Hello America Info Please ?

[modeller]

I'm getting confusing messages from the States. Do you want a health service for all your people as it is in the rest of the developed world or not ? Please explain your answers ?

[jno]

you'll probably get a fuller answer from someone like Clanad, but broadly speaking, the argument against what many of them see as a socialist health service is that it ought to be up to individuals to decide what they want to spend on health, same as they decide what to spend on cars etc. They are generally taxed less than us, leaving them with more of their income to do with as they please.

There is also some distrust of leaving decisions about individuals' health up to bureaucrats.

[modeller]

Thanks ! Who or what is Clanad ?

[Clanad]

Here's the story in a nutshell. By most counts only about 12 to 15 million people in the U.S. are without health insurance and in most of those cases it's their personal choice not to do so rather than economics. Of the majority of people that have health insurance (in large part made available by their employers who pay some or all of the cost) most say they are satisfied with their insurance and care. (The best in the world).
In the U.S. two government supported health care systems exist for senior citizens above about the age of 62. One is Medicare that pays for doctors, etc., and the other is Medicaid that pays for hospitalization. Problem with the system is two-fold. The reimbursement rate to the doctors and hospitals is much lower than the standard charge... so much so that many doctors and hospitals opt not to participate in the system. To make up for that difference, seniors can buy supplemental insurance to bridge the gap. It's really quite inexpensive, but many rely only on their government Social Security for retirement income, not having planned for it during their productive years.
(Contd.)

[Clanad]

(Contd.)
Although the citizens of the U.S. have sympathy for those that can't afford health insurance, (and contribute by requiring hospitals to accept anyone that comes to the emergency room, the cost being spread thorughout the rest of the system) the giant bureaucracy and loss of freedoms of choice that we see demonstrated in "the rest of the developed world" are of great concern.
Just last week, Canada's Premier of Labrador and Newfoundland opted to come the U.S. for heart surgery rather than have the procedure done in Canada. Nothing official has been offered by way of explanation, but speculation is rampant that he didn't want to have to deal with Canada's national health care.
Here's the deal... every country that has implemented national care has had to limit access to such care... usually a ration scheme run by the government themselves. The costs are far outpacing the ability of the citizens of those countries to bear the tax imposed.
In our opinion (not universal of course) the costs, bureaucracy, loss of services and expanded government are just not worth the trouble, especially with the evidence from other countries.
Obama seems to want to push ahead with the attempt to pass the bill before Congress, but it doesn't look like it will pass, given this is an election year and the citizenary is against by about 67%...

[Clanad]

Thanks for the confidence, jno... hope you can make it back to the U.S. soon... but wait for this miserable winter to end... global warming, don't you know!

[VHG]

This is an English based web site read by mostly people living in England, so I am not sure who this question is aimed at.

[VHG]

And as an English person living in England it seems to me....

Lots of people who own and run hospitals and health insurance schemes get VERY VERY rich on the system as it is.

So they "bribe" (no other word for it) various politcians and media people to say how awful it would be if they went for a "fairer" health care system.

Meanwhile the poor get ill and die because of lack of health care support.

Anyone who does not believe me watch the Michael Moore film Sicko.

See an advert for Sicko here:

https://www.youtube.com/watch?v=xlDAUKSh9CQ

[Clanad]

Aha! That must be the reason people from all over the world are coming to the U.S. for it's excellent health care... I always wondered about that...

Fact is most doctors are in private practice and many hospital are run by religious organizations... the profit is on the average about 9% to 9.5% on the giant investment necessary to staff and run hospitals (much less for rural hospitals). Most corporations expect at least 20% return on their investment.
I guess I don't put much stock in a guy like Moore that condemns capitalism... a system that's made him a millionaire.

[shaneystar2]

Hi Clanad
Can you explain please ,when you say that you have the best health care system in the world why people have to resort to this sort of thing .

http://news.bbc.co.uk.../americas/7420744.stm

Is it as Jno says that they choose to spend their hard earned on other things or is it because a lot of people are caught in a poverty trap and insurance isn't their first priority .
I watched a programme about this on TV a while back and I was quite astounded .

[modeller]

I've been told by American friends that they go onto this site so I assumed they did so in the States but maybe they do so when visiting this country. I thought, maybe incorrectly ,that all sites were available anywhere in the world. Is that not the case ?
Thanks for all the information so far . What is surprising if so many Americans 67% are against it how did Obama get elected being as that was a key part of his election promises.

[Buenchico]

The USA has (overall) better trauma care than the UK (or most Western European countries) but, despite massively greater per capita expenditure, it has (for example) lower cancer survival rates. If I had to fall ill, and rely on the local health care services, I'd much rather be in Cuba than in the USA.

Some interesting data here:
http://www.guardian.c...s-us-healthcare-obama

Chris

[Clanad]

In any society, there are those that will not supply their own needs. There are those that cannot of course. The quoted "47 million" has been bandied about quite a bit here during the attempted passing of the health care bill. When fully parsed by independant sources) it always comes out to the 12 to 15 million I presented above.
Fact is, though, rarely does anyone fall through the cracks regardless of their ability to pay. I suppose you could decry the need to rely on the mercy of others, but the question then becomes one of why over 300 million people need to drastically change their mode of acquiring health care to provide for the 12 to 15 million?
Look... when a commodity like health care becomes free, then procedures and care are very soon overburdened by those who go to the doctor for any and all, even imagined, illnesses. As I undertand Canada's system... one goes to a clinic but doesn't see a doctor but a nirse or a nurse practioner who then detemines the need to see a doctor. You have no choice in which doctor, and we hear all the stories about waiting 6 month to a year to get an MRI ... much less a more complex operation. So... the government of any country with a socialist type of health care system must...must... limit access or soon the entire system goes belly up.
My family, for example has been seeing the same doctor at the same clinic for decades. That would end with a thud if government run health care is instituted.
The same complainers about not passing such a bill refuse big time to put a limit on the zillion dollar awards given by juries to tort lawyers suing hospitals and doctors for malpractice... only 25% of such award is returned to harmed indivdual. It's obviously the attorneys that have a large lobby in Washington D.C. and are quite successful at it....

[janetla]

The us health system is full of waste of money. This year, a relative ended up in hospital with appendicitis and required surgery. We are uk residents, and this was paid for by her travel insurance. Following the surgery she spent almost three days in critical care, hooked up to machines and requiring the attention of a nurse for completely unclinical reasons. I am an ex nurse so I know she did not need the highly intensive care for so long. The reasons she spent so much time there was because, on the second and third day the doctor did not turn up to see her and agree to transfer until early evening. He said it was too late to transfer her to a ward and she 'might as well stay'. All at enormous cost to the insurance company. When we mentioned this to all our (resident american) friends, they all said, without exception, well of course they kept her there, then they can charge more money. Not every american thinks that the health system does not need changing, what many people do not realise is that people often cannot get cover for pre-existing conditions - just the things you are likely to need care for - and even people with relatively minor conditions have very large deductibles (excesses to us in the uk). The system is very far from perfect, and sadly many americans only care about how they personally will be affected, and care absolutely nothing about those who cannot afford care and die through lack of it. The huge costs of health care do not provide the benefits either that are indicators of a healthy society - such as perinatal mortality rates, child and maternal mortality rates, these are abysmally high for a developed and rich country such as america is.

[Clanad]

Chris... According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology :

American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women.
American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.
Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.
These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.

Canada's system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 found that overall cancer survival rates are higher in the United States than in Canada:

(Contd.)

[Clanad]

(Contd.)

For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.
It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government.
In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.
The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.
Lastly... new drugs are developed much sooner in the U.S. and are much more quickly availble... even to the uninsured...

[janetla]

I would like to say, I love the usa, have many friends there, and until recently owned a property and visited two or three times a year. But still there are many things about the culture that are difficult to take and the sheer selfishness of some people is astounding - health care is not a privilege, it is a right, as is education and should never be based on the ability to pay.

[shaneystar2]

Hmm I see .It all seems very money orientated . An I'm alright Jack sort of attitude .Pretty obvious that the haves don't want to share with the have nots .Whereas here your GP will see you if have a palace or a hovel
"when a commodity like health care becomes free."
Healthcare is not exactly free here .We pay for it through our NHS contributions throughout our working lives and as a child of the NHS I have no complaints about a system that provides health care for all .

[Clanad]

I'm glad you brought that up janetla...
the United States has one of the highest rates of the industrialized world only because it counts all dead infants, including premature babies, which is where most of the fatalities occur.

Most countries do not count premature-infant deaths. Some don’t count any deaths that occur in the first 72 hours. Some countries don’t even count any deaths from the first two weeks of life. In Cuba, which boasts a very low infant-mortality rate, infants are only registered when they are several months old, thereby leaving out of the official statistics all infant deaths that take place within the first several months of life.
African-American babies are far more likely to die than white ones, which is often taken as evidence that poverty and lack of health insurance are to blame. That’s entirely plausible until you notice another racial/ethnic gap: Hispanics of Mexican or Central or South American ancestry not only do consistently better than blacks on infant mortality, they do better than whites. Social disadvantage doesn’t explain very much.

(Contd.)

[Clanad]

(Contd.)
Nor does access to prenatal care, as the health care critique implies. It used to be assumed that if you assured that pregnant low-income women could see a physician, their infants would do much better. Not necessarily. When New York expanded access to prenatal care under Medicaid, the effort reduced the rate of low birth weight infants by just 1 percent. In Tennessee, after a similar effort, researchers found “no concomitant improvements in use of early prenatal care, birth weight or neonatal mortality.” So why does our infant mortality rate exceed that of, say, Canada, where health care is free at the point of service? One reason is that we have a lot more tiny newborns. But underweight babies don’t fare worse here than in Canada — quite the contrary. The NBER paper points out that among the smallest infants, survival rates are better on this side of the border. What that suggests is that if we lived under the Canadian health care system, we would not have a lower rate of infant mortality. We would have a higher one.
(Source: American Enterprise Institute )

[modeller]

Thanks everyone I'm learning a lot.