Nationalistic Blinders, National Healthcare and Sicko

Admiral Valdemar · Post by **Admiral Valdemar** » 2008-03-01 03:23pm

Stas Bush wrote:When you deal with healthcare, the American position is "Pay or suffer!". It sounds brutal enough, you know, and if most Americans don't see a problem with that, they have a huge broken ethics problem indeed. And that attitude will have to be fixed before they seriously support a nationalized healthcare system.

Of course, the bull-speak "every man gets what he deserves in our pro-market system!" (in relation to ilnesses which can strike any person at random, like he deserved it, yep) is just the same "pay or suffer" motto spoken in obscure terms.

It's ironic, isn't it? that a nation so vehemently against Darwinian teachings seems to extol the virtues of natural selection in the most damaging way to society.

Jade Falcon · Post by **Jade Falcon** » 2008-03-01 05:22pm

PainRack wrote:Its odd, since everytime you explained the concepts of insurance to them, they claim that they understand. Yet, they fail to see the connection, they're STILL paying for someone else healthcare under insurance. The sole difference is in terms of pool. Under a national, or even state based system, you have a larger pool of people paying for the same number of cases.

To take off the blinkers, the issue is truly how much money is flowing into the system and how much it can do with that. NHC is no better or no worse than managing money than a private system(ignoring bureaucracy, but anyone who believes that this doesn't apply to large conglomerates in the US is on moonshine). If State A is treating 5 thousand people with a 1 million dollars, I expect their healthcare and waiting time to be better than State B which is treating 5 thousand people with 10 thousand.

I may be reading it wrong, but it seems that unless it's written into the Constitution, a lot of Americans are against something, going along with the paranoia about the "evil government". Basically it usually comes down to "Where does it say in the Constitution that Healthcare is a right".

brianeyci · Post by **brianeyci** » 2008-03-01 05:49pm

If you're trying to convince someone of the benefits of universal healthcare, and the person has already heard of 30 million uninsured and decided that point is irrelevant, math comes to the rescue.

Suppose all other factors are equal. A for-profit healthcare system requires issuance of dividends and profit, a reasonable rate of return. Meanwhile a non-profit system can be a zero sum game. Revenues can equal expenses and net earnings can be zero, and the system can still function, all other things being equal. Meanwhile, a for-profit corporation with zero net earnings won't last long unless it's a venture or IT stock like a Google.

Of course the rebuttal will be, where the fuck does the money come for expansion? Well, the answer is the government can tax. One dollar from every single person in the country is a lot more money for the healthcare system than the small amount of people who get sick. So the healthcare system can actually be better, better funded with a universal system than a for-profit system can ever hope to be, because not too many people are sick at once and put money into the system at one time.

And of course you can bring zero-sum game again when they whine about possible tax increases. Obama did this; he said there's inefficiencies in the Federal Budget, 5-10 percent, that can be removed. What he means is bullshit that can be cut. The key is, the budget can pay for this crap already without raising taxes.

This kind of non-emotional, rigorous argument can convince even the most staunch anti-government freak about the benefits of universal healthcare. You will not reach them with "30 million uninsured" or "it could happen to you" because they don't see it that way.

This kind of argument should defeat the "private are more efficient than public" because those kind of guys never define what they mean by efficiency, and if you ask them for numbers or math they won't be able to find any -- because proof for that doesn't exist (administrative overhead for American healthcare is huge, that's huge inefficiency.)

TheKwas · Post by **TheKwas** » 2008-03-01 06:00pm

America already spends more on healthcare than the majority of European countries and Canada, they just throw it away on an ineffective system. Reform the system and you can SAVE money.

brianeyci · Post by **brianeyci** » 2008-03-01 06:04pm

I knew that, and I've seen the charts of spending. But in the short term, decreasing spending on healthcare will decrease quality of healthcare. Moreover many Americans are unwilling to accept other countries' systems as evidence.

Instead I suggest, why give them that bone? Healthcare in the US could be better than it is now, spending the same amount. Zero-sum game is the way to argue.

Jade Falcon · Post by **Jade Falcon** » 2008-03-01 06:06pm

How exactly is the system ineffective. I've heard this quite a number of times on SB that the US Healthcare as is is more expensive than say, the NHS yet not as effective.

Is it a case of far too much administration, lawsuits, what?

brianeyci · Post by **brianeyci** » 2008-03-01 06:10pm

Sorry, I saw TheKwas as saying "inefficient." Ineffective isn't the same as inefficient. If you've got the money, quality of care in the US is just as good as anywhere else.

I think it's important to be precise to convince the fiscal conservatives, and if someone uses the word ineffective they should make it clear what they mean -- either 30 million uninsured, or quality of care.

aerius · Post by **aerius** » 2008-03-01 06:10pm

brianeyci wrote:Instead I suggest, why give them that bone? Healthcare in the US could be better than it is now, spending the same amount. Zero-sum game is the way to argue.

Unfortunately, "zero-sum game" is likely beyond the vocabulary and math comprehension of the average American. Their understanding generally ends at "tax cuts = more money!!" and "tax raises = bad!!"

Post by **Darth Wong** » 2008-03-02 02:22am

Jade Falcon wrote:How exactly is the system ineffective. I've heard this quite a number of times on SB that the US Healthcare as is is more expensive than say, the NHS yet not as effective.

Is it a case of far too much administration, lawsuits, what?

The US has the highest infant mortality rate among first-world nations. The US has nearly 40 million people who are NOT covered by its health-care "system". I'd call that "ineffective", especially when they spend twice as much per capita on health care as those other nations do.

TheKwas · Post by **TheKwas** » 2008-03-02 03:24am

Yeah, I was getting at 'inefficient'. Not entire sure why ineffective came out.

Instead I suggest, why give them that bone? Healthcare in the US could be better than it is now, spending the same amount. Zero-sum game is the way to argue.

The problem with your argument is the "assume everything else is equal" part. Conservatives refuse to believe that the government bureaucracy can do anything right that doesn't involve dropping bombs on villages. Even if there's a bigger pool of people opting into the system, and there's no funds being sucked away in the form of profits, they will still believe that the inefficiency of government bureaucracy will outweigh everything else. If you tell them that overhang costs are higher in America than in most other industrial countries, they will say that America needs to go more private and that all that overhang is due to government regulations.

Furthermore, it relies on the assumption there really is fat that can be trimmed in the federal budget, which is often suggested at election time but rarely discovered once governments actually get to power.

Moreover many Americans are unwilling to accept other countries' systems as evidence.

Correction:

Moreover many Americans are unwilling to accept evidence.

Darth RyanKCR · Post by **Darth RyanKCR** » 2008-03-02 09:32am

A question about the Canadian system, if I may ask. While in Disneyworld for our 10th wedding anniversary we overheard a conversation between a couple in a resturant and a cast member/waitress there. The waitress was from Canada. She was asked how long she is here for. She said for over a year but Disney only does 6 months with people at a time. They asked why and she indiciated she did not want to go back and the healthcare system was one of the reasons why. She indicated that you don't select doctors they interview you and decide if they want to take you on. She also said that yeah the medicine is cheaper but (and this is where I don't remember exactly) there is a city tax, province tax and national tax added to it, on top of what is taken from income tax to pay for the whole system.

How much of what she said was true? I'm just curious.

Thanks

Post by **Darth Wong** » 2008-03-02 09:47am

Darth RyanKCR wrote:A question about the Canadian system, if I may ask. While in Disneyworld for our 10th wedding anniversary we overheard a conversation between a couple in a resturant and a cast member/waitress there. The waitress was from Canada. She was asked how long she is here for. She said for over a year but Disney only does 6 months with people at a time. They asked why and she indiciated she did not want to go back and the healthcare system was one of the reasons why. She indicated that you don't select doctors they interview you and decide if they want to take you on. She also said that yeah the medicine is cheaper but (and this is where I don't remember exactly) there is a city tax, province tax and national tax added to it, on top of what is taken from income tax to pay for the whole system.

How much of what she said was true? I'm just curious.

Thanks

She's full of shit. I have had three different family doctors in my adult life, and I have never had an interview to get one. There are provincial and federal sales taxes, but there is no such thing as a city tax on medication. I suspect she was actually an American who was trying to bad-mouth the Canadian system for some reason. Either that, or she's actually a Canadian but she's a blithering idiot who never actually needed health care because she's so young, and so believed what American right-wing assholes were telling her about her own health care system.

One thing about the health-care debate is that Americans have never been shy about spreading outright lies.

brianeyci · Post by **brianeyci** » 2008-03-02 10:01am

Actually depending on where she lived, it could be true but exagerrated. In Alberta and British Columbia, there's direct deductions from your payroll to pay for healthcare, and in Ontario there's a health income tax. Obviously you'd have to know where she lived to figure out how much of an exagerration.

But city tax? I've never heard of that, sounds like a lie. As for doctors selecting patients, that's basically a lie unless you're an old coke addict. Certain doctors in the country interview you (of course they do to find out your medical history and it's hardly like a job interview, after all if you don't tell them it's your loss) and they can actually reject you. The CMA defends this, and basically it's about doctors who don't want to take high maintainence patients like drug addicts or old overweight out-of-shape (think Ariel Sharon) patients who suck up a lot of their time.

But that is hardly all the doctors unless you don't live in one of Canada's seven major cities. If she lived in Toronto she could walk down the street and find five doctors on the same block. Could even be ten literally, since they're often in clinics together.

What you have to keep in mind about ancedotes like this is they're usually representative of a specific set of circumstances and not the whole.

Post by **Darth Wong** » 2008-03-02 10:06am

brianeyci wrote:Actually depending on where she lived, it could be true but exagerrated. In Alberta and British Columbia, there's direct deductions from your payroll to pay for healthcare, and in Ontario there's a health income tax. Obviously you'd have to know where she lived to figure out how much of an exagerration.

I don't think anyone would be surprised to know that there are income taxes.

But city tax? I've never heard of that, sounds like a lie. As for doctors selecting patients, that's basically a lie unless you're an old coke addict. Certain doctors in the country interview you (of course they do to find out your medical history and it's hardly like a job interview, after all if you don't tell them it's your loss) and they can actually reject you. The CMA defends this, and basically it's about doctors who don't want to take high maintainence patients like drug addicts or old overweight out-of-shape (think Ariel Sharon) patients who suck up a lot of their time.

I've never had such an interview, and I did live in a rural community for a while. But some doctors have a policy of refusing to treat smokers because they're tired of giving them advice they won't take, and smokers often don't realize how obvious their habit is (hint to smokers: you stink). I wouldn't be surprised if smokers walk into a doctor's office, he smells the stink on them, and he makes up some bullshit about how he has to do an interview to decide whether he wants to take them on.

The ironic thing in terms of a US/Canada comparison is that this aspect of the Canadian system is actually due to its most free-market aspect: the fact that private doctors are actually independent contractors who bill the state. As independent contractors, they can decide to take on fewer patients if they want.

Jade Falcon · Post by **Jade Falcon** » 2008-03-02 10:46am

A few years back when I moved house I had to move to a different practice. Registering there did mean filling in a form and meeting one of the doctors for a number of questions.

I wouldn't have called it an interview however, and the questions might have been necessary since I have had epilepsy since I was 10, so they wanted to get some more details. There wasn't any question about me being turned down though.

SCRawl · Post by **SCRawl** » 2008-03-02 11:03am

Darth RyanKCR wrote:A question about the Canadian system, if I may ask. While in Disneyworld for our 10th wedding anniversary we overheard a conversation between a couple in a resturant and a cast member/waitress there. The waitress was from Canada. She was asked how long she is here for. She said for over a year but Disney only does 6 months with people at a time. They asked why and she indicated she did not want to go back and the healthcare system was one of the reasons why. She indicated that you don't select doctors they interview you and decide if they want to take you on. She also said that yeah the medicine is cheaper but (and this is where I don't remember exactly) there is a city tax, province tax and national tax added to it, on top of what is taken from income tax to pay for the whole system.

How much of what she said was true? I'm just curious.

Thanks

Others have already exposed this person's bullshit, but the issue of a "city tax" remains. The only thing that I can think of is property taxes and assorted municipal-level user fees -- which shouldn't be all that unfamiliar to Americans -- none of which contribute directly to the health care system.

Aaron · Post by **Aaron** » 2008-03-02 03:22pm

Darth Wong wrote: I've never had such an interview, and I did live in a rural community for a while. But some doctors have a policy of refusing to treat smokers because they're tired of giving them advice they won't take, and smokers often don't realize how obvious their habit is (hint to smokers: you stink). I wouldn't be surprised if smokers walk into a doctor's office, he smells the stink on them, and he makes up some bullshit about how he has to do an interview to decide whether he wants to take them on.

It's happening a fair bit in the Ottawa Valley, all the doctors in town here do it. Or were doing it before they stopped taking new patients and the new doc in Arnprior was doing it. The practice here though is to submit a questionaire and then do an interview, we've never got a call back after the putting in the sheet. Which is why we have a doctor in Kanata and the fact that most of the docs here are ex-military.

I have never had an explanation of why they do it but I imagine it's because there are so few of them up here that they want to be able to weed out a certain element.

brianeyci · Post by **brianeyci** » 2008-03-02 03:40pm

Ultimately to make an ironclad argument for universal healthcare you have to mention a whole slew of details like pre-existing conditions or how people drive themselves to bankruptcy and only then can they access Medicaid or other programs for the extremely poor.

But people like that woman aren't interested in details. Aerius is right, they're only interested that they pay x here and y there and if y < x then y is obviously better...

...until you get cancer.

Aaron · Post by **Aaron** » 2008-03-02 03:47pm

brianeyci wrote:Ultimately to make an ironclad argument for universal healthcare you have to mention a whole slew of details like pre-existing conditions or how people drive themselves to bankruptcy and only then can they access Medicaid or other programs for the extremely poor.

But people like that woman aren't interested in details. Aerius is right, they're only interested that they pay x here and y there and if y < x then y is obviously better...

...until you get cancer.

I find that most Canadians that bitch about our system are either young or have never had to use it.

SCRawl · Post by **SCRawl** » 2008-03-02 07:37pm

Cpl Kendall wrote:
brianeyci wrote:Ultimately to make an ironclad argument for universal healthcare you have to mention a whole slew of details like pre-existing conditions or how people drive themselves to bankruptcy and only then can they access Medicaid or other programs for the extremely poor.

But people like that woman aren't interested in details. Aerius is right, they're only interested that they pay x here and y there and if y < x then y is obviously better...

...until you get cancer.
I find that most Canadians that bitch about our system are either young or have never had to use it.

My former boss -- a few jobs ago -- used to bitch about it. In his case, though, he needed to have several rounds of surgery to remove scar tissue from his larynx, which would have enabled him to breathe through his nose instead of the hole in his throat. The only guy in Eastern Canada capable of performing the surgery (an ontolarynxologist, IIRC) was rather busy with cancer patients, as opposed to morons who got themselves fucked up in a drinking/driving crash.

(Just to round out the story: my old boss had one procedure done, and had scheduled the second one. It took months to get these surgeries scheduled, and one time an emergency came up that got him bumped. Anyways, when he showed up for the second procedure, he was drunk. Needless to say, they didn't operate on him that day, and never did again. A few years later, due in some small part to this and other circumstances, he blew his brains out. Ah, memories....)

Darth RyanKCR · Post by **Darth RyanKCR** » 2008-03-02 10:30pm

Thanks for the replies. I don't know if she called it a city tax but I remember there being about 2 or three taxes on the medications. Of course my memory could be faulty here. It was back in September and I had wanted to ask earlier but things kept getting in my way like a stress test to determine when I go on a transplant list.

Post by **Darth Wong** » 2008-03-03 01:17am

Darth RyanKCR wrote:Thanks for the replies. I don't know if she called it a city tax but I remember there being about 2 or three taxes on the medications. Of course my memory could be faulty here. It was back in September and I had wanted to ask earlier but things kept getting in my way like a stress test to determine when I go on a transplant list.

I don't know why you would even bother asking a young waitress in Disneyland about the Canadian system. It is almost a certainty that she has never had much (or any) need to use the system, so how much would she know about it?

Darth RyanKCR · Post by **Darth RyanKCR** » 2008-03-03 01:23am

Darth Wong wrote:
Darth RyanKCR wrote:Thanks for the replies. I don't know if she called it a city tax but I remember there being about 2 or three taxes on the medications. Of course my memory could be faulty here. It was back in September and I had wanted to ask earlier but things kept getting in my way like a stress test to determine when I go on a transplant list.
I don't know why you would even bother asking a young waitress in Disneyland about the Canadian system. It is almost a certainty that she has never had much (or any) need to use the system, so how much would she know about it?

She seemed to be in her 30's or so and was only in the US for about 1 to 2 years. We didn't actually talk to her. We overheard it when she was talking to another couple. We always like hearing about where people are from.

Post by **Darth Wong** » 2008-03-03 01:32am

Darth RyanKCR wrote:
Darth Wong wrote:
Darth RyanKCR wrote:Thanks for the replies. I don't know if she called it a city tax but I remember there being about 2 or three taxes on the medications. Of course my memory could be faulty here. It was back in September and I had wanted to ask earlier but things kept getting in my way like a stress test to determine when I go on a transplant list.
I don't know why you would even bother asking a young waitress in Disneyland about the Canadian system. It is almost a certainty that she has never had much (or any) need to use the system, so how much would she know about it?
She seemed to be in her 30's or so and was only in the US for about 1 to 2 years. We didn't actually talk to her. We overheard it when she was talking to another couple. We always like hearing about where people are from.

A Disneyland waitress in her 30s, who would say stupid shit about how all doctors require an interview in Canada and how there's a city tax?

Aaron · Post by **Aaron** » 2008-03-03 05:42am

Darth RyanKCR wrote:Thanks for the replies. I don't know if she called it a city tax but I remember there being about 2 or three taxes on the medications. Of course my memory could be faulty here. It was back in September and I had wanted to ask earlier but things kept getting in my way like a stress test to determine when I go on a transplant list.

She's probably referring to the sales tax and the pharmacy's filling fee: they charge a certain amount to fill the prescription on top of the actual cost. It varies from pharmacy to pharmacy.