This just came up in another thread and I've repeated it here..

The socialised medicine issue in the US confuses the hell out of me - what's the problem? I just can't make sense of the case against.

Here in Britain I get healthcare from the state.

Northing's perfect - but it works. It's high quality. It's free apart for a nominal prescription charge (waived for those on a low income). It's been running for over half a century and the sky hasn't fallen in.

If I want to pay for private health care I can - the medicine is no better but the hospitals have better art on the walls. But I'd still pay my full taxes - that's non negotiable and you don't hear complaints.

Tell the British or the French that socialised medicine is a Bad Thing and that the American model is better and we'd laugh so hard we'd puke. Try to take it away and there'd be a revolution - pitchforks, torches, the works.

Watching Michael Moores' Sicko made me realise just how lucky I am to live here.

I don't understand how the American right can maintain the belief that it wouldn't work, can't work, when there is so much evidence to the contrary and working models around the world to emulate.

Saying it would be too expensive to set up seems like a hollow claim when $700bn has just been pulled out from a box under the bed - what have they been saving up for? How much more is in that box? What's more important?

People are dying and bankrupting themselves and their families - It's immoral.

Anyway - this is a international forum. If our American cousins want more information, facts, personal stories, resources, history, kick ass ethical arguments - you only have to ask and I'm sure the rest of us can provide them.

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If I remember my college history correctly, the only way Bevan was able to get doctors to agree to the formation of the British NHS was to 'stuff their mouths with gold'. Given that pharmaceutical companies enjoy profits in the billions, I wonder how much gold you'd have to shovel in there to finally shut them up?
Doctor salaries are all over the map. Primary care doctors make in the $120 - $180K range. ER doctors make between $200-250K and the more in demand specialties, can make easily make $300k+. If you think this is ridiculous consider the following:

For this salary doctors go to undergraduate school, then 4 years of med school and then anywhere from 3 - 8+ years of training for which they are paid but a pittance and work anywhere from 80 to 120 hours a week depending on specialty and program. A new doctor once finishing all of this schooling has an average of (IIRC) $200K or more in loans for school to pay off. Then there is malpractice insurance which for some specialties in some states eats up a significant portion of that salary. Then there are the costs of setting up a practice or joining an existing one. The only doctors that are actually making it rich are those that accept cash only patients. Plastic surgeons, dermatologists primarily although there are others. It's difficult to complain about them since they only charge what the market will bear.

"The AMA doesn't want to see an increase in the number of doctors here because that would drive the average doctor's salary down. If you keep access tight, and you milk insurance for all its worth, you can make huge amounts of money".

I'm sorry, but where does that information come from? There is already a shortage of primary care physicians, particularly in low income areas because they simply can't make a living off of medicare patients. OBs are leaving practices in droves in some areas because they can't afford the malpractice insurance. Costs go up not down, technology gets better, more people are cured and yet for all of this doctors are already getting paid less and less.

So no, doctors are not getting rich off our backs. Not by a long shot. What is sad is that the perceived value of certain critical professions are being so undervalued. Teachers make next to nothing because of this and one day if things continue you will see doctors in the same boat.

Finally, I'll apologize in advance if I sound a bit heated. You see, my family has been living the life of one of these 'over paid' doctors for a few years. My husband is in his 2nd year of residency. My kids and I hardly ever see him, our expenses are high and our salary is low. There will come a day when this changes as it should. Yes it was our choice, I could have told my husband NO when he asked me to support his desire to go to med school and he probably would have given up his dream of being a doctor. But that's part of my point, to make a choice like this there had better salary waiting waiting at the end. Otherwise why would ANYONE choose this life?

Some food for thought: What other profession is asked to give up their life for up to 16 years and then are told they are over paid! As my husband likes to tell me, we here in the U.S. want the best health care in the world but we want it free and we want it now and frankly both of those things are never going to happen.
I don't have any knowledge of how other countries train their medical professionals. When you say 5 years start to finish, does that include undergraduate, med school. and residency/traning? Do they get a traditional undergraduate degree or is that not required? It may be easy to say that they can do it so why can't we. But that assumes a lot of factors that are in play here that might not be in play elsewhere. For example the U.S. I believe is much more litigious than most other countries.

It sounds like their level of training is similar to what Physician assistants have here. I believe most PAs go to an undergraduate 4 year program and then have 2-3 years of PA school/training. Many primary care practices rely heavily on PA's and NPs to see most of their patients and this seems to work well. I can certainly see a strong case for most of primary medicine being handled by PA's and NPs and I think we are already heading in that direction however there will still be a need for some FPs with additional training to handle the more difficult cases.

"In Korea, where I lived for several years, I could walk into a drug store in my neighborhood and consult with a pharmacist about my condition. He or she would then prescribe a medication for me and dispense it, all without a doctor's prescription."

This would be a HUGE liability problem in this country. I know I keep bringing up liability, but it is because it's a big issue here. Even doctors are reluctant to prescribe meds to patients without seeing them because if it turns out to be a more complex issue then appears they have just opened themselves up to a lawsuit. I can just imagine the can of worms that would be opened up if pharmacists were able to prescribe. I'm not saying that because it's a problem now then it could never be done. But before anyone would be willing to take those risks we would have to completely overhaul the way medical malpractice works.

"We need to streamline the medical education process and allow access to those who show the interest and ability to do the job. I don't believe that it should take sixteen years or more to produce a family medicine practitioner; that is simply ridiculous."

FPs don't train for 16 years. I was covering the whole spectrum of specialties when I said that. Surgeons, orthopediacs etc. are in that range. I'm also including undergraduate degrees. For internal medicine, FPs, GPs it's more like 12 (undergraduate, med school, residency).

I can't say whether docs need the amount of training we give them or if there are ways to cut down on the number of years. Perhaps med school could be more streamlined but I'm not convinced. Speaking from what I observe with my husband I believe they need all the training they get. He's doing a 3 year (somewhat unusual) residency in ER, he's in his 2nd year and most definitely is not ready to begin treating without some over sight. He's tell you that himself in a heartbeat, and he was a paramedic for 12 years so he's not completely new to emergency medicine.

I'm not saying we can't do better. I responded to your contention that doctors in the U.S. are over-paid and yes, I do take issue with that. You said you were pre-med for a couple of years so you must have some idea. But if you haven't done it it's hard to understand the sacrifices that doctors make to get where they are. We really do seem to expect world class health care and yet we just don't seem to be willing to pay for it. Just look at what we have been willing to pay CEO's who usually have less training than a doctor to see how we value how we spend our money.
(cont. because I apparently AN things I'm too wordy.)

As for your experience trying to teach. I'm sorry :( I believe that we have entirely gone in the wrong direction with our public school system. I don't think it should take a teaching degree to teach in the upper grades. I'd much rather have an enthusiastic professional from the field (science, math, etc.) teaching my kids than a teacher who just teaches rote memorization so kids can do well on tests.
Paul, I agree wholeheartedly. It just seems surreal to hear Americans worrying about a nationalized health system. We have one here in Australia and, while far from perfect, it ensures that people who need health care usually get it, regardless of their income - and they get the same level of care as anyone else.

A few examples. I am on a disability pension. Two years ago I needed to have my gall bladder removed. I don't have private health insurance. I had two choices. If I wanted an operation immediately, the government would pay a portion of my costs, but I'd have to kick in an extra $2000. If I was willing to wait, I could have the same doctor, the same hospital, for free. I opted to wait and it cost me nothing. The wait was two months which was uncomfortable, but bearable given my condition. If I had been in screaming pain and had to be rushed to hospital, my case would have been prioritised and I would have had it done immediately, for free.

My brother has terminal brain cancer. He requires MRI's every couple of months. These cost over $500 each. Under the public system, he has had three brain surgeries, countless MRIs, and chemotherapy under the care of top surgeons and oncologists and radiologists - all for free. He will die from his cancer eventually, but thanks to the care he has received, his initial diagnosis of 12 months to live has been greatly extended and he has lived with the recurring tumours for 11 years now.

As far as our general medical care goes, we can go to any general practitioner we like. Some GPs 'bulk bill' which means they charge you nothing, and just accept the fee paid by the government. Others charge you the medicare rate plus a small surcharge (around $10) and, although you have to pay upfront, you fill in a form and the government deposits their contribution straight back into your bank - or you can go to a shopfront and they will give you cash back.

Pensioners and people on low incomes, are eligible for subsidised prescriptions if the medications are on the government's list. So, instead of paying $17 or even $40 for a prescription - it costs about $4. There is a 'safety net' for everyone, so if your pharmacy bills exceed a certain amount per year, you become eligible for subsidised prescriptions above that amount, no matter what your income.

Pathology is also mostly free (i.e. bulk billed), as are most xrays, etc. I've had MRIs, CT scans, ultrasounds, and xrays in recent years - all completely free.

There is absolutely no sense that people who opt for public health care get second-rate service. We get exactly the same care, beds, and doctors as any other patients.

There is also absolutely no sense that the government is making decisions about our health - as the insurance companies seem to do in the US. I've never had a doctor consult a government agency about whether or not they can perform an operation on me or any member of our family - the decision rests with the doctors and surgeons. If someone needs surgery, they get it.

As you said, you can opt for private insurance and you might get your operation sooner and in a posher, private hospital - but we have a friend with top level private insurance and I can honestly say she is no better off in the private hospital than we have been in the public system.

I had an internet friend die recently - probably in part because he had no insurance and had had to battle to get any kind of medical care in the US. He desperately needed medication, but couldn't afford it. He spent, I think, three months battling for treatment, but died before anything was done. A nurse at the clinic he was attending said to him, "Well, if you went grocery shopping, you wouldn't expect to walk out with your groceries for nothing - why should you expect to walk out of here with free medications?" It was appalling!

I agree that the US medical system is seen as a sick joke by the rest of the world and does nothing to help the rapidly diminishing status of the US
I already said this but it's worth saying again:

Here in the U.S. people expect to get the best health care in the world. They want it free and they want it now.

Socialized medicine might indeed be the best solution but typically it really is more complicated in the U.S.. Most of us here simply want all citizens to have access to health care and while socialized medicine would do that better than we are doing it now there are still problems.

In this country we can not make any reforms that insurance companies don't support and that is an uphill battle. Second, many people are against socialized medicine simply because that's not the way it's done here (at least it wasn't until the $700B wall street bailout), so there is a ton of inertia. Second, many people don't really see that socialized medicine is the fix that others believe it is. As you stated those that can afford private health care will buy it and many doctors will decide to work outside the system. There continues to be a two-tiered system in socialized medicine, granted it's better than the large number of people that don't have health insurance at all, but I think many who are for health care reform see that as an obstacle. We want all people to have equal access to health care and we don't want to have to wait months to see a government doctor. I think the ideal for many is that we find a way to give everyone the health care they deserve while still keeping the industry private.

For us this is a very complex issue and also a very crucial one. I agree completely that our system is broken and there need to be considerable reform but I'm not entirely convinced that a purely socialized system is the best option.
What I find to be the biggest issue is how economy for you must rule everything and the constant mentality of "what I earn is mine to take". There also seems to be the issue with taxes, that some people simply refuse to pay taxes because "the money will be given to others without them earning them". This too promotes the system you currently have. What I do find the most appalling however, is how even those from the poorer parts of the society actually agree with this and think it is better.

Why cannot a minimum level of health care be given to everyone? The answer is simply, people honestly don't think others are worth the economical effort it takes for them to pay an additional part of the taxes going there. It seems to be to be a mentality issue over economy, and once people really think a purely socialized system will be better, a reform would be easily done.
You know the funny thing is that you've hit on the reason why we let people sleep on the street in my city. It's sick and sad. The worst part is that those of us that don't like it tend to feel powerless.

It really sickens me to see million dollar condos going up across the street from a part of the sidewalk a group of homeless people are sleeping on.

It's disgusting really. When my older sister had cancer her insurance cut out during the first few months of her treatment. The last thing a cancer patient should have to worry about is how they are going to pay for treatment. They shouldn't be punished for getting sick by having to go into serious debt, or worry about being refused insurance due to their medical history.

That's before you get into those of us uninsured working class people that miss out on preventative medicine and cross our fingers every day hoping that we don't wind up sick or injured.

The system is just screwed. I don't understand how anyone can watch the situation my sister went through and still justify the way things are.
I don't either. I have been in that situation many times when the only way for me and my family to get through is with the help of governmentally paid money. People happily pay funds to their local churches but do the churches give free healthcare? I am pretty sure the amount of money some people pay to their churches is well over the needed amount of additional tax money which would be required by the population as a whole to create a functioning general healthcare system.

The problem with insurance companies is that they are all privately owned and thus they are mostly concerned with how much money they earn. if it turns out you can't pay your surgery or whatever else you might need by yourself and need the help of the insurance company you will most often get cut off without any help. Or would the problem turn out to be more serious and complicated there too they might remove their support because the costs rose over what they expected. Ultimately, the solution is to offer a governmentally owned insurance company people can subscribe to and that company should not first and foremost be profit-driven but there to actually help people.

However, with your communism phobia I can't see when it will happen soon. I don't know the whole story why you started to fear communism so much in the first place, but at some point communism became equal to socialism and thus, socialism bad because communism is bad despite it's ok to have socialist systems in other areas such as your policeforce or the army.

I guess here too, there is a great lack of education. I still believe that most advocators against a socialist reform of your healthcare system have never been in the situation when they direly need free healthcare because they are refused by the insurance companies if they own an insurance at all.
Just a thought, one possible reason why Americans don't like socialized health care could be because of medicare and medicaid. We see that the social parts of our health care system are even worse than the rest. Yeah if you are poor enough you get social health care but they hardly pay so they can hardly get services. Texas was recently sued a couple times over it in Frew v Harkwins and it was found there was inadequate access to services, the state lost once then refused to comply because it cost less to fight a second law suit. Now they have lost the second one and are complying this time.

Then they see the level of care people get from our social health care, the doctors offices are dirt, ghetto and warn down. The waits are excessive and then you only get about 3 mins of the Dr's time. So if you have questions you better know them and ask fast. The health care is not always very comprehensive, there are many services left out of the care. For example TX offers no mental health care under Medicaid unless you live in Dallas or you are a foster care child. The rest of the state doesn't have mental health care for the poor.

I think when many Americans see the difference between our social health care system and the private system and think it would be worse to socialize the whole system.

Then you have to consider that according to Kaiser Foundation this is the break down of who has what kind of insurance.

United States Percent

Employer 53.4%
Individual 4.9%
Medicaid 13.2%
Medicare 12.1%
Other Public 1.1%
Uninsured 15.3%

http://www.statehealthfacts.org/comparebar.jsp?ind=125&cat=3&am...


Then according to Centers for Medicare and Medicaid Services (CMS) public spending on health care was $1,038 billion and private spending was $1,206 billion in 2007. So when you put those together you can see that the government covers 26% of the population for 46% of the cost and private covers 58% of the population for 53% of the cost.

http://www.cms.hhs.gov/NationalHealthExpendData/Downloads/proj2007.pdf

So the whole American attitude against socialize health care could just be a matter of perspective. We see a failure of a social system here but don't ever interact with a successful social health care system anywhere else.
You make a good point. I think each state makes it's own rules and some are much better than others. Some states require doctors to accept medicaid patients for the privilege of being licensed there. Others don't have that requirement and as a result many choose not to accept medicaid patients. Here in my area it seems that the ER is the place of choice for medicaid patients because many doctors have opted out of medicaid or if they do accept it they don't keep time open for sick appointments. The result is long waits, no continuity of care and higher costs to the system.

It's going to be hard for most people to accept socialized medicine because what we have now is so poor and spotty. Frankly, I'm not sure I trust our government to get it right either.
Agreed I trust the government with my health care at all. They do such a poor job on what I have seen so far. And I worry about fundies getting ahold of the rules for my health care decisions. By that I mean fundies would love to eliminate coverage for birth control and such so if the government was the source of health care and fundies eliminated government money for birth control / abortion that would effectively eliminate that option for many people.

Also the government refuses to pay reasonable prices often times. I remember here a few years back how many burn units in MO were being shutdown because of the price paid by medicaid and medicare. They were paying something like 60 cents on the dollar. The thing the pushed that over the edge was the increase in uninsured coming into those burn units because of meth lab explosions. But since they were uninsured and in need of emergency care they were paid through medicaid.

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