Health

[jazzfish]

Between Jo Walton, The Decembrist, and my own experiences with Those Pig****ers, I have to know:

What are the actual objections to nationalised health care?

Comments

[markush.livejournal.com]

You know what happened to me. I was without insurance, and fell into the cracks of the system. I might be out of debt sometime next decade, assuming I don't have another incident. I don't want what happened to me to happen to someone else. Saying that...

I agree that a system like England isn't going to work here. We are too large, too varied and too socially independant. The problem is that the PRIVATE insurance companies are starting to use the same structure for their programs. Your doctor isn't in our PPO system? Too bad, you'll have to find another one. Sorry, the procedure that your doctor wants to use is too expensive, use the cheaper treatment, even if it has a worse chance of you surviving.

People in the U.S. are going to foreign countries for certain procedures, simply because they are too expensive here, and their insurance plans won't pay for them. Sure, if you have the money, you can get in right away, but if you don't, too bad, so sad.

What we need is not a national health care program. What we need is a national health insurance program (or at least reform). Already, employers and employees pay for their health insurance. Moving all of this money into a national health insurance program will allow the insurance to bargain for everyone, and use the savings to provide some insurance protection for those who are unemployed or self-employed. It could also bargain with drug companies for reduced rates for prescriptions, and possibly include malpractice insurance. Medicare and medicaid services and Veteran's Benefits could also be rolled into it, providing more savings.

What I envision:
Tier 1: Emergency Health coverage. Designed for those who are not paying into the program at all. It covers emergency procedures (perhaps with other services that we want to provide to those who are without jobs, i.e. neonatal care, etc.). It's designed so that if something critical goes wrong with somebody, they won't be in debt for their lifetime. (An 80/20 split seems reasonable, but that's a detail issue.)
Tier 2: Standard coverage. The level of coverage that most companies already provide to their employers. This will also cover dependants and so forth. Whether or not the employer or employee pays for it depends on contractural issues.
Tier 3: Advanced coverage. For a higher fee, you get the type of coverage you see in the most progressive company insurance programs. Perhaps have a buy-in for employees. (The company provides standard coverage with the employee having an option for the higher level of coverage. Or if a company wants to try to attract certain outstanding employees, pay for all of it.)

There may be higher tiers, that will cover certain procedures not allowed at lower tiers (much as it is now). There will also be certain procedures (experimental or cosmetic or what-not) that would likely not be covered at all.

There are, of course, details that would need to be worked out. The oversight level will need to be pretty high, as what we have here is basically a regulated monopoly. Doctors already don't like to deal with medicare patients, so they may have issues with everyone being on what is essentially medicare. (Perhaps provide reduced malpractice insurance to those who are willing to sign up with the program?) And of course, medical insurers will fight this tooth and nail, as it basically puts them out of business. But it seems like it would be reasonable, without too many changes to our current health system as it now stands. If you can afford it, the U.S. Health system is one of the best in the world. We just need to make it so that it is, in fact, affordable.

[laughin.livejournal.com]

Interesting. I can see any doctor I want.

If you really want things to be cheaper, chuck the trial lawyers and reduce malpractice insurance. And get rid of the FDA.

[markush.livejournal.com]

The problem is that sometimes the doctor really does screw up someone's life forever. If some poor guy comes in for an appendectomy, and gets his legs cut off by mistake, then what should he do? There needs to be some sort of mechanism for responsability and accountability in place, and currently that system is civil court. Perhaps it should be changed to some sort of arbitrary level, so that the court system is bypassed.

Of course, then we get into how much mistakes could cost. Lose a leg, get $50,000. An arm, $40,000. An eye, $75,000. Lose a life, $250,000.

And if you don't agree with the assessment, back into civil court it goes, unless we pass a very specific law saying that the arbitration levels cannot be challenged in court. It would definitely solve the malpractice issue. Part of the reason malpractice is so high is to cover those cases where a jury rewards tens of milllions of dollars to a plaintiff. That, and insurance companies want to make money, and doctors are legally obliged to buy it, so they have a 'captive' audience, so they can charge more.