have not had their flu shots this year, for example, and they are free.
That makes a lot of sense. It would be funny if it weren't so sad that many Americans have been convinced that socialized medicine will bankrupt their country, and at the same time they spend more money, both public and private, for worse outcomes. The savings of "medicare for all" or whatever form takes would far outweigh the cost of any hypochondriacs, obese people or drug addicts who might abuse the system.
Not to mention, those people are still using the private medical system, which still increases premiums for everyone, so either way, those costs are baked into the system.

gaja

  • Handlebar Stache
  • *****
  • Posts: 1142
Re: Universal Health Care Practicalities
« Reply #42 on: January 31, 2019, 02:31:07 PM »

But: our system is built on an acceptance of a strong state, that tells us what is best for us.

Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.

The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.

I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.

I think you make us sound too nice. A major motivation for a lot of politicians and economists in Norway is that healthy people pay more taxes than sick people. We have detailed calculations showing how much the state will get in increased revenues for each additional person we can get to finish school, stay healthy, and be employed. These calculations include reduction in teenage pregnancies, less crime, etc.

jim555

  • Handlebar Stache
  • *****
  • Posts: 1922
Re: Universal Health Care Practicalities
« Reply #43 on: January 31, 2019, 03:53:10 PM »
The problem is both parties need to be on board and that is not going to happen.  Republicans would sabotage any universal system at the first opportunity.  They would purposefully under fund it and then say look it doesn't work.

RetiredAt63

  • Senior Mustachian
  • ********
  • Posts: 10063
  • Location: Eastern Ontario, Canada
Re: Universal Health Care Practicalities
« Reply #44 on: January 31, 2019, 04:48:38 PM »

I think you make us sound too nice. A major motivation for a lot of politicians and economists in Norway is that healthy people pay more taxes than sick people. We have detailed calculations showing how much the state will get in increased revenues for each additional person we can get to finish school, stay healthy, and be employed. These calculations include reduction in teenage pregnancies, less crime, etc.

I don't know if anyone has done the calculations for Canada, but it makes sense - if people are healthy they are more productive.  And happy.  And the government is carrying out its mandate of peace, order and good government (well, that's the federal mandate, not sure what the provincial mandate is in the BNA Act, except to look after everything not specifically allocated to the federal government, which therefore includes health care).

scottish

  • Handlebar Stache
  • *****
  • Posts: 1258
  • Location: Ottawa
Re: Universal Health Care Practicalities
« Reply #45 on: January 31, 2019, 05:16:27 PM »

But: our system is built on an acceptance of a strong state, that tells us what is best for us.

Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.

The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.

I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.

I think you make us sound too nice. A major motivation for a lot of politicians and economists in Norway is that healthy people pay more taxes than sick people. We have detailed calculations showing how much the state will get in increased revenues for each additional person we can get to finish school, stay healthy, and be employed. These calculations include reduction in teenage pregnancies, less crime, etc.

It's not just taxes.   Healthy people are also contributing to the economy much more effectively than sick people.   Everybody wins.

Boll weevil

  • 5 O'Clock Shadow
  • *
  • Posts: 29
Re: Universal Health Care Practicalities
« Reply #46 on: January 31, 2019, 10:41:34 PM »

Yes. I wanted to get beyond the "universal health Care is bad" debate. I wanted to know how the system would actually run.


To be a bit glib, it depends on how the system is set up.

I think the fear is health care becomes "free" and then too many people try to take too much out of the system and it leads to long lines and a lot of taxes. And that's definitely a possibility.

But it doesn't have to be that way. For instance, in Japan the government sets the prices at hospitals, but then people are expected to pay 30% of that out of pocket, which acts as a rationing mechanism. I don't think the US medical establishment would allow the government that much control over pricing, but the concept could still be employed. One possibility I've come up with is for the government to establish a "should cost" value of a procedure (which it already has done for Medicare) and then the government covers a percentage of that price, but the health care providers are able to charge whatever they want, with the patient responsible for the difference. And there's a lot of ways to tinker with it from there... do you set one price for the entire country or do you set up regional prices to account for the cost of living? Is it a flat percentage, or do people pay a larger percentage for common procedures like going to the family physician when you've sprained a wrist and a smaller percentage for more serious (and probably more expensive) issues like cancer?

The big problem with that concept is that this maintains the pay-for-service system which is really one of the roots of the health care expense problem. There's some thought that the entire system has to change so that it is focused on wellness/overall health. Because right now the providers increase profits by performing more procedures and charging as much as they can for them, while the insurance companies increase profits by increasing premiums and minimizing the number and cost of procedures. But what if you merge a hospital with an insurance company, as is already starting to happen? Now the hospital has a an incentive to perform fewer procedures and be more honest about the pricing since they are essentially charging themselves.

But if we go to a system focused on wellness that's funded mostly by annual premiums rather than fee-for-service, does the money to pay the premium come entirely from the government, or does the government just provide a portion of the premium and the customer/patient is still expected to pay at least some for various reasons (i.e. tailoring coverage and instilling competition)?

Are you allowed to pay more to get a procedure done at your convenience, or will you be forced to essentially get in line and the you'll be seen whenever they get around to you?

Will medical tourism be encouraged or even allowed?

How I think the system should be set up is different from how other people think the system should be set up, and it's going to come down to who is able to implement their plan.

FINate

  • Handlebar Stache
  • *****
  • Posts: 1214
Re: Universal Health Care Practicalities
« Reply #47 on: January 31, 2019, 11:00:27 PM »
My only request as a tall person: If we're going to have some type of "fat tax" can we please fix the BMI calculation such that it stops insisting we're two-dimensional beings? Seriously, my three-dimensional self would have to be unhealthily thin to be within current BMI guidelines.

Boll weevil

  • 5 O'Clock Shadow
  • *
  • Posts: 29
Re: Universal Health Care Practicalities
« Reply #48 on: January 31, 2019, 11:03:41 PM »

If you're asking for the actual mechanism of making decisions on who receives treatment, and the level of treatment they receive, then 'panels' are the correct answer. Somewhere, probably at multiple levels - federal, state, center - groups would get together and make standards. People do tend to get histrionic over the idea, but such decision making groups already exist. Transplant boards, premie care teams, oncologists; they're already holding such decision making panels.



Another existing decision-making group is the insurance companies. Among other things, they decide whether certain procedures are covered, declare providers as in-network or out-of-network, and determine how many alternative solutions you must try before getting back surgery or expensive medication.

Abe

  • Handlebar Stache
  • *****
  • Posts: 1177
Re: Universal Health Care Practicalities
« Reply #49 on: February 01, 2019, 12:02:06 AM »
Many countries with government-managed healthcare systems have criteria used to justify medications and procedures based on value per quality-adjusted life-year (QALY). Essentially it looks at how many extra years of non-dependent life a procedure or drug provides. For example, if a chemotherapy agent provides a overall survival benefit of 12 months, but half the patients in the trial had a poor quality of life (unable to perform any tasks independently), then the QALY would be 0.5. This is obviously a simplification of the calculations.

The main point is that many countries have used this method to say to drug companies "we will approve this drug for this disease if you provide it at this price." That has been effective at managing costs. The US does this in an ad-hoc way (insurance denials mostly). This is the major reason our costs are going nuts:
US health spending went from 5% to 18% of GDP from 1960 to 2010, compared to 4% to 8% for UK and 5% to 10% for Germany. I would say for the vast majority of illnesses, outcomes in the latter two are on par with the US.

Other interesting facts, comparing US and UK systems:
the UK spends a larger fraction of total budget on mental health (14 vs 9%)
US spends more on heart disease, hypertension, diabetes (22 vs 14%)
US spends twice as much on orthopedic issues (9 vs 4.5%)
Cancer spending is the same (5.5 vs 5.5%) - I was surprised by this.
Everything else was fairly similar (1-2% difference).

Interestingly, none of these countries' systems particularly reward people for healthy behavior, and this shows in the majority determinants of health: weight, smoking, diabetes and cancer.

- Obesity rates are higher in the US (34%) than UK (28%) and Germany (24%), but not dramatically.
- The US has lower smoking rates (14%) than UK (20%) and Germany (24%)
- Diabetes rates are similar: 10%, 6% and 8%
- Cancer rates are much higher in UK (608 per 100k annually) than US (440) and Germany (313)

So overall the US population isn't that much more unhealthy than in Europe, we just suck at controlling costs. The solutions are cultural changes that are hard to implement, so no good solutions on my end (other than the cost effectiveness evaluation).