Who should pay the healthcare costs of the uninsured?

[ShawnD]

Suggestions/alternatives? If you are proposing government care, we have examples of that in the form of Medicaid/Medicare already. If one finds shortcomings in those two systems its plausible to suggest a universal government plan would contain more or the same.

I remember someone saying that doctors don't always get paid by Medicare on time so they'll end up treating an old person and expect to get paid... but the money just doesn't show up or it arrives extremely late. Does anyone know if this is true? It would certainly explain wait times caused by doctors refusing to treat uninsured old people because they know they won't get paid for it.

 

[mheslep]

Universal coverage- just what is sounds like, everyone has health coverage.

Well exactly who is everyone? Does that cover illegal aliens or just Japanese citizens? They NYU article on Japan you reference does not address that ( probably not much of a problem there).

Could be a combo of private+government,

Well that could equally well describe the US system: private+Medicaid+Medicare+veterans care, etc.

 

[mheslep]

My father had colo-rectal cancer, and with surgery and subsequent chemotherapy and radiation, the bill was well over $100K. Compare that to $300-$1000 per check up - every 5 to 10 years, and there's a bargain.

Would those checkups do anything prevent the cancer and associate chemo costs, or just provide an earlier notice and a better chance of survival?

 

[Evo]

Just wait till one is older. My mother-in-law often has to wait weeks or months for medical care. She gets put in a queue.

That's because there are fewer doctors that deal with medicaire and medicaid, dealing with the government is a nightmare. I'm well aware of this with my own mother. Private care is immediate and better quality, but it's not free.

This is likely the reason that an increasing number of people in countries that have socialized medicine that can afford private medical care and insurance opt for it rather than being restricted to using the socialized care available to them.

 

[baywax]

It seems natural that a society that ensures the right for every individual's education (up to a certain age) could justify and legalize the practice of universal health care and education. But, if the result is major disparity between economic districts and a respectively determined quality of (education, health care) then the model is flawed and inefficient.

 

[Evo]

So how does an uninsured person in the US get treatment for lung cancer without having to sell their house?

That's obviously ridiculous. So, unless someone has a house to sell, they can't get cancer treatment? What if they have a house, but there is no profit to be made? What if they don't own a house?

Also,it is not all computerized now. I forget where I read it (either in Nature, Science, NEJM, or JAMA), but something only like 10% of all medical records are actually in computers.

You would be hard pressed to find a medical office or hospital that isn't computerized in the US. We're not talking about historical medical records.

 

[mheslep]

... my mother has had more surgeries than anyone can afford. Under the US system she would have died when I was around 3 years old;

How can you possibly know that?

she had a significant portion of her intestines removed and a bag was put in place of it. It was just last year that he spent about 2 weeks in hospital and had another surgery for that same problem. Total cost out of pocket: $0

Of course its not zero. First, as you and Baywax posted above the Ca tax rates are very high, second I read that in addition everyone in Ca must pay an annual health care premium; in http://en.wikipedia.org/wiki/Medicare_(Canada)#User_premiums". The hit on the US system is not that it could be 'free' if the US switched to socialized med, its that its very inefficient taken as a whole, as is well documented by Turbo-1 and others above. US spends more per capita than anyone in the world.

 

[ShawnD]

How can you possibly know that?

Did you ever see that episode of the simpsons where Homer needs a quadruple bypass but can't afford it, so they're talking about what it will be like when he dies? That's exactly what would happen. When you don't pay for colon surgery, you die.

 

[gravenewworld]

That's obviously ridiculous. So, unless someone has a house to sell, they can't get cancer treatment? What if they have a house, but there is no profit to be made? What if they don't own a house?

You would be hard pressed to find a medical office or hospital that isn't computerized in the US. We're not talking about historical medical records.

Exactly, it is ridiculous. If you are uninsured and need treatment here in the US, you don't get it unless you have the cash to pay for it. If you are uninsured you don't get screened for cancer, you don't get your cholesterol and blood pressure checked, and you don't get your medication. You [being uninsured] only get treatment when it is too late and you have to take a trip to the ER. Then after you get out of the ER you have to pay all of the 1000s of dollars in bills yourself.



Also who said anything about just historical medical records? Hardpressed to find a hospital that doesn't use electronic records? ARE YOU SURE ABOUT THIS CLAIM?

Groups Push Physicians and Patients to Embrace Electronic Health Records
Tracy Hampton, PhD


JAMA. 2008;299(5):507-509.


Experts agree that electronic health records can save lives and money by reducing the costs and harms associated with medical errors and by cutting down on redundant tests and procedures. But a number of unresolved issues, including affordability and privacy concerns, have made hospitals, physicians, and patients slow to adopt them.

Although those hurdles remain, government and nonprofit organizations, as well as technology giants such as Microsoft and Google, are attempting to drive the technology forward. What is envisioned is an easily accessible electronic system that, by coordinating the storage and retrieval of individuals' health records, increases efficiency, reduces costs, and promotes standardization of care.

Numerous vendors have been marketing patient health records that are managed and controlled by each patient, but only a minority of consumers are buying into them. Although most individuals have yet to be sold on the idea of a personal medical diary, experts say that new technologies and an expanded scope of their benefits may change their minds.

"Millions of people are going every day to the Internet to look for medical information. We are in a time where patients are being empowered, and they're looking for convenience," said C. Peter Waegemann, CEO and executive director of Medical Records Institute Incorporated, a Boston-based company that promotes adoption of health information technology.

One of the most recent and ambitious projects that strives to tap into this perceived patient empowerment is Microsoft's HealthVault, a free software and services platform aimed at helping people better manage and monitor their personal health information (http://www.healthvault.com). "People . . . must navigate a complex web of disconnected interactions between providers, hospitals, insurance companies and even government agencies," said Peter Neupert, corporate vice president of the Health Solutions Group at Microsoft. HealthVault allows individuals to collect their health information from many sources, store it in one place, and share it with whomever they choose. They also can connect a wide variety of devices to a computer and upload the data to their individual HealthVault accounts.

Google plans to follow suit, although details are not yet available. Similarly, Intuit Incorporated, a provider of business and financial management solutions, is expected to come onto the scene and offer a system of its own. Other types of vendors also are striving to boost patient interest. Wal-Mart and Intel are leading a large employer coalition to develop a model called Dossia, and America's Health Insurance Plans and the Blue Cross and Blue Shield Association have worked together to develop a personal health record model that enables patients to transfer data when they change health insurers (http://www.chcf.org/documents/chronicdisease/PHRPerspectives.pdf).

Waegemann envisions a time when a personal health record site might include not only a patient's prescription data, but also a list of nearby pharmacies with information such as details on drug prices and hours of operation. "Or it might suggest that before you have your scheduled surgery, there's an alternative way through rehab," he noted. Some physicians will not be happy about these qualities, he conceded.

Efforts are being made to regulate and monitor such personal health record systems as they evolve. According to the National Committee on Vital and Health Statistics (the statutory public advisory body on health information policy to the Secretary of the Department of Health and Human Services), personal health records that are available today are heterogeneous, which makes collaboration and policy making difficult. The committee has published recommendations for realizing the full potential of personal health record systems to improve health and health care: vendors should clarify the respective rights, obligations, and potential liabilities of patients, clinicians, and other stakeholders; consumers should have the right to make an informed choice concerning the uses of their personal information; security should be ensured; and information should be exchanged with electronic medical records, which are documentations of care provided by clinicians to patients and are maintained by hospitals or health care practices (http://www.ncvhs.hhs.gov/0602nhiirpt.pdf ).

This last recommendation is particularly important, said Waegemann. Personal health records will be valuable only if accurate medical information is provided by physicians and other clinicians through electronic medical records generated at the point of care. "Microsoft and Google are trying to create partners in the electronic medical record world who can directly download information into a patient's personal health record," said Waegemann.


PHYSICIAN ADOPTION

But only a minority of practices and clinics currently use electronic medical records. A study of surveys on electronic health record adoption published last year found that approximately 24% of physicians used electronic health records and only 5% of hospitals used computerized physician order entry (Jha AK et al. Health Aff (Millwood). 2006;25[6]:w496-w507).
"There's a wide range, though," said Waegemann. "In Massachusetts, there are between 70% and 80% [of physicians who use electronic medical records], but in Mississippi, there are only single digits." He added that there also are differences among specialties.

The lack of widespread use of electronic health records can be attributed to a number of factors, from finances and logistics to privacy concerns and lack of interest. A 2007 poll of more than 800 health care professionals conducted by the Medical Records Institute found that the most commonly cited barriers to implementation of electronic medical records systems include a lack of adequate funding or resources, anticipated difficulties in changing to an electronic medical records system, difficulty in creating a bridge from paper to electronic documentation and record keeping, and an inability to find a system at an affordable cost (http://www.medrecinst.com/MRI/emrsurvey.html ).

In an attempt to encourage more use of electronic medical records, the Centers for Medicare & Medicaid Services (CMS) has announced a pilot program that will give higher Medicare payments to physicians who adopt them (http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1204776 ). The agency will begin recruitment in the spring and would like 1200 physician practices to participate. The program is part of President Bush's technology agenda, which seeks to have electronic health records for most US individuals by 2014 (http://www.whitehouse.gov/infocus/technology/ ).

In the first year of the CMS program, physician practices will receive extra payment for using an approved electronic medical record to manage patient care. Within the program, practices that perform better than others on designated clinical quality measures will receive larger bonuses.

However, critics say that many physicians in small- and medium-size practices cannot afford to establish and maintain electronic records. Physician organizations would like Congress to consider offering financial help, such as grants, loans, and tax credits for physicians who purchase the necessary technology.

The CMS anticipates that most physicians would improve the quality of care and save money over time by using electronic medical records. One cost-benefit study of ambulatory primary care settings found that the estimated net benefit from using an electronic medical record for a 5-year period was $86 400 per clinician (Wang SJ et al. Am J Med. 2003;114[5]:397-403).


PRIVACY ISSUES

One of the greatest concerns over adoption of either electronic medical records or patient health records is ensuring adequate confidentiality. In a 2006 telephone survey of 1003 US individuals by the Markle Foundation, a New York City–based organization that promotes information and communication technologies, 80% of individuals said they were very concerned about identify theft or fraud and 77% were worried about the possibility of their information getting into the hands of marketers (http://www.markle.org/downloadable_assets/research_doc_120706.pdf).

The Coalition for Patient Privacy—a bipartisan group of state and national consumer organizations—wants the federal government to pass privacy laws that will place patients in control of how their electronic records can be used and shared (http://www.patientprivacyrights.org/coalition ).

"Congress should restore every American's right to control access to their sensitive health and genetic records," said Deborah Peel, MD, founder of Patient Privacy Rights, a national consumer health privacy watchdog organization based in Austin, Tex, and a member of the Coalition. She noted that after signing their Health Insurance Portability and Accountability Act (HIPAA) forms, most US individuals believe their health information will not be disclosed without their permission. According to her organization, the HIPAA rule authorizes more than 4 million entities—such as insurers, health care clearinghouses, and clinical professionals—to use and disclose an individual's health information without his or her consent.

Microsoft has joined the Coalition for Patient Privacy in calling for legislation to include basic privacy protections for electronic health records. "Such protections are needed to ensure the creation of a health IT ecosystem that consumers can trust," said Frank Torres, Microsoft's director of consumer affairs.

Peel said the privacy protections built into Microsoft's HealthVault reflect the privacy principles of the Coalition for Patient Privacy. "They have set a new and high bar for the entire health IT industry—they're specifically stating up front that they're going to meet 17 principles for privacy from the Coalition for Patient Privacy," she said. Those include patient control of all access, no secret databases, and no data mining. Microsoft has stated that it will log every time records are created, changed, or read, leaving a clear audit trail.

While adoption of electronic medical records and personal health records are considered the way of the future, "the majority of them actually violate long-standing laws that information should not be released without consent," said Peel. She noted that most vendors of hospital-wide electronic medical record systems reserve the right to data mine and own patients' health information.

"We want health IT—it's going to do great things. But it's going to destroy people’s futures, including jobs and credit, if we don't build in privacy," said Peel.

So where are all these uses of electronic medical records that you speak of? Do you only have anecdotal evidence? Where are your facts to support your claim that most of medicine "is computerized now"?

 

[mheslep]

..., the US certainly isn't a free market health care system, but that is only because it has evolved into an oligopolist run market due to the free market approach. The oligopolist system that we have is due to the inherent nature of the market.

No, as I explained above the current system (3rd party payer) is based on government policy (employer based tax break) that has been in place since WWII, which in turn stemmed from a government wage and price control policy.

Huge barriers to entry in providing health care will always limit free market activity.

Its not about the insurance companies. The only 'barrier' to the individual dealing directly with health providers is put in place by the government.

 

[mheslep]

Also who said anything about just historical medical records?

The 'Electronic Health Records' to which the article refers are historical medical records. Please no flood posts, a link and a paragraph or two will do.

 

[Evo]

Exactly, it is ridiculous. If you are uninsured and need treatment here in the US, you don't get it unless you have the cash to pay for it. If you are uninsured you don't get screened for cancer, you don't get your cholesterol and blood pressure checked, and you don't get your medication. You [being uninsured] only get treatment when it is too late and you have to take a trip to the ER. Then after you get out of the ER you have to pay all of the 1000s of dollars in bills yourself.

Hospitals that aren't already charity hospitals work with charities and government agencies to help uninsured patients cover some or all of their medical expenses. You don't know what you are talking about.

So where are all these uses of electronic medical records that you speak of? Do you only have anecdotal evidence? Where are your facts to support your claim that most of medicine "is computerized now"?

Again, pay attention, we're not talking about medical records, we're talking about billing.

 

[baywax]

Did Americans get a govt. sponsored program called "Participaction"? The whole thing was injected into the curriculum of elementary schools across Canada. And an aggressive media ad campaign supported the effort. It was simply about kids and adults getting active with the science info backing the health benefits of staying physically fit.

Nutrition, cell physiology and human physiology are taught in elementary schools here now. Kids are able to one-up me about some of the function of organelles, absorption rates of certain foods and tons of stuff I didn't learn until grade 10 biology. A ten year old knows how to break a fever, the ideal body temperature and quell a cough without cough medicine without going to a doctor or even calling a medical help-line. This is what I would call the development of a self-reliant population. You may think that having money is a sign of self-reliance when it comes to medical issues... but, think again.

 

[mheslep]

It seems natural that a society that ensures the right for every individual's education (up to a certain age) could justify and legalize the practice of universal health care and education.

I suppose the idea of considering education or health care as a 'right' is seductive but regardless its a misuse of the concept. A right may not be denied, as in freedom of speech/assembly, and since education and health care by their nature are provided to you by someone else, the label of 'right' inevitably grants you the ability to force someone to provide the service which brings you into conflict with their 'rights'. People may well choose to underwrite these systems via charity or governmental means, but its illogical to consider them rights. Also, regarding providers, there's no reason government should be in the business of producing education. Government might subsidize it, or regulate it, but should not produce it anymore than it should produce cars. I hope government involved health care does not go the way government has in education.

 

[mheslep]

I see several sources saying the US has higher incidence of medical errors than most countries, but I don't see any clear reason why this is so. I see some suggestions about patients moving about from doctor to doctor, but I assume that must happen in many countries. I only see this somewhat wonkish list http://www.nchc.org/facts/quality.shtml" but again seems like good advice to any system:

* Redesigning care processes based on best practices;
* Using evidence-based medicine to improve clinical practice;
* Using information technologies to improve access to clinical information and support clinical decision making;
* Coordinating care across patient conditions, services, and settings over time, and
* Incorporating performance and outcome measurements for improvement and accountability.

 

[baywax]

I suppose the idea of considering education or health care as a 'right' is seductive but regardless its a misuse of the concept. A right may not be denied, as in freedom of speech/assembly, and since education and health care by their nature are provided to you by someone else, the label of 'right' inevitably grants you the ability to force someone to provide the service which brings you into conflict with their 'rights'. People may well choose to underwrite these systems via charity or governmental means, but its illogical to consider them rights. Also, regarding providers, there's no reason government should be in the business of producing education. Government might subsidize it, or regulate it, but should not produce it anymore than it should produce cars. I hope government involved health care does not go the way government has in education.

Good points... however you're missing the key ingredients to rights... that is the "facilitation of human rights" and that is what a government is bound by law to do... facilitate the right to free speech, and facilitate the right to assembly. This is why you see police separating certain factions at assemblies... they are (apparently) facilitating the right to assemble in a peaceful fashion. This is why you see federal libraries with access available to everyone to freely read and write. Are you telling me that the right to freedom of speech is impinging upon a librarians right to unemployment... no... actually, what are you telling me?

We do not infringe on the rights of doctors, nurses etc... by employing them to provide health care to the population. We facilitate the rights of humans to receive adequate and quality heath care. This involves employing and paying 150 grand a year to doctors or a fee schedule that matches their patient load.

There are no laws that prohibit a doctor's right to practice privately, elsewhere, perhaps in a country where human health issues are a gold mine for the private and commercial interests of incorporated clinics.

The cowardly Hyenas always go for the weak and injured in the population.

 

[gravenewworld]

No, as I explained above the current system (3rd party payer) is based on government policy (employer based tax break) that has been in place since WWII, which in turn stemmed from a government wage and price control policy.

Its not about the insurance companies. The only 'barrier' to the individual dealing directly with health providers is put in place by the government.

Monopoly and oligopolist markets arise due to natural barriers to entry like huge start up costs etc. This is exactly what has happened in the US, natural barries to entry into supplying health insurance have created a system where only a few companies control almost all the health care for the majority of the population (like the finding by the GAO found).
Find me an example of a 100% free market of something in the US, you won't find it, everything has some form of government policy regulating it. Even with government regulated health care in the US, the health insurance industry is still aimed at maximizing profit$ first, patient care second.

The free market is OVERRATED. It shouldn't be used as the best approach for everything. You don't see people clamoring for a free market based approach to something like national defense.

The 'Electronic Health Records' to which the article refers are historical medical records. Please no flood posts, a link and a paragraph or two will do.

YES SIR, MR. BOARD MODERATOR SIR!

Hospitals that aren't already charity hospitals work with charities and government agencies to help uninsured patients cover some or all of their medical expenses. You don't know what you are talking about.

You don't know what you are talking about. Charities and government agencies don't cover the costs for entire procedures many times. Did you even read the NY times article? Where were these so called government agencies and charities that would pay off all of the debts of those patients mentioned in the article? Medical care isn't free. If you read the FTC link also, you would have read that medical debt is debt you are obligated to pay, just like credit card debt. Apparently you seem to think that large amounts of medical debt doesn't exist for people since it could always be paid off by the government or through a charitable organization. I think that you, me, and everyone else knows that is absurd.

So apparently you know more about medical debt than this Harvard study

http://www.hms.harvard.edu/news/releases/2_2Himmelstein.html

Illness and Medical Bills Cause Half of All Bankruptcies
2 Million Americans Financially Ruined Each Year
Harvard Study Finds 2200% Increase Since 1981
Most of Those Bankrupted by Illness Were Middle Class and Had Insurance

So where are all those "government agencies and charity organizations" if that many people filing for bankruptcy have medical debt?

Again, pay attention, we're not talking about medical records, we're talking about billing.

Really, so how am I supposed to deduce that you are talking aout billing exlusively when you posted this?

It's all computerized now. When my doctor needs to prescribe something, what my plan pays for pops up and he asks me which option I want.

Your doctor would have to have a record of any medications that you may be allergic to or possible other medications you may be on to avoid drug drug interactions before asking and prescribing which drug choice you would want that your company would pay for.

When you say It's all computerized now, I assume that your doctor was able to pull up your medication history electronically before asking which medication you want.


So, if the US health care is so great, then why do only 5% of hospitals use electronic medical records? Electronic records save lives, time, and money.

 

[ShawnD]

Graven raises an interesting point about bankruptcy. I did a google search to compare bankruptcy rates in Canada so I could compare with the US, and it looks like somebody thought of this before me and already made a website about it

http://www.bankruptcycanada.com/blog/canadian-and-us-bankruptcy-rates/

The US bankruptcy rate (6.9 per thousand) for the year 2004 is more than twice as high as the Canadian bankruptcy rate (2.6 per thousand). The main reason for the huge disparity in bankruptcy rates in Canada and the US is because of the different health care systems in the two countries.

 

[Evo]

You don't know what you are talking about. Charities and government agencies don't cover the costs for entire procedures many times. Did you even read the NY times article? Where were these so called government agencies and charities that would pay off all of the debts of those patients mentioned in the article? Medical care isn't free. If you read the FTC link also, you would have read that medical debt is debt you are obligated to pay, just like credit card debt. Apparently you seem to think that large amounts of medical debt doesn't exist for people since it could always be paid off by the government or through a charitable organization. I think that you, me, and everyone else knows that is absurd.

I am basing this on first hand knowledge.

So apparently you know more about medical debt than this Harvard study

Apparently.

You have said that if you aren't insured you can't get medical treatment without going bankrupt, that is really not true. No one is saying that medical expenses can't become overwhelming, but it is not the scenario you are painting that without insurance there is no help. Here is an example of what I am talking about

Healthcare for all New Yorkers
Paying for your healthcare

Financial concerns should not keep New Yorkers from seeking the healthcare their families need. At HHC we are committed to helping our patients find financial assistance, whether through a low or no cost insurance program or through a reduced fee arrangement.

HHC offers its patients the opportunity to examine a variety of payment options. Click below to learn more:

HHC Options - HHC's own financial assistance and charity care program
MetroPlus - An HHC subsidiary which offers health plans under Medicaid, Child Health Plus, Family Health Plus and MetroPlus Gold
HHC hospitals accept a variety of other health insurance plans.

http://www.nyc.gov/html/hhc/html/access/paying.shtml

So where are all those "government agencies and charity organizations" if that many people filing for bankruptcy have medical debt?

See above. As I mentioned previously, if the medical expenses aren't emergency, you would have agreed to the expense, so a creditor would have a better chance of collecting. What percentage of the medical debts were for emergency medical treatment that the patient hadn't previously agreed to? Also, many people aren't aware of the help available to them, although it's unusual for a hospital nowdays to not offer assistance in finding ways of being paid. Bankruptcy is an all too easy way of getting out of paying off debts, but courts are starting to crack down and make it harder to file for bankruptcy. Just because people aren't aware of the help available to pay for medical expenses doesn't mean they aren't there.

Really, so how am I supposed to deduce that you are talking aout billing exlusively when you posted this?

Because it was in response to

Doctors spend a LOT of time and money deciding which insurance plans to participate with, and their staff have to learn the ins and out of each plan, including which procedure codes are acceptable and covered under each plan and which are not.

When you say It's all computerized now, I assume that your doctor was able to pull up your medication history electronically before asking which medication you want.

Each time I go to the doctor the nurse asks me what drugs I am allergic to and verifies which drugs I am currently taking, she inputs this into the computer in the examining room.

So, if the US health care is so great, then why do only 5% of hospitals use electronic medical records? Electronic records save lives, time, and money.

Again, we're not discussing medical "records". You are the one that is bringing up medical records. I brought up the fact that billing is computerized, that includes knowing which drugs my insurance covers best. As of 3 years ago 3/4ths of US physicians had computerized billing, that number is probably closer to 100% now. I can't imagine a hospital that doesn't have computerized billing.

The use of electronic records in health care lags far behind the computerization of information in other sectors of the economy. In health care, billing applications were the first to be computerized. Electronic billing systems are used in three-quarters of physician office practices, but computerization of clinical records has been much slower.

http://www.cdc.gov/NCHS/pressroom/05news/medicalrecords.htm

 

[TVP45]

Moonbear pointed out the problem that, I think, most are missing. Hospitals really do bill things like $10 kleenex boxes and major insurance companies pay rates like $1.25 and the hospital accepts that. The uninsured person is stuck with the whole $10. And this is done on most things. Some physicians are fighting back by setting prices at the standard insurance reimbursement rate, but that is still few and far between.

 

[Evo]

Moonbear pointed out the problem that, I think, most are missing. Hospitals really do bill things like $10 kleenex boxes and major insurance companies pay rates like $1.25 and the hospital accepts that. The uninsured person is stuck with the whole $10. And this is done on most things. Some physicians are fighting back by setting prices at the standard insurance reimbursement rate, but that is still few and far between.

Yes, but like in the link to the hospital I posted, they will make "reduced fee" arrangements. Of course they are going to ask full price first, they are a business, but you can negotiate them down. In the case of the un-insured 19 year old I mentioned, when he checked out, they had a pre-prepared "package" of forms to file to get his expenses paid and they helped him fill them out. They want money, they don't care who they get it from, and they know they aren't going to be successful going after an unemployed 19 year old, so it behooves them to assist the patient in seeking financial help.

 

[mheslep]

Good points... however you're missing the key ingredients to rights... that is the "facilitation of human rights" and that is what a government is bound by law to do... facilitate the right to free speech, and facilitate the right to assembly.

Whoa, I think you are far over inflating the facilitate balloon here. There is only one function for which government was originally granted a reason to exist by the US framers: to insure life/liberty/property, in pursuit of which the federal government is tasked to provide for the common defense and the states are to provide a police function and thereby protect life and limb. All the other rights enumerated in the US ten amendments are there specifically to stop government (federal or state) from infringing them and not in any way to task government with facilitating them. I don't care to have the government facilitate any of those 10 amendments, it merely needs to take heed that it does not infringe itself.

This is why you see police separating certain factions at assemblies... they are (apparently) facilitating the right to assemble in a peaceful fashion.

Good point, but the peaceful part is the only job the government has there - state/local protection of life/liberty. The cops shouldn't be doing anything else providing protection.

Are you telling me that the right to freedom of speech is impinging upon a librarians right to unemployment... We do not infringe on the rights of doctors, nurses etc... by employing them to provide health care to the population. We facilitate the rights of humans to receive adequate and quality heath care. This involves employing and paying 150 grand a year to doctors or a fee schedule that matches their patient load.
There are no laws that prohibit a doctor's right to practice privately, elsewhere, perhaps in a country where human health issues are a gold mine for the private and commercial interests of incorporated clinics.

I'd say its very clear at least in the Ca. case that a doc's rights to freely pursue his/here interests are impinged. They're Canadian citizens. As such they should have a right to freely practice their profession in they're own country without being told by the government what they're worth. Imagining no rights are impinged since they're free to leave is tantamount to banning free speech locally and claiming no rights are violated because there is free speech elsewhere, let them go elsewhere if they want to rabble rouse. If you (wisely) allow private care in parallel with the state plan which allows those who can afford it a better deal, well then you are walking away from the original idea that health care is a right. Either it is a right meaning no one can be deprived in any way of the same care enjoyed by the next guy (ala speech, right to life/liberty), or it is not.

The cowardly Hyenas always go for the weak and injured in the population.

Absolutely, the life/liberty/property proctection argument. This is why, the only strong reason why "Governments are instituted among Men". When the government starts getting big into other things the Hyenas just buy themselves a seat the table, makes it much easier for them.

 

[baywax]

Whoa, I think you are far over inflating the facilitate balloon here. There is only one function for which government was originally granted a reason to exist by the US framers: to insure life/liberty/property, in pursuit of which the federal government is tasked to provide for the common defense and the states are to provide a police function and thereby protect life and limb. All the other rights enumerated in the US ten amendments are there specifically to stop government (federal or state) from infringing them and not in any way to task government with facilitating them. I don't care to have the government facilitate any of those 10 amendments, it merely needs to take heed that it does not infringe itself.
Good point, but the peaceful part is the only job the government has there - state/local protection of life/liberty. The cops shouldn't be doing anything else providing protection.
I'd say its very clear at least in the Ca. case that a doc's rights to freely pursue his/here interests are impinged. They're Canadian citizens. As such they should have a right to freely practice their profession in they're own country without being told by the government what they're worth. Imagining no rights are impinged since they're free to leave is tantamount to banning free speech locally and claiming no rights are violated because there is free speech elsewhere, let them go elsewhere if they want to rabble rouse. If you (wisely) allow private care in parallel with the state plan which allows those who can afford it a better deal, well then you are walking away from the original idea that health care is a right. Either it is a right meaning no one can be deprived in any way of the same care enjoyed by the next guy (ala speech, right to life/liberty), or it is not.

Absolutely, the life/liberty/property proctection argument. This is why, the only strong reason why "Governments are instituted among Men". When the government starts getting big into other things the Hyenas just buy themselves a seat the table, makes it much easier for them.

Canada doesn't allow lobbyists to sit at the table. Lester B. Pearson started the universal health care act and the student loans act back in the mid 1900s. This was based on the model that was started by Tommy Douglas who was then premier of Saskatchewan. Douglas enjoyed great success with the idea. But, as I've pointed out, it wasn't a law that governed the health of 300 million people... it was in Saskatchewan with perhaps just a few million. Then Lester Pearson introduced it to all of Canada which was still a nation of only about 22 million or so.

You'll note that the universal student loans act and the universal health care act were instituted at the same time... these acts facilitate the right to quality of life. Quality of life ensures a strong nation and its a win win situation.

Its the same principal governing both education and health. With education offered free and health offered free people's quality of life is somewhat guaranteed to be bettered by both initiatives.

It may be that the whole idea justified "income tax" to begin with. Since it really was a war measures act to collect income tax and was actually supposed to be abolished by definition, after the war (providing we won the war) perhaps being able to offer something of value to the tax payer such as free health and education helped to maintain the perception of value for the money in Canada.

I really don't have a grasp of the state and federal roles in your amazingly complex country of the United States. The American rules for football are enough to put me off! Just don't •••• with Hockey rules... ok?! But, in Canada the Feds send money to the Provincial govts to facilitate the medical act. Each province has the right to distribute the cash as they see fit... as long as everyone it their province is adequately covered for health insurance. Let's remember we have only 8 provinces and 3 territories.

Alberta probably has no premium for its citizens... no monthly bill. And they have no prov. sales tax either. That's because they've allowed Exxon, Shell, Chevron etc... and some Chinese players to dig the •••• out of their tar sands... threatening the health of their citizens with contaminated water sources... while collecting royalties from these companies. But other provinces charge a premium from their citizens because they are the "have not" provinces and need to add to the Fed. govt's health care payments.

I haven't addressed the other points in your post. There are huge issues that arise out of either system. The public funded system leaves much to be desired. The privately funded system leaves even more to be desired.

If we dug up stats on the number of people wandering the streets with mental health problems we'd probably match each other per capita. The fact that these people are left to fend for themselves is a major drain on the economy of the federal and (state), civic, provincial budgets. Police spend 50 percent of their budgets answering calls concerning the un-cared for mentally ill. This means close to 50 percent of crime is a direct result of no medical care or shelter for the mentally impaired. This also means the budget for police is being bled by the lack of funding for this condition when the police could be nice and busy facilitating the right to peaceful assembly... which is a right we don't have in Canada!

 

[TVP45]

Yes, but like in the link to the hospital I posted, they will make "reduced fee" arrangements. Of course they are going to ask full price first, they are a business, but you can negotiate them down. In the case of the un-insured 19 year old I mentioned, when he checked out, they had a pre-prepared "package" of forms to file to get his expenses paid and they helped him fill them out. They want money, they don't care who they get it from, and they know they aren't going to be successful going after an unemployed 19 year old, so it behooves them to assist the patient in seeking financial help.

I quite agree that, for an unemployed 19 yo, they will negotiate. But, for a 35 yo, earning $30k a year with $50k equity in his house, 2 cars, and a modest IRA, tain't going to happen nearly as fast. That, of course, may be a regional thing - I have little knowledge out side the Atlantic central area.

 

[TVP45]

Whoa, I think you are far over inflating the facilitate balloon here. There is only one function for which government was originally granted a reason to exist by the US framers: to insure life/liberty/property, in pursuit of which the federal government is tasked to provide for the common defense and the states are to provide a police function and thereby protect life and limb. All the other rights enumerated in the US ten amendments are there specifically to stop government (federal or state) from infringing them and not in any way to task government with facilitating them. I don't care to have the government facilitate any of those 10 amendments, it merely needs to take heed that it does not infringe itself.
Good point, but the peaceful part is the only job the government has there - state/local protection of life/liberty. The cops shouldn't be doing anything else providing protection.
I'd say its very clear at least in the Ca. case that a doc's rights to freely pursue his/here interests are impinged. They're Canadian citizens. As such they should have a right to freely practice their profession in they're own country without being told by the government what they're worth. Imagining no rights are impinged since they're free to leave is tantamount to banning free speech locally and claiming no rights are violated because there is free speech elsewhere, let them go elsewhere if they want to rabble rouse. If you (wisely) allow private care in parallel with the state plan which allows those who can afford it a better deal, well then you are walking away from the original idea that health care is a right. Either it is a right meaning no one can be deprived in any way of the same care enjoyed by the next guy (ala speech, right to life/liberty), or it is not.

Absolutely, the life/liberty/property proctection argument. This is why, the only strong reason why "Governments are instituted among Men". When the government starts getting big into other things the Hyenas just buy themselves a seat the table, makes it much easier for them.

I think you have confused Mr. Jefferson's writings with those of Mr. Madison. The original ten amendments, commonly called the Bill of Rights, did not apply to the states until after the Civil War (1866 I believe). Mr. Madison specifically tried to make them apply through the so-called "Lost Amendment", but that was removed by the convention prior to approval of the Constitution. Thus, freedom of religion, for example, did not exist in all states until the 1820s, and freedom of political speech did not exist in all states until after the Civil War.

 

[mheslep]

I think you have confused Mr. Jefferson's writings with those of Mr. Madison. The original ten amendments, commonly called the Bill of Rights, did not apply to the states until after the Civil War (1866 I believe). Mr. Madison specifically tried to make them apply through the so-called "Lost Amendment", but that was removed by the convention prior to approval of the Constitution. Thus, freedom of religion, for example, did not exist in all states until the 1820s, and freedom of political speech did not exist in all states until after the Civil War.

I meant that most of the states had their own rights protections installed in their own state constitutions. That Bill of Rights for instance, was the Virginia Bill of Rights. And yes in 1866 the 14th amendment to the US constitution enforced federal prohibitions on the states governments as well. I emphasis the word 'prohibitions' here, not facilitations. The amendments are loaded w/ phrases like 'congress shall pass no law', the government ... 'shall not', rights are reserved to the people, etc.

 

[mheslep]

I agree to leave hockey alone. However:

Canada doesn't allow lobbyists to sit at the table

They've slipped by you, the sneaky bastards, and these are only the ones who officially signed up:
http://lobbyist.oico.on.ca/Integrity/RegistrationGeneral.nsf/MainFramesWeb?OpenPage"All of the medical stake holders, docs, nurses, etc in there, along w/ big oil and gas. Google query quickly shows plenty of cases where their money is getting to the pols.

 

[baywax]

I agree to leave hockey alone. However:

They've slipped by you, the sneaky bastards, and these are only the ones who officially signed up:
http://lobbyist.oico.on.ca/Integrity/RegistrationGeneral.nsf/MainFramesWeb?OpenPage"All of the medical stake holders, docs, nurses, etc in there, along w/ big oil and gas. Google query quickly shows plenty of cases where their money is getting to the pols.

The link is to a govt of Ontario document. Ontario is a province. That province holds the nation's capital but its really just a province. I can see where you're at with this, we have medical staff on the health minister's payroll and they are the door into the govt.'s deal making and regulating. The Medical Association of Canada and the MA of each province is fairly vigilant about what policies are acceptable or not... and what treatments are good or not. We do not dodge incredible finds like Vitimine D and all its benefits just so a pharmaceutical company can sell its anti-depressants or its designer anti-growth hormones for cancer. We don't shrink from using the Hyperbolic Chambers to heal diabetics wounds rather than hiding its benefits and going with some designer drugs made by Pfizer. This is because there are doctors in the Associations who have a conscience and see the need to unburden the whole system with generic drugs and home remedies... and this is because they are assured a salary from the govt... they're not bound to anyone company, institute or group of incorporated doctors... or the humungous entanglement of insurance companies you deal with in your incredibly beautiful and dawn early light of a place... America.

But I know for a fact Monsanto and big Oil have had a go at our polly wolly doodle all day ministers of state. How else could they be riddling our country with contaminated soils and water and genetically modified cannola, etcetra... not to mention the cloned beef and mad cow. I don't mean to be protectionist but... that's why we have a military. To protect quality of life. That's why we facilitate the health act... to protect quality of life... that's why we have an education act... protecting quality of life.

If we just let the free market educate our children... how well would that work? If the free market comprised our military... would that look like Blackwater to you? How about if we just let the lobbyists run the country... if they aren't already!

 

[gravenewworld]

Apparently.

You have said that if you aren't insured you can't get medical treatment without going bankrupt, that is really not true. No one is saying that medical expenses can't become overwhelming, but it is not the scenario you are painting that without insurance there is no help. Here is an example of what I am talking about
Quote:
Healthcare for all New Yorkers
Paying for your healthcare

Financial concerns should not keep New Yorkers from seeking the healthcare their families need. At HHC we are committed to helping our patients find financial assistance, whether through a low or no cost insurance program or through a reduced fee arrangement.

HHC offers its patients the opportunity to examine a variety of payment options. Click below to learn more:

HHC Options - HHC's own financial assistance and charity care program
MetroPlus - An HHC subsidiary which offers health plans under Medicaid, Child Health Plus, Family Health Plus and MetroPlus Gold
HHC hospitals accept a variety of other health insurance plans.
http://www.nyc.gov/html/hhc/html/access/paying.shtml

So you point out a city program? State/city programs vary widely state by state. The example you pointed out isn't true everywhere else in the country. I know for a fact that here in PA, if you don't have insurance you can get coverage by the state for about a $30 deductible per month, however the waiting list to get coverage through the state for the uninsured is 1-2 years long because of limited funding! What are you supposed to do until then?

Those living outside of NYC in NY state are also restricted by income for state health coverage. A family of 4 is only allowed to make $32 K a year (and the middle class are one of the fastest rates of growing un and underinsured).

See above. As I mentioned previously, if the medical expenses aren't emergency, you would have agreed to the expense, so a creditor would have a better chance of collecting. What percentage of the medical debts were for emergency medical treatment that the patient hadn't previously agreed to? Also, many people aren't aware of the help available to them, although it's unusual for a hospital nowdays to not offer assistance in finding ways of being paid. Bankruptcy is an all too easy way of getting out of paying off debts, but courts are starting to crack down and make it harder to file for bankruptcy. Just because people aren't aware of the help available to pay for medical expenses doesn't mean they aren't there.

What does it matter? Emergencies don't care if you have insurance or not, they could happen to anyone at anytime. So basically what you are saying is that if you are uninsured and ever in a car accident, have a mishap at work, or slip and fall and break a leg you are SOL. http://www.latimes.com/business/la-fi-bluecross13feb13,0,4778416.story

Blue Cross halts letters amid furor

Its request to doctors for data that could lead to policy rescissions was widely criticized.
By Lisa Girion and Jordan Rau, Los Angeles Times Staff Writers
February 13, 2008Facing a torrent of criticism Tuesday, Blue Cross of California abruptly halted its practice of asking physicians in a letter to look for medical conditions that could be used to cancel patients' insurance coverage.

http://query.nytimes.com/gst/fullpa...932A05751C1A9669C8B63&sec=&spon=&pagewanted=2

H.M.O.'s to Drop Many Elderly and Disabled People

http://www.latimes.com/business/la-fi-insure9nov09,0,3065397,full.story?coll=la-home-center

Health insurer tied bonuses to dropping sick policyholders

By Lisa Girion, Los Angeles Times Staff Writer
November 9, 2007

One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

http://www.latimes.com/business/la-fi-insure17apr17,0,3901131.story

Insurer allowed to drop Realtors' health coverage

Lisa Girion, Los Angeles Times Staff Writer
A judge ruled Monday that Blue Shield of California could cancel group health insurance for the California Assn. of Realtors, apparently dooming it to the growing list of organization-sponsored health plans that have died in recent years, leaving people uninsured.

Interesting, BCBS did the same exact thing to my company.

Need I go on?

 

[mheslep]

Interesting, BCBS did the same exact thing to my company.

Did your company drop all health care coverage plans when it lost BCBS, or did it get another? What's so exceptional about BCBS?

 

[mheslep]

If we just let the free market educate our children... how well would that work?

It works quite well actually, considerably better than the public schools by all kinds of metrics - if you can afford it. I favor programs to make it affordable, but that's another discussion, we're veering off health care...

 

[mheslep]

I note in the http://www.euro.who.int/document/Obs/EuroObserver6_1.pdf" . Japan also has 100's to 1000's of private insurers though I can't locate a population percentage. More interestingly, on checking the full report backing the EO article, many of these plans do not entail an employer based tax exemption - the original problem since WWII w/ the US system.

 

[baywax]

It works quite well actually, considerably better than the public schools by all kinds of metrics - if you can afford it. I favor programs to make it affordable, but that's another discussion, we're veering off health care...

Its simply a matter of congruency... if we're going to tout the "better quality of life for the nation's children" line with govt. sponsored education and govt. paid for military protection but Health is left out in the cold for the free market, then it is a contradiction and somewhat dysfunctional. The military get (basically) free medical aid... does every citizen have to join the military to get subsidized health coverage?

 

[mheslep]

Its simply a matter of congruency... if we're going to tout the "better quality of life for the nation's children" line with govt. sponsored education and govt. paid for military protection but Health is left out in the cold for the free market, then it is a contradiction and somewhat dysfunctional. The military get (basically) free medical aid... does every citizen have to join the military to get subsidized health coverage?

There's the other side of that argument: If health care must be run by the government why not our life giving food? Government grocery stores? And housing? Transportation, clothing, on, and on. With regards to the military, as I have some background there I can say that, as an organization the military is one of the most inefficient beasts you'll ever encounter, especially the Army. Its the high levels of motivation and dedication that none the less make it go.

 

[CaptainQuasar]

There's the other side of that argument: If health care must be run by the government why not our life giving food? Government grocery stores? And housing? Transportation, clothing, on, and on. With regards to the military, as I have some background there I can say that, as an organization the military is one of the most inefficient beasts you'll ever encounter, especially the Army. Its the high levels of motivation and dedication that none the less make it go.

I have to point out that the government does run, or at least substantially fund, quite a lot of that stuff. Bailouts of Amtrak and airlines, HUD and all sorts of housing development, food stamps, rationing during wartime, etc. It's not quite so free market, especially when some executives can come up with a good enough excuse to siphon off some government money.

Publicly funded and managed healthcare is no more incongruous than publicly funded and managed police departments and firefighting. If we can make the police, the fire departments, and the military run (not to mention get into regulating things like professional baseball) we can make a healthcare system run. Certainly for the same amount we're paying for it now.

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