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From what I can tell, there’s a lot of name calling, shouting, and general finger pointing taking place over US healthcare reform, and very little grown-up discussion going on. 


I’m sure I’m not the only one who’d like to talk about this without having to listen to people ranting, so for the next few Thursdays, I’ve decided to open up my blog for those who want to have an actual back and forth about US healthcare in general, as well as the pros and cons of the proposed bill and what changes you would like to see our glorious leaders make to the current system.


If you’d like to join in, please follow these simple rules:


No swearing. Sorry, but if you can’t make a point without cussing, this is not the place for you.


No name calling, finger pointing, or general venting about things as they are now, as they were before the Democrats/Republicans (delete as appropriate) did so and so, or as they would be if only the Democrats/Republicans (delete as appropriate) would do so and so. Again, if that’s all you have to contribute, please do it elsewhere.

Only cite something that's in the current healthcare bill if you can provide a link to the relevant page number/wording in the actual 1,000+ page proposal. 

Before we start, in the interest of disclosure, my politics are a little to the right of center. To some people that would put me on a par with Genghis Khan, but that’s only because A: you never knew my old gran, and B: you don’t know much about Genghis Khan. 


I believe the State should care for those who can’t care for themselves.  I also believe it should look out for those who need help getting back on their feet, but not those who see living off the state as a career. 


After five years in the US, I can see the healthcare system here is far from perfect, but I lived over forty years in the UK, and though you may not want to hear it, I can tell you the system is far from perfect there.


Let’s talk healthcare.


If it helps get the ball rolling, here are my thoughts:


1.  I would allow insurance companies to compete in other states, just as the motor insurance industry does.  The increased competition would (one would hope) drive insurance costs downwards.


2.  I would impose harsh penalties on hospitals, doctors and patients who attempt to defraud the Medicare system (as I understand it, Medicare currently loses hundreds of millions of dollars per year to this).   


3.  I would set up a government funded organization to oversee insurance companies and make sure they don’t unfairly back out of contracts. This same organization would pay for/eventually take over medical bills resulting from unexpected injury eg; car crash victims where there is no clear liability.


4.  I would impose harsh fines on the ambulancechasers.com companies, when they bring frivolous lawsuits.

No doubt, I’ve missed a lot.

Bearing in mind the rules listed above. 


If you had the power to do so, what would you change about the current healthcare system in the USA and why?

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( 15 comments — Leave a comment )
Aug. 13th, 2009 03:54 pm (UTC)
Personally, I think copying something like what they do in Europe, but with the option of having private medicine available to those willing to pay for it would be the best bet. That way, no one will die on the street, but the people with more income can get spectacular (as opposed to acceptable) health care.

Trust me - most people who can accede to high-quality care will do so, leaving the public system to those who truly need it and saving the government billions.

This system works pretty well in Argentina (the downside is that every Bolivian with a serious health issue comes around to get it treated), and I don't see why it wouldn't work in more organized nations.

I don't believe that everyone should be condemned to having the same level of health care if they can afford better (which is why I don't like most European systems), but I also feel that people shouldn't be allowed to die because their insurance lapsed.
Aug. 13th, 2009 05:01 pm (UTC)
Thanks, Gustavo.

Do you know how much money comes from people's wage packets to cover the public system? I think it's now 11% in the UK -subject to an upper limit, after which it's 1% - though it's been a while :)
Aug. 13th, 2009 04:40 pm (UTC)
I would lower the age for Medicare and work to make certain that children had comprehensive health coverage.

Then I would begin working toward a single-payer system. I realize the health insurance companies wouldn't like that, but they've had their chance, imo.
Aug. 13th, 2009 05:12 pm (UTC)
Hi, Ken. If I understand things right, Medicare is the nearest equivalent to a public system in the US, though it's only for people within a certain age range. Is that right, or is it more complicated than that?

Agree 100% on the children thing, but I wonder if it wouldn't be cheaper for the government to have some kind of 'preferred customer discount' with hospitals/doctors etc. or even tax deductibles based on the number of patients seen.

As I see it, one of the biggest objections to a single-payer system is the cost. Setting aside the 'can't put a price on someone's health' argument (valid as it may be). Have you any thoughts on how to pay for it, in a way which wouldn't affect employers costs to the point where they either lay people off, or stop employing more people?

I wonder if the answer might be to somehow take the employee contributions out of the equation altogether, so that the onus is on the person insured. Though quite how we could do that, I don't know? Any thoughts?
Aug. 13th, 2009 06:07 pm (UTC)
First, call me Mark. :)

Yes, Medicare is similar to a public system, except you can "pay up" and receive more services, or so I understand it. It's age-specific, though, so that's why I wish they would look into lowering that.

Personally, I think a public option would help keep insurance companies honest. There's really no real "competition" between companies now. If they were many more mutual companies (pay out what they take in) it might be different.

As for paying for it, the American people they are going to have to chip in. If you lay out what they are going to get in return, what it will cost them, I think the majority will at least consider it. But, of course, the insurance companies will never go for that. They're just too powerful and I'm afraid they're going to remain that way.

While we might have reform in this country, I don't ever see anything like a universal coverage happening. We're actually lucky, my family has good coverage. But we're the exception and not the rule. :(

Aug. 13th, 2009 06:20 pm (UTC)
Oh dear, sorry about the 'Ken' thing - and for all the numerous other times I've done it. That'll teach me not to look up people's names on their profile.

I think you're right about the lack of competition between insurance companies. It's certainly not helped by the closed competition for each state.

I hope your back feels better soon :)

Aug. 13th, 2009 07:59 pm (UTC)
Thank you,thank you, thank you for starting this discussion. I've been thinking about the topic myself, in part because HH is a registered nurse and works in a large medical research hospital. I think you've got a good start on a list. To that I would add something I say about every government program:

1. If the government says it will pay for X percentage of health care costs, that is, in fact, what it should pay for. As it currently stands, what Medicare covers does not necessarily match the cost, leaving a balance that has to be picked up by someone else, usually those with private insurance.

2. We need to take a long hard look at "machines that go bing" (yes, I'm thinking of Monty Python's "Meaning of Life"). If they are not more effective than the current technology, hospitals and doctors offices should not purchase them. When a doctor recommends a certain test, patients can ask about the cost and they can ask if there is another technology that would cost less and achieve comparable results. I know this can be done because I have done it with my cardiologist.

3. Pharmeceutical companies that accept federal funds for research should have to reduce their prices to reflect the support we have already given them through our taxes, even if it means lower shareholder dividends.

By the way, living in Vermont, my husband has seen his share of patients who come from Canada in order to get treatment sooner than they would. Clearly, there is no perfect health care system.

Oh, and

4. An emphasis on preventive health for all ages.

5. Universal Catastrophic coverage. Even if you've lived a healthy life, a tumor can happen, or a car accident, and that sort of major calamity is beyond anyone's control. People shouldn't have to worry about how they're going to pay for treatments while they're worrying about getting well.

Edited at 2009-08-13 08:03 pm (UTC)
Aug. 13th, 2009 08:22 pm (UTC)
By number 1, do you mean that the amount is the public thimks is covered is 'spun' to make it seem larger than it actually is?

I'm with you 100% on 2 and 4, 300% on 3 and 5.

I wonder if a single-payer, government run insurance which just covered number 5 might be in an eventual compromise. It would certainly get my (metaphorical) vote.

Thanks for your input :)

Aug. 13th, 2009 08:33 pm (UTC)
It looks like everyone is talking about this on the Internet these days. I was reading some news from USA, and then asked an American friend about it and he explained it to me. I also read on The Times that Gordon Brown twitter'd about it be because some Americans politicians critised the NHS, and the twitter site crashed because of the 'We love the NHS' campaign.

As I can see you're from the UK. How good is the NHS? What if you're a tourist and a car run over you and the like?

It's said that the best Health Care in the world is the French one. I'm from Argentina and ours is good, but it also depends on which part of the country you live in.

I found your journal via bondo-ba. I checked your website. Are you still a musician or just a writer?
Aug. 13th, 2009 09:05 pm (UTC)
I could be wrong, but I think us Brits regard the NHS as a member of the familly ie: We can trash-talk it all we like, but outsiders do so at their peril :)

I think you're covered in the car crash thing, but to be honest, I don't know for sure. Certainly the European Union citizenns would be okay.

I've heard good things about the French system too. For all I rag on them, I'm actually part French, but ragging on them is a national pastime in England ;)

Gustavo said you had good coverage in Argentina too.

In the UK, there is definite healthcare rationing. Let's face it, in these days of incredible scientific advances, no country (not even the USA) could cover all health payments for everyone, no matter how noble the ideal.

In my opinion, it's done in a subtle way, usually by delaying diagnosis and treatment. For the younger citizens, it means an annoying wait, but when it comes to things like hip replacements for the elderly, a long delay can often mean the patient dies of some other problem before his operation becomes due.

Of course, a lot of this is due to the top-heavy bureaucracy you get with any government run system, but there is a DNR (Do not Resuscitate) policy in the UK which can be (and certainly has been) abused in the past.

As for music, I haven't sung in public since moving to the US in '04 (much to the relief of the people here). I do have a recording studio in the basement that mess about with on occasion, but nothing serious.

How about you?
Aug. 13th, 2009 09:24 pm (UTC)
I found really interesting that you Brits can trash the NHS, but outsiders do so at their peril. Like a member of the family. Good comparison.

According to the WHO ranking, France is number 1. Italy is second. And USA is 37.

And as regards me, I'm a musician who loves literature.

Aug. 13th, 2009 10:38 pm (UTC)
Wow. #37 is not good.

Thanks for the info, Bruno :)

What sort of music do you play?
Aug. 14th, 2009 03:59 pm (UTC)
I play some indie/art-rock/prog/alternative sort of music. Nonetheless, labels don't say much. I just try to write good songs, but failed, lol.
I don't want to be a spammer, but you can listen to some of my tunes at myspace.com/moonlighthorses
Aug. 20th, 2009 07:31 pm (UTC)
"I could be wrong, but I think us Brits regard the NHS as a member of the familly ie: We can trash-talk it all we like, but outsiders do so at their peril "
I agree with that. The way I heard about it on the radio was that the people against Obama's plans had turned around and started attacking the NHS. My first thought was, what on earth's it got to do with them? Yes, there are imperfections in the NHS system, but is anything perfect? From what I've heard about the system in the US (and I know there are big gaps - someone care to fill me in a bit?), the NHS sounds a lot better than that.

The way I understand it is, in the US if you get hurt, or have an illness, you need to pay a lot of money for the treatment. I've heard that a huge number of people won't get broken bones set because they can't afford it. How true is this? How much is insurance, generally?

So far I've only had positive experiences with the NHS, but I only turned 18 in March, so so far I haven't been paying anything for my medical care/prescriptions/etc.
Aug. 20th, 2009 08:10 pm (UTC)
The 'free at the point of service' idea behind the NHS is admirable. However, it is subject to healthcare rationing and also long delays for expensive operations (whether due to red tape, or cynical budget watching, or both).

As you probably know, it's not uncommon to wait eighteen months or more for a hip replacement on the NHS.

I've spent four or five hours sitting in an Emergency Room on more than one occasion. This is partly due to the 'urgent cases first' system, which I have no problem with, but also down to the general lack of coverage in the ER in the first place - again due to budget constraints.

As I understand it, there is some kind of guaranteed accident coverage for the uninsured over here in the US, but I don't pretend to know much about it.

I've had some experience with the American doctor/dental/hospital system over the last five years and I'd say it's of a far higher standard in quality, staff attitude and - for hospitals at least - cleanliness than the UK. Then again, I'm lucky enough to be insured. No doubt many Americans have a different experience.

The sad thing is, I think just about everybody agrees we need healthcare reform over here. We could probably have it too, if both sides worked together instead of bickering and trying to portray the other in a bad light.

Then again, that's just my opinion :)

Thanks for your input :)

Edited at 2009-08-20 08:12 pm (UTC)
( 15 comments — Leave a comment )

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