Universal Health Care: No Sick Joke

Small businesses—and large—have trouble attracting the best job candidates because of the high price of health care. Entrepreneurship demands nationalized medical insurance. Pro or con?

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Pro: Cure for the Uninsured

Since 2000, employer-sponsored health insurance premiums have risen by an average of 73%. For small firms, they’ve more than doubled. This rapid run-up in costs, plus pressures from an increasingly globalized economy, is causing firms of all sizes to pull back from offering health benefits. In 2000, 67% of nonelderly Americans had employer-sponsored health insurance. Just 63% do today.

Large companies increasingly hire workers on a contingency basis through contract houses, temp agencies, or contracts with self-employed people. This allows companies to reduce the number of workers with benefits. Small firms have always faced higher premiums per person than large firms and so have been far less likely to offer health coverage. Since many are new, they feel especially reluctant to provide a fringe benefit that’s more than doubled in cost in just the last six years.

Moreover, many startups exist as virtual companies: They’re groups of self-employed associates, rather than employees. This means they must find health insurance on their own, which costs even more than employer-group coverage.

For 20 years, the services sector, where small firms are the norm, has generated employment growth in the U.S. This, plus employer resistance to rising premiums, has transformed who’s uninsured. Today, almost 60% of the U.S.’s 46 million uninsured are 19 to 45 years old. Significantly, a quarter of all 25- to 34-year-olds and one-fifth of all 35- to 44-year-olds are uninsured. Both those figures have doubled in the last 25 years.

We need to recognize this sea change and create a universal coverage plan. The real question is: How will we finance it? A starting point is to recognize that universal coverage involves a social compact—and individuals should be required to enroll.

Second, individuals and companies should contribute; firms reap large benefits from having a healthy workforce. The federal government would raise funds to subsidize lower-income households and cover most of the expenses of people with extremely high medical costs. Universal coverage can easily include private health plans. But unless we reconfigure the financing, private health insurance will soon exist only for a fortunate, small minority.

Con: No Right to “Free” Health Care

The cause of the U.S. health-care mess is governmental interference. The solution, therefore, is not more governmental control, whether via nationalized medical insurance or a government takeover of medicine.

Health insurance costs so much today because the government, on the premise that there exists a “right” to health care at someone else’s expense, has promised Americans a free lunch. When a person can consume medical services without needing to consider how to pay for them—Medicare, Medicaid, or the individual’s employer will foot the bill—demand skyrockets. The $2,000 elective liver test he or she would have forgone in favor of a better place to live suddenly becomes a necessity when its cost seems to add up to $0.

As the expense of providing “free” health care erupts accordingly, the government tries to control costs by clamping down on the providers of health care. A massive net of regulations descends on doctors, nurses, insurers, and drug companies. As more of their endeavors are rendered unprofitable, drug companies produce fewer drugs, and insurers limit their policies or exit the industry.

Doctors and nurses, now buried in paperwork and faced with the endless, unjust task of appeasing government regulators, find their love for their work dissipating. They cut their hours or leave the profession. Many young people decide never to enter those fields in the first place.

What happens when demand skyrockets and supply is restricted? The price of medicine explodes. What was once to serve as a free lunch for everyone becomes lunch for no one.

The solution? Remove all controls. Recognize each citizen’s right and responsibility to pay for his or her own health care, and return to insurers the entrepreneurial freedom to come up with innovative products.

True freedom would bring health care into the reach of the average U.S. citizen again—just as it has done for other goods and services, such as computers, cell phones, and food.

Opinions and conclusions expressed in the BusinessWeek Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.

Reader Comments

logic

I'm sorry Onkar, but you're exactly wrong about the source of paperwork that's driving physicians up the wall. I am a physician, as is my wife. It's the bizarre, nonstandardized information demands of private-sector insurance companies that drive us crazy. The amount of actual government paperwork (DEA renewals and the like) is trivial compared with the massive hair ball of private-sector forms, ever-mutating, that are dropped upon us like so much dung.

Quite honestly, a single-payer health-care system would be a godsend for docs like me. One set of forms, period. Life would be sweet(er).

Ed McClelland, Albuquerque, NM

Interesting article. One concept that will work well is outlawing health insurance. This would accomplish a lot of good. With no health insurance, prices would drop to unheard of lows. The power of the buyer would return to this market. Folks would find other ways of financing their health care. The efficiency of the market would improve.

Smiley

Insurers come up with innovative products? I've had employer-sponsored health coverage for years, and the only innovations I've seen from the health insurance industries involve charging more and more each year while providing less and less coverage.

And single-payer coverage and other "socialist" schemes have worked quite well in many European countries as well as Canada without the dire results predicted by the free-market-is-God crowd.

Joe

This is a no-brainer, a health security tax paid jointly by the employer and employee (like Social Security), and every citizen and legal resident is covered. The super-rich are free to pay for their own gated hospitals, and illegal aliens must pay for their own care or be deported.

The con article is a joke unless we want a society where the law of the jungle rules. What a right-wing nut-case this guy is.

Kevin

It's amazing how all the comments make no mention of the underlying theme of universal health care: the subordination of one group to another. Why should I pay for my neighbor's health care when I have to take care of myself? Instead of an honest argument about why I should sacrifice my property to others, i.e., those who didn't earn it, we are forced to listen to these ad hominess, emotional, and dubious static-driven substitutes for reasoning. Joe is right about one thing--"this is a no-brainer"--especially for those who evade the real issue.

Daniel

Re Logic's comment, Onkar said "each citizen’s right and responsibility to pay for his or her own health care," not "private-sector insurance companies." His basic argument seems to be stop leaning on government and insurance companies to pay for one's own medication.

Your next argument will be that "people cannot afford the procedure/medication without the help" If the price becomes unreasonable in the free market, no one will pay the doctors for the procedure, forcing them to lower prices to stay in business. The price of procedures is inflated due to the insurance company and government pressures in the first place. Or there are always loans, savings plans, or other financial routes for clients to use to pay for the procedures or medication they need.

Dan Edge

Papa Joe is a no-brainer.

If socialized medicine is superior to the more capitalistic U.S. system, why do so many come to the U.S. for medical treatment each year? Why is this not reciprocated? Why don't U.S. citizens flood across the border to Canada for medical treatment? The Canadians come over here in droves, not wanting to wait six weeks for Big Brother to grant them an appointment to get an MRI.

I don't have health insurance, but when I need to see a doctor, I make an appointment for the next day. If Papa Joe gets his way, I'll have to wait in line to get my blood pressure meds refilled.

Bravo to Onkar Ghate for telling it like it is. Down with socialized medicine.
--Dan Edge

Paul Hsieh, MD

As a practicing physician, I can attest to the fact that what Onkar Ghate writes in the "con" article is exactly right.

The distortions of the market caused by the government policies in Medicare and Medicaid percolate through the semi-private insurance sector. Doctors fees through the "private" sector are now routinely pegged to a percentage of Medicare, because the government is the 800-pound gorilla in health economics. What we currently have is at most a semi-free market, and the problems of the current system are due to the government regulations, not the free market component.

The tax laws giving favorable advantage to employer-based health benefits disincentivize people from purchasing innovative Health Savings Accounts, as profiled in the recent Business Week article at: http://www.businessweek.com/magazine/content/07_22/b4036086.htm.

Government mandates on insurance prevent carriers from providing low-cost high-deductible catastrophic care, which is what insurance should be (just like it is for fire insurance or automobile insurance)--namely a protection against rare but expensive problems. The current system of insurance is more of a system of pre-paid care. Health insurance should not cover routine visits any more than car insurance covers regular oil changes.

Laws restricting interstate insurance competition also prevent portability and lock people into their current jobs for fear of losing their current coverage.

More government in the form of a "single-payer system" or government mandates (a la Massachusetts) merely worsen the problem. Attempts by governments in other countries and other U.S. states to guarantee a so-called "right" to health care have merely led to worse patient outcomes and higher costs.

Forcing everyone into a government-run system of medicine just because some people are uninsured would be just as wrong as forcing everyone into a government run housing project just because some people are homeless.

The free market provides better products at cheaper prices, something that anyone who has recently purchased a DVD player knows. Consumers take that for granted in fields like home electronics. And in the sectors of medicine that are relatively free, the same thing happens--just witness the steady improvement in quality and decrease in prices for Lasik procedures and cosmetic surgery. If similar free-market policies were adopted for the rest of American medicine, the cost savings and quality-of-life improvements for Americans would be incalculable, with ordinary working-class Americans benefiting the most.

A free market in medicine is the only way Americans can get the high-quality affordable health care they need and deserve.

vzeebjtf

What is "the law of the jungle"? That each of us is responsible for his own life, and may not enslave others to support him? If so, I vote with the "right-wing nut case."

William Sekerak

Ghate has it right. Simply observe the markets with the most regulation, and it is obvious what controls accomplish.

Education, medicine, housing, energy--need I say more?

"HR"

Onkar is partially correct in his assessment. But for the largesse provided by a combination of government subsidies, and the granting of monopoly powers to the pharmaceutical, legal, and medical industries, the cost of health care would have stayed more within the reach of many more people. I would even venture to say that medical insurance would probably still be correctly called “hospitalization.” (“Hospitalization” insurance was what they called it when the costs of long-term hospitalization were the only financially catastrophic consequence of seeking medical care. Now even minor outpatient surgical procedures can cause many people to fall into bankruptcy.)

It is a long-established economic fact that suppliers produce for their own benefit and demanders seek benefits according to the opportunity costs they are willing to give up in exchange for the benefits they might gain from a transaction. Such transactions are an ecological event in that the transacting parties must take their relative positions and personal assessments of the various personal outcomes resulting from the transaction (and the contexts in which it occurs). Such is “deep planning”—too deep for outsiders to meddle with in the hopes of increasing the outcome in terms of value. Outside meddlers can only drive up the costs involved and hence lower the marginal utility to be gained by either party.

Since it is the transacting parties who are seeking value and giving up the opportunity costs of any alternatives and since meddling unduly reduces everyone’s profit (i.e., value), it is best to leave the transactors alone to work matters out for themselves.

I don’t see the ethical value of wanting to reduce the value to be gained by the transactors in any transaction by meddling in it. I am speaking from principle here. I am not sure of the intricacies of the minds of people who would interfere. I never understood the need for such interference. But many smarter people than I see such a need. Such meddlers have always espoused high philosophies as justification for their meddling. This is why I am not a philosopher.

The Ayn Rand “objectivist” crowd, though they give nodding acquiescence to the need to remove “subsidies,” rarely, if ever, speak to the evils of government-sanctioned monopoly powers. (Notice that there is no mention of medical deregulation in the “con” article.) This is because objectivists and other neo-cons in general have no problem limiting the responsibility of persons by promiscuously granting the “right” of incorporation to all comers. It is easy for them to so promiscuously sacrifice the damage recovery rights of victims on the cross of “tort reform.” They say it is OK to limit by law the right to establish one’s own name in a profession of his choosing, rather than allowing him to establish himself by proof of his abilities before his peers.

The liberals are no better with their cries for subsidies and more ubiquitous regulation—with their mindless emphasis on the “more” in the “more regulation” than anything else.

The fact is that until we stop eating one another, humanity will stay in its insane state of mutual cannibalism. Only a few of us see it. Unfortunately, Ayn Rand’s life became a waste because her not quite finished work has become a mere religious tool for the superstitions of the neo-cons. They will probably have their aristocracy of wealth—but not one of earned honor.
H.R.

Mark

The only "mindless idealism" that I see in these two angles--particularly in the comments section--is that of the "free market" junkies whose consistent argument is that they're entitled and others aren't.

To suggest that you shouldn't have to pay for your neighbor's health insurance because "he didn't earn it," is obscene. It's a fairy tale to think that you yourself are not dependent upon others in your life.

Insurance companies do need to be abolished. A single-payer system is a step in the right direction, but one prone to abuse--though much less so than a free market in which availability is controlled solely by the producers.

The answer is a free market for the producers, but not for the buyers. The government could buy drugs from the companies but control the distribution of them. This way, producers could easily make their cost back by selling in bulk to a guaranteed buyer, and the government's lack of interest in profits would eliminate market manipulation and consumer abuse.

Not free health care--just a system that thrives, as all markets suppose to do, on supply/demand equilibrium rather than quarterly profits.

RPannier

I always find these stories about why we shouldn't have universal health care quite amusing. Why do you think all these Canadians are crossing the borders? Universal health care provides less. The government screws it up.

I've lived in Korea for eight years, and prior to that, I lived in Europe for two and before that, I was in the U.S. Army. In the 10 years of living abroad I have always paid into universal health care, and the longest I've ever waited to see a doctor was one hour and 45 minutes. I pay $216 a month for health care that covers the my wife, my two daughters, and me. An office visit is about $7 (depending on the exchange rate) and my prescriptions run $3 to $7.

Health care rates in the U.S. are ridiculous. The quality of health care per dollar spent is almost the worst of any post-industrialized nation. Yes folks, those evil, godless, Socialist Swedes, Danes, Norseman, and French have better-quality health care than the USA does.

To Dan Edge, does the term "medical holiday" mean anything to you? Thousands of Americans travel to Thailand and other places around the world to get quality medical care at better prices. It's sad when it's cheaper to buy a plane ticket to Bangkok, stay in a hotel, have knee surgery, do rehab, and fly back to the U.S.

your ol pal

The "con" argument reminds me of the two guys being chased by a jaguar in the jungle, and one says to the other, all I have to do is run faster than you. How pathetic is this self-serving, I-got-mine attitude? And of course, as long as health care is provided by the employer, we are all indentured servants and they own us, yes?

Richard Parker, MD

As a practicing physician, I wholeheartedly agree with Onkar Ghate’s excellent analysis of the evils of government regulation in health care. Dr. Ghate is correct in pointing out that it is government controls that have caused the skyrocketing cost of health care we are seeing. He is also correct in pointing out that the solution is therefore not more government control via nationalization of the insurance or health-care industry, but rather a free-market system that brings back the incentive to produce quality health care at affordable prices.

The desire to force "free" health care via government takeover is not driven by any noble desire to bring affordable health care to America—there is ample evidence such attempts have failed miserably in countries where it has been instituted (such failures are typically evaded or ignored by those who cry out for "free" health care enforced at the point of the government’s gun). The motivation for government-enforced health care is pure power lust, and the type of evil that simply enjoys seeing suffering for the sake of suffering.

Sean

I love the argument that says if health care is free, everyone's going to be rushing to the hospital or doctor. This logic is the same that says having police and a fire department is going to cause an increase in crime and arson. Give me a break.

As for you doctors who offer your opinion as fact: You presently enjoy a monopoly that would make U.S. Steel blush. Don't piss on my leg and tell me it's raining. As long as you profit without competition from the pain and suffering of your neighbors, I render your opinion worthless. Your interests are not in healing--they are in your bottom line and any argument that says "you have no right to health care" pretty much bears that out.

This is the type of evil that enjoys seeing suffering for the sake of profit.

Jim in DC

I can't understand how anyone could support a system with 100+ major insurance companies with disparate payment, billing, and patient record-keeping systems. Each of those companies has corporate boards, corporate headquarters, CEOs making millions, and stockholders who want their cut. The insurance companies don't provide a service that actually heals anyone. They exist purely to make money and have no incentive to provide equal care to everyone who pays into the system.

Every major industry has gone through a period of significant mergers to try to squeeze out inefficiencies. I think the health-insurance business is probably closer to the banking industry than most analysts have considered. Banks merged like crazy during the 1990s. Health insurance is a transactional business that needs to consolidate.

Nick

This was the same debate France had. They chose socialized medicine. We all see the results--unless you're one of those politically correct dingdongs who needs to constantly lie to make your point. In case you're dense enough to miss the point: The rest of the world comes to the U.S. for health care when possible. Not the other way around.

Jerry Hoehn

First of all, let's get something straight. It is not accurate to call it universal health care; this name is deceptive and dishonest. "Universal" is another way of saying "government controlled," and the word "care," the true meaning of the word care, is not something that you can force a doctor to provide. Care is voluntary; it presupposes a voluntary relationship between a doctor and a patient. The word "care" can only legitimately be used within the context of a private health-care system, because it is only under such a system that this concept actually exists. Government can force people to do a lot of things but it cannot force a doctor to care for someone in the true sense of the word "care."

Let's call it what it really is: a government compulsory medical system. It is a system under which Washington bureaucrats are given more latitude over how our hospitals are run than physicians.

Everybody is greedy, especially senators and congressmen; they take greed to a whole new level that most businessmen cannot even fathom. Anyone who thinks bureaucrats will not get their kickbacks under a government compulsory medical system has obviously not been watching the news for several years. A free market system doesn't eliminate greed; it just keeps it under control.

The reason heath care is so expensive is that socialists have already basically gotten what they wanted on a smaller scale. For a long time, the federal government has required hospitals to treat anyone who appears at an emergency room whether or not they can pay. If someone is having a heart attack, for example, the emergency room responds, even though officials may find out later that the person is an indigent; this has been going for years and guess who has been paying the bill? You, in the form of higher insurance premiums.

Someone has to pay for the endless supplies, sophisticated equipment, the medicines, the salaries, and other expenses required to treat an uninsured heart patient. That person is you. This is why your health insurance is so expensive. If you think insurance premiums are expensive now, you have only had a taste. When everybody, in effect, is forced to become an indigent patient, your high insurance premiums will take the form of significantly higher taxes. You will just be sending your check to the IRS instead of your insurance company, but it will be a much larger check. The same indigent patients who do not pay for health care now will become indigent patients under a government plan who will not pay taxes. We'll have roughly the same number of taxpayers (formerly insurance customers) paying into the system--except now we introduce that wonderful concept of government waste and we all go broke as a result. If our government can make a hammer cost $1,000, imagine what they can do to the price of Xanax.

If anyone thinks that the fantastic American achievements in health care technology will still be possible under a government compulsory medical system, would you bet your life on it? We still have a whole slew of diseases that need a cure; and are you really willing to mess with the engine of a system that has cured more diseases than any other system in history? Do you really believe that investors are going to continue taking incredible risks to produce a drug like Xanax with the knowledge that their great invention might just be taken away from them "for the common good"?

tgolferman

The world is currently competing with China. China provides no health-care services for a vast majority of its population. China by recent accounts either manipulates its currency for unfair advantage in trade or somehow has magically undervalued its currency. Labor in China has virtually no rights. We (the rest of the world) are struggling with health-care cost increases because our health care system overhead is huge, but the number of jobs that add value to a product are moving to China, and the pie available to pay for health care is shrinking. We have a few choices: Go to universal health care, start manipulating our currency for an unfair advantage and there will be a big enough pie to pay for health care, or forget about health care as a country and be responsible for own own health and when it's your turn to go, you go.

Aside from accidents that require health-care services, aren't we all suckers if we're willing to pay higher insurance premiums and deductibles because of the person that puts garbage in his or her body and doesn't exercise? Why should everyone else have to pay for others' negligence? Either we all pay universally through the tax system or we scrap this broken system and stop paying for these insurance company castles and medical institution cathedrals along with the waste, fraud, and abuse normally associated with an industry this size.

Roger

I live in Germany and am self-employed and privately health-insured. This insurance is expensive, subject to an increasing deductible depending upon frequency of use, and may be canceled should the insurance company determine that I am abusing it. So, essentially, I have to guard against major calamities, and pay routine medical expenses out of pocket, typically at triple the rate a physician would charge the publicly insured recipients (most wage-earners).

The "success" of the socialized medical system can be estimated by considering that my several physician friends all agree that the socialized medicine side of their operations is permanently bankrupt, that they depend on guys like me to keep from having to close their offices.

So, in paying my insurance and paying for minor problems out of pocket, I am de facto already subsidizing the less healthy or fortunate.

The "success" of the socialized medicine system can further be estimated by the government's recent consensus, that it is "unfair" for guys like me to get "better" benefits than others get in the compulsory socialized sector. Which brought to pass a law instituting a complicated "load-sharing" formula in the near future between the public and private health-care sectors, against economic experts' warnings that this will raise everybody's costs. Guess who was right? The economists: The first stage of reforms has already raised prices. Guess who will benefit? Hint: Not the doctors or the patients or the pharmaceutical companies. Ah yes, the 300+ public insurers with top-heavy management salaries and inefficient management structures who have to date run up the biggest public health-care deficit since Count Bismarck founded the system in the late 1800s. And somebody else benefits: the politicians who will "trade" their "efforts" in this "grand reform" for more votes in the next election. That's who. Question: Isn't buying votes illegal?

Next question: "Is that what you want in the USA?" Double taxation of the rich, increased taxation of the poor, reduced benefits for all, but another well-paid term in office for the politicos who sold you this bogus bill of goods? Your choice. Chose wisely.

For my part, I second Mr. Onkar Ghate--for his correct economic theory, correct predictions, correct ethics. Ethics, you ask? Yes, because although I may chose to accept an obligation to act as "my brother's keeper," should he be in a tough spot, I have no right to impose this burden on anybody else.

Joseph Conrad

The high price of health care in the U.S. derives from the cost of shortcomings in the performance of corporate and health-care provider business and operating processes.

Corporations large and small continue to compete and succeed in the marketplace "on the cheap." They believe having a two-tier wage-and-benefits hiring system (newer workers get lower wages and benefits) and outsourcing are the most effective ways to control labor costs. They're willing to sacrifice the experience and expertise of skilled workers in favor of less experienced and less expensive, more compliant younger workers. All they have to do is dumb down the tasks to be performed.

Corporations would rather blame poor performance on rising labor and health-care costs--and outsource--rather than examine their business, operating, and decision-making processes. U.S. corporations in particular are extremely averse to self-perception and changing behaviors based upon its results. Stated another way, U.S. corporations--regardless of size--would rather outsource, hire young, and buy new software and equipment to throw at a problem than simplify (cut steps), optimize (define and cut costs), and then accelerate (with new software) their business processes and supply chain. Doing is much easier than thinking and then doing.

Today, everybody wants to cut costs and hire the best. But most are totally unwilling to take the time and make the effort to examine and revise their business processes and systems. Moreover, most believe labor cost reduction and new software will save them from their own stupidity, arrogance, and lack of vision.

K Prasad

We should remember that all those countries with universal health care are not as affected by America's obesity. The results of poor diets and lack of exercise in this country account for a large part of health-care costs. This is not a burden to be placed on your neighbor.

Maybe we should entitle everyone to healthy food and gym memberships first?

Mike V.

A few facts, which are irrefutable:

1. Today, both health-insurance companies and health-care providers in the U.S. are both heavily regulated by the federal and state governments. We do not have a free market now. Our current system is a mixture of socialism and capitalism. So, anyone who is angry about the current system should not claim that medicine and health insurance have failed under the free-market system, and that socialized medicine is now the only answer. Rather you should claim that the mixed economy is failing, and you should try to identify which element--the market or the government--is the poison and which is the nutrition.

2. Capitalism, in general, has created the highest standards of living in human history. All the traditional essentials of human life, food, clothing, and shelter, are available in greater abundance under capitalism than under any government directed social-economic system. To the extent that a free market has been allowed to operate, the highest standards of health care in human history have also resulted in the United States and Westernized countries.

3. The primary motivation of medical-care providers and insurance companies are, and ought to be, no different from from any other business or profession, i.e., to provide the best quality product or service for the consumer in order to make the greatest profit. Or to put it another way, to make the most profit over the long term, doctors and insurance companies should provide the best-quality services possible.

billd

The government is already the 800-pound gorilla. If you add up payments to health care from Medicare, Medicaid, the VA system, and federal and state employees health insurance, you will get about 60% of total health-care spending.

So you Libertarian types say that the answer is to develop a free market. It's not going to happen. Get over it. Eliminate Medicare? Right. Try it.

At this point, I think the best plan is to emulate the French. They deliver a far superior result at a much lower cost.

To do nothing is unacceptable. This will become the big issue in the next Presidential election.

Frank

Yes it's true that rich people come to the U.S. for extra special treatment, but I am a hard-working American who cannot afford it.

I lived in Windsor, Canada, next to Detroit for 20 years and had great health care. One of Windsor's problems was working Americans coming over with bogus I.D. cards to get that free health care.

If your system is so good, why are Americans going to Canada to steal theirs?

I also lived in Europe and if you never have, how can you say its system is inferior? If you go, try asking the regular Joe on the street if he would rather pay for yours.

Also, why are we the only industrialized nation on the planet without a national health system? Do you think it's because America knows better?

You are so arrogant, you probably answered yes.

Uninsured

The anagram of "Onkar Ghate" is "Khan Rat Ego."

Onkar, something you may have not considered while you are driving your Mercedes AMG SL550 over the bodies of street urchins and listening to "Ride of the Valkyries":

Since hospitals are free to charge non-negotiated (i.e., unlimited) rates to those without insurance, how is someone making $30,000 a year and just getting by financially supposed to pay for a $250,000 appendectomy?

You may be a heartless human being.

Lothar Schwarz

Capitalism is the main reason we are paying so much for health care. We need more restrictions on hospitals, pharmaceuticals, and doctors in regard to how much they can charge, with prices so high--especially for prescriptions. We are paying five times as much for the same medication, so I would say socialized medicine is better and cheaper. And send Dr. Ghate away.

Xander. O

I am still reeling from the Onkar Ghate comparison between inexpensive computer retail products and health care. Even at their most expensive, early computers and cell phones never cost for the average person the same amount chemotherapy does in real dollars. And no retail product is equal to one's life. The constant, ideologically illogical argument that a market will provide in all circumstances is blind. And blindness is a health problem.

Angela

This is a case where everyone knows where the problem is but is afraid to say it. We are so afraid of the words "socialized medicine" that we go around in circles trying to find a solution under free enterprise that doesn't exist. Once we leave the insurance and the employer out of the equation, the solution is simple: Think of health care in the same terms we think of elementary education. Taxpayers fund a basic service available to anyone for free. And for those who have the money to spend or simply like to feel apart from the crowd, there is the private school and in the case of health care, doctors in private practice and private hospitals with the amenities of a country club, if that is what they want.

Mike Jones

After spending 35 years in the health-insurance industry, I have seen many changes. The main problem is no one has come up with a good solution for providing health insurance to the consumer. Government is not the answer. That would only make everything more expensive, and the care would suffer. How anyone of sound mind can believe that the government can do things better than the private sector is beyond me--just a bunch of people who want a free lunch.

ron

Speaking for mental-health private practitioners, I can tell you the providers are having their reimbursements cut each year--5% chopping off 5% or added paperwork or more requests for additional authorized sessions. Working with family practitioners, I find that they are finding the same thing to be true for their practices. When there is an announcement of an increase, it takes a long time to get down to the practitioners and often the raise is minimal--in fact, often less when you count the new additional requirements to "prove" medical necessity or evidence-based practice. Most providers are considering other options or are looking for different careers. The people making the most money are those at the middle companies, the managed care organizations (MCOs) and the health maintenance organizations (HMOs). As far as the practice of capitalism, it stops before it reaches the private practitioners.

Edward Elgar

Dear American Friends:
I live in Britain. For 20 years, I worked and paid taxes for National Insurance, partly for the National Health Service. I am now unable to work because of serious health problems, which are unlikely to abate. The prognosis is long-term incapacity (or should that be indigency?) My medicine is not "free." It is funded by the insurance premiums I paid for 20 years as part of my contract between citizen and state.

Rob Johnson

Have any of you been to the dentist lately? It's $5,000 for a bridge, $435 for two cavities. Where do the less fortunate go?

Alec

The pro-deregulation crowd exists on intellectual dishonesty. First, most government regulations were at the behest of the insurance and medical industries specifically to increase their profits. The pharmaceutical and insurance lobbies are immensely powerful in DC.

Second, the anecdotal information about people traveling to the U.S. for health care only pertains to the wealthy. The wealthy don't have a health-care crisis, or really any sort of crises. That's the beauty of being wealthy. Rich people from other countries can and do come to America for treatment, but middle- and lower-income Americans can't get access to the same level of care, and that's the problem.

RIch, MD

One of the basic problems with health-care statistics is that the general health of a population is multifactorial. When you read that people in the U.S. are less healthy, have higher rates of infant mortality, etc., you must understand that much of the disease present in the U.S. is due to lifestyle choices, not lack of health care.

Even if health care was "free," do you think the obesity problem in the U.S. would disappear or even decrease? Drug and alcohol abuse, lack of two-parent households, terrible diets, and education problems all contribute negatively to our nation's health--and not because health care is lacking. If you look deeply at the numbers, you will see that, for example, after being diagnosed with cancer, people in the U.S. actually do much better overall than our counterparts in socialized-medicine countries. I work in our health-care field. It is not perfect, but in general it works.

Julie Z.

If hospitals can charge the uninsured an unlimited amount for procedures, the staff at Martin Luther King Jr. Harbor Hospital in Los Angeles should have been falling over one another to help Edith Rodriguez when she arrived in the emergency room. But no, this public hospital, begun "as the result of a community need," let her bleed to death on the floor over the course of 45 minutes.

Had she not relied upon "free" services and instead had gone to a private hospital that must deliver a quality product because it competes for business, she would have been treated, and she might be alive today. In debt, perhaps, but alive. You who say that placing a dollar value on a human life is heartless, there is the value of your socialized medicine.

Robert Batt

For a debate on health-care issues, let me throw this one into the discussion. Why do employers provide health benefits at all? They don't provide car insurance or home insurance. It's breaking the backs of even the largest corporations. It creates have's and have not's, those with benefits and those without. The health-care crisis is not the fault of U.S. corporations.

What should replace it, and what about the windfall corporations would get by not providing benefits? There are many ideas out there, so let the debate begin. Just get health care off the employers' backs.
Robert B

Texas

The only answer for providing access to group health insurance for all of our population regardless of income level is single-payer health insurance. The free-market system is dysfunctional. It is manipulated by insurance companies whose only desire is to maximize profits while minimizing care expenditures. Drug companies oppose block negotiation of drug prices, because their profits are higher if they divide and conquer.

I see several people claiming to be doctors posting fictitious undocumented claims that the government is the one responsible for the high cost of medicine in the U.S. I find it difficult to believe legitimate physicians can seriously believe the drivel they are preaching unless they happen to be employed by a pharmaceutical or insurance company.

Single-payer health insurance is the only workable solution to our health crisis. It's working in Canada and France, and it will work for us.

Susan Burrows

I'm with Ghate. It is the big government interference that has created this monster in health care. Let economics take its course and keep the government out. We will survive and be better off for it.

Rick

Can we please stop using BS political rhetoric to try and confuse people about a proposed government takeover of one-third of the American economy. Single-payer means the government takes over health care. Universal health care means the government takes over health care. At the very least, please just call it exactly what it is, socialized medicine. Proponents of socialized health care do not use those words, because they scare the hell out of the average American, and rightfully so. Americans are terrified by the prospect of our government taking over health care exactly because we have seen what a horrible job it has done in so many other areas, and how absolutely corrupt some of our politicians are.

Nom D Plume

To all the free-market ideologues who have posted here, a few facts to you from somebody who actually learned economics in a real PhD program rather than from Rush Limbaugh or Ayn Rand:

First, there is no such thing as a market free of government intervention. No market can function without secure property rights, and who guarantees those? Hate to tell you, it's the government.

Second, it is a myth that we are always collectively better off if everyone acts in his or her own narrow self-interest. There are lots of reasons why the market might not perform up to its ideal. Any time the market price fails to capture all relevant costs, the market will produce the wrong outcome. Air pollution is a perfect example. If polluters were forced to pay for the full health and environmental impact of their pollution, there would be a lot less of it. But can't the market solve the problem through tradable pollution credits, you say? Guess who sets the caps, regulates the market, and monitors compliance? Your good old friend the government.

What's the government doing when it intervenes in this way? It's weighing the interests of a small number of polluters against the interests of all the rest of us. This is a valid and important role of a representative government: It's where we come together to make decisions about things that affect all of us. It might not always work the way it should, but then neither does the market. Welcome to the messy real world.

So let's examine that great U.S. health care system. Rich Canadians and Europeans go to the U.S. for their health care; isn't that proof that it's the best system in the world? What nonsense. It's only proof that it's the best system for the few people with enough money to afford it. Ask average Canadians or Europeans if they would trade their system for the U.S. one. Then wait for them to stop laughing.

The true test of any system is how well it serves the whole population, not the select few. The U.S. spends far more per capita on health care than any other advanced nation, yet has among the worst health-care outcomes. I have a hard time believing this can all be attributed to "lifestyle choices," as suggested above. Having lived in the U.S., Germany, and France, I must say the U.S. system doesn't always measure up. If we would drop our dogmatic adherence to some cartoon version of economics (market = good; government = bad), we might actually find a pragmatic solution that is better than what we have now.

Another person in the system

This discussion has focused largely on health-care financing while almost totally ignoring the many other facets of the health-care industry that contribute to spiraling costs.

We have created an environment of patient entitlement that is devoid of personal responsibility.

We have created an environment that encourages unreasonable expectations; it is not surprising that 30% of Medicare expenses are for treatment within the last six months of a patient's life.

We have created an environment in which the threat of litigation is used to manipulate providers into performing unnecessary, pointless, or futile services.

We have created an environment in which the lion's share of reimbursements goes to those who are exposed to the least liability.

We have created an environment in which the true costs are concealed from those receiving services and the service providers are, in many instances, prohibited from attempting to pursue the recovery of these costs.

We have created an environment in which people expect providers to follow free-market principles while simultaneously imposing onerous regulations upon them (e.g. the obligation to continue to provide treatment once it has started).

The severe imbalances in the health-care system must be fixed before it will be possible to control costs.

Brant Gaede

This is about freedom, above all the freedom of doctors to practice medicine. It is also about the freedom of consumers to buy medical treatments and services.
--Brant Gaede

Jeff

Canada and France decided to socialize their health-care systems, because they did exactly what we are doing now; they regulated and slapped so many controls on the industry that the marketplace lost its efficacy in creating efficiencies. They regulated and regulated and regulated, and strangled the marketplace to death; then they turned around and blamed the marketplace for all of the problems.

Today American hospitals and the medical industry in general are heavily regulated. The more regulated they get, the more inefficient our health system becomes. Our government is like a big fat water hose extinguishing the fire of an incredibly brilliant, agile, and efficient marketplace. You see this innovation working amazingly well every day in other sectors of our economy that are not so heavily regulated. No one is proposing a government takeover of the computer industry, where prices are dropping like a stone.

I can only hope that we will not do what these other countries have done and essentially give up on a free market that has provided us with so much incredible innovation, and essentially go back to the dark ages of an all-powerful government and suffocating economic controls--where the “Federal Health Management, Preventive Medicine, and Wellness Preservation Subcommittee” has to hold two weeks of hearings to decide whether or not I get a blood transfusion.

Bill

To respond to one of the previous contributors to this discussion, I don't believe that someone needs a PhD in economics, or to listen to Rush Limbaugh, or read Ayn Rand books to see that our government cannot and should not take over the American medical industry. One only need to take a trip to the Post Office, Department of Motor Vehicles, any government-run school, or a government-run hospital to see that our government is completely incapable of doing a good job at almost anything. This is just common sense.

A PhD in economics is a good thing to have, but it is not required to make simple decisions such as this.

Bolden

It's amazing to see the different opinions between patients and doctors. Let's face it, people want to live their lives any way they want to and then get cheap drugs to fix their lifestyle-created problems. Obviously, there are people who do live their lives properly and still get sick or hurt, but the vast majority of problems are created by us. If people spent a little more on their health (money, time, and energy), they would be a lot healthier and this would be a non-issue. The problem is that people seem to delegate responsibility for their own health to their doctors or their neighbors instead of themselves. Wake up, and realize our habits are our own worst enemy.

Bolden

By the way, preventive medicine is an oxymoron, because drugs can only treat problems when they arise, and when used to try to "prevent" something from happening, the toxic chemicals only create other problems.

Zora

I think the average person who advocates universal health care simply doesn't understand what it takes to become a doctor in the U.S. Doctors are people, very hard-working people. They do not endure their rigorous training just to turn around and serve others for free. They are not priests.

There are four years of medical school to complete that will set back every aspiring MD an average of 150K. Then there are three to seven years of residency in which they generally make less than 60K. There is a huge up-front investment in time and money that the most qualified people will not be willing to make if the U.S. switches to a universal health-care system. These individuals would instead be attracted to other high-paying fields such as engineering, law, etc. Thus, the "doctors" of the future would effectively be middle-management types who graduated from local technical colleges.

I think I'll go ahead and pay a little extra to be treated by the guy who scored 1500 on his SAT and graduated as his class valedictorian.

Marco

Anyone who is an advocate of universal health care should go get sick in Canada or Europe. Only then will you see how "wonderful" government health care is. The system here in Quebec is expensive to the taxpayer, guarantees a 4- to 10-month wait to see most specialists, and promises long waits in emergency rooms. I am Canadian by birth, American by choice. I have lived through the horrors of universal health care, and I have to say that I would prefer to pay out of pocket medical expenses in the U.S. vs. free medical in Canada.

The problem I see with universal health care is that since there are no up-front costs (co-pays) associated with doctor visits, the public tends to abuse the system. Also, Canada’s policy on price fixing has forced a portion of its medical talent to move elsewhere. My statements are not meant to criticize the medical talent in Canada--the doctors, nurses, and support staffs are very professional. However, the problems associated with Canadian medical care start at the government level. Thank you, government of Canada.

Sonia

Zora makes an interesting point about the high cost for doctors to get an education. In turn, doctors must charge a great deal of money to repay loans and achieve a decent standard of living.

In France, most doctors go to public universities that are subsidized like most other educational institutions. As a result, obtaining an M.D. costs them almost nothing, and they do not have to charge patients an arm and a leg just to make ends meet.

Having lived in both the U.S. and France, I far prefer the health-care system in France, where the patient's well-being comes first, regardless of (in)ability to pay for care.

Smiley

In what fantasy world do people go to the hospital just because it's free? I've gotten MRIs, X-rays, and several other medical tests. It's really unpleasant at best. Unless I actually believed I needed to, I wouldn't subject myself to visits to a hospital or even doctors' offices. Certainly there are hypochondriacs who will do exactly what everyone fears, but public policy can't be designed around a handful of losers.

e angus

Medicare pays a primary-care physician $7 less than the cost of overhead for a simple visit but pays procedural specialists $2,429 dollars an hour, and the primary care physician is stuck with all the onerous paperwork and night calls.

John

Having lived with the British NHS and the American health-care "system," I can tell you flat out that the British system is far superior.

While in Britain, my daughter came down with appendicitis. We phoned 999 (British 911). The ambulance was there in 10 minutes, they rushed her to the local hospital, and she was examined, medicated, and on the operating table within half an hour.

She was kept in for a week, in a private room, since she had been close to peritonitis and they wanted to make sure that no complications arose.

After this, she was allowed home with a nurse visiting daily for the first week until it was clear that she was recovering rapidly.

The cost of all this to me? Well, higher UK taxes. At my earning level, that was about 32% overall, but the cost of the treatment itself was zero. Not a penny, and they even offered us a bus pass to visit her in hospital.

Now that sounds a little better than lying on the emergency-room floor, vomiting blood, and being allowed to die, as happened recently in the U.S.

The American medical system is a complete disgrace and anyone, like the Rand-ists, who claim that all people should pay for their own treatment obviously have never been poor and without coverage. What an abysmally selfish and stupid attitude. Let's just let poor people die then, shall we, even though one of their children may be the next Einstein.

Europeans, even the British, live longer, live healthier, and live happier than Americans. And for those who claim American medicine is the best there is, think again. There are plenty of Americans going to Europe for treatments they can't get here at any reasonable price.

In fact, more Americans are emigrating to Europe than Europeans are immigrating to the U.S., for which the American medical "system" must be held at least partly to blame.

John

Zora brings up an interesting point. America is the only country in the world where people become doctors with the prime purpose of making a lot of money.

Add to that the cost of American university education and you have a situation where even someone who went into medicine as an avocation (and yes, Zora, there are such people, even in the home of the selfish and the land of the greedy) have to make huge amounts of money just to stay ahead of the interest payments on their education.

True, European doctors make far less money, but they aren't burdened with huge education costs either, and almost all of them approach medicine as an avocation, rather than a wealth-creation scheme.

Face it: Making money off other people's being sick is just plain immoral.

Lafayette

OG: Health insurance costs so much today because the government, on the premise that there exists a "right" to health care at someone else's expense, has promised Americans a free lunch

Yes, it is called a "birthright." Ever hear of it? From having read the rest of your screed, I think not.

So, here's some instruction: A birthright is intrinsic; that is, we are born with it. We have, according to the Declaration of Independence, an intrinsic right to "life, liberty, and the pursuit of happiness." Mind you, happiness is not guaranteed, but its pursuit is.

So, what does this clarion call to birthrights institutionalized in our Declaration of Independence mean? First of all, you think it means liberty is the right to refuse government intervention in the market mechanism, because it distorts the mechanism and makes whatever goods and services are provided too expensive.

One can also interpret the "life and liberty" as the intrinsic right to a guarantee of life and its quality--that is, health care throughout our lives. Yes, liberty implies freedom of choice, but there exist remarkably good health-care systems that allow choice and deliver care at far less than rip-off prices. This article mentions one, France's.

Why do the French pour so many of their tax dollars into supporting this system (because even though a payroll tax provides some funding, most still comes from the state)? Because they perceive it a fundamental right of birth that medical care should be available to all, and at a reasonable cost. Just like justice is available to all, defense of the nation is for everyone, secondary schooling is afforded to all, etc.

There are services that should be, no doubt, provided by the private market mechanism. But where that mechanism has proven dysfunctional--in services that are considered crucial, even strategic to life (and the pursuit of happiness)--the market mechanism needs fixing. More than fixing, it needs a heart transplant.

A nation cannot fix its health-care system if that system has dysfunctional market pricing, which means uncontrolled pricing due to a perpetual excess of demand over the supply of health-care services (remedial treatment, convalescence, preventive controls).

To control pricing, one need only increase supply. But the supply of health-care services has proven to be inelastic. Why? The cost of educating and training medical staff. Fix that problem, and maybe one can get a better handle on market forces. One does not simply press a button and turn out a dedicated, competent nursing staff overnight.

Good luck. It is near a mission impossible to expand the supply of trained medical staff in the short run. It will take decades to generate an adequate supply of competent health-care services staffs.

Jerry

Doctors do not make money off people's illnesses; they make money by helping sick people and making them feel better so they can lead happier lives. I'm not sure how anyone could reasonably call this immoral. Making money from hurting people--like a hitman does--is immoral. What is really immoral, and I mean grossly immoral, is making doctors servants of the state, telling what to do, how to do it, who to treat, when to treat them, etc. These professionals did not work to get where they are in life to become lowly government employees. To propose such a punishing and horrible imposition on our doctors, the best doctors in the world, is immoral on a whole new level. That is just plain evil.

Tom

So where do "birthrights" stop and providing for your own needs start? In a socialist economy everything--food, transportation, housing, and a job--is a "birthright." What we have found from experience is that socialist/Communist governments do a horrible job of delivering all of these "birthrights."

The word "birthright" is very scary. It is a word socialists love because they can use it to pull the wool over the eyes of the uneducated and the poor. They use this kind of language to fabricate ridiculous arguments for everything from free health care to a free automobile for every citizen.

Health care is not a birthright any more than food, clothing, and shelter. In no way, shape, or form did the Founding Fathers indicate they advocated anything but a very limited government. It doesn't take a genius to extrapolate from their writings that they would be strongly opposed to government taking over 33% of the American economy.

Pierre

Then French system is a "hybrid." And it is deteriorating fast, mostly due to the fact that the Muslim-Arab population is abusing the system: family allowances, unemployment benefits, and so on.

One positive aspect is that the French government curbs the appetites of international drug companies and controls the price of medicine. On average, the cost of a month's supply of prescription medicine in France only gets you 10 days in the U.S.

richard

Of course, the issue is not free health care but rather universal access. The discussion leaves off on a major price policy that is also to blame for U.S. prices, i.e. the astronomical costs of medical schools. Do not expect to be able to create a universal health-care system with nurses paying $24,000 in tuition and doctors paying several times that. And of those who bleat about what they know not, I have lived the U.S. model, the German model, the Austrian model, and now the British model. They all have merits, but I have only been without cover in one country.

Zac

I have just one comment. I cannot believe that no one has absolutely pounced on John from Britain's comment. He claims he pays 32% of his pay for health care, and seems to think this is a bargain. If you tack 32% onto existing taxes, do you think this is cheaper than the health insurance cost currently being paid? Thirty-two percent is an astronomical number and completely unacceptable. If John makes 60K a year, that means in essence he is paying $1,666.66 per month for health insurance. If he was about 40 and his wife was the same age, he could get full coverage here in the U.S. for him and two children for less than $500 a month. Government guaranteed insurance for three times the current rate--where do I sign up?

Stan

Another British taxpayer here. I think John meant that he paid 32% of his total income in taxes. It certainly would not be 32% for health care alone.

There is always excess demand for health care. It has to be rationed some way, either through queuing or through price. The latter means that 50 million citizens of the most powerful--and one of the wealthiest--countries in the world have no health-care coverage. I would find that totally immoral, but it's your country.

You do have to wait for minor operations on the NHS, but if it's serious, you will always be dealt with immediately.

Barnett

The comment about 32% was about his total tax load. NHS is actually one of the cheapest systems in the West, and consequently has many problems due to aggressive cost cutting and price restrictions. However, that is now beside the point, as he is not paying 32% for that care.

The problem with so many proponents on here is their support of a complete government takeover (á la NHS) or a completely free-market system (á la--oh, that doesn't really exist anymore). You don't need to do one or the other. You can take our system and basically rearrange the financial workings of it to make it more equitable and effective, while meeting that market requirement of having all care be available at some cost. The scare is that socialized medicine will eliminate access to care in the pursuit of equity among citizens; however, that need not be the case. Structure a new system around the French one, where there is not only an extensive public presence in the delivery system but also an ability for a private market to provide special and experimental treatments, and with some tinkering you can get what you want.

Perfection as is pursued by the extreme ends is never achievable. Instead, work to come as close as you can while giving everyone a clearer head and some more workable guarantees.

Sonia

Pierre
June 19, 2007 05:19 PM
The Muslim-Arab population is abusing the [French] system: family allowances, unemployment benefits, and so on.

Family allowances (CAF) and unemployment benefits (ASSEDIC*) are not linked to health care (CPAM), so the comparison seems a bit dodgy to me.

In any case, it would be interesting to see the data that supports your statement. Could you provide a link or some other reference please?

*Only people who have actually been employed can actually receive unemployment benefits.

Warren

I've lived under the Canadian system, and I'm living in the U.S., and I will say that they both work OK, with the Canadian being better if you have nothing catastrophic and the American being better if you are not poor.

That being said, why is this such a crisis in the wealthiest country in the world? Why is it that so many European countries seem to get it right? Yes, there are exceptions, but what happened to cause so much of this current crisis in the last 30 years?

Could it be liability? The tech race? Dare we admit that other countries with a more "socialized" system are working better than ours?

I believe we all have to contribute to our health. At least give children decent health care. It is a right if we make it that.

Lauren

Bad, bad idea. With socialized medicine, you're encouraging even more illegals to flood in. I am incredibly skeptical that modern politicians and "intellectuals" are simultaneously encouraging amnesty and socialized medicine. And on this forum, many people have been speaking of how "rich" we are. We've lost about 15% share of the world's GNP since the middle of last century, completely paralleled with the advancement of social programs. It's not only the debate of helping out a couple poor folks; we're really talking about disintegration of the working principles of our nation. I'm reading The History of Money--great book. Every time, a powerful centralized government will bankrupt its own people in exchange for more power. They get power through your heart-strings--education, health services. The argument always comes back to how one would be icy to deny people these "human rights." Please, the mockery that they have made of education is sad at best.

Newton

Why does everyone assume "socialized" health care means price controls, wage controls, more bureaucracy, excluded benefits, etc. There are countless ways the U.S. government can make health care more accessible and more affordable. My personal suggestion is to have the U.S. government act as a universal PPO. Every person who is in the U.S. legally (citizen, tourist, PR, work visa, etc.) gets a health ID card. Any time someone obtains a health service or product (doctor's visit, prescription drugs, etc.), she shows her health ID card, pays 10% (or some other small percentage) of the total price, and the U.S. government reimburses the other 90% to the health-care provider. In this way, free-market competition is preserved, along with the autonomy of doctors, dentists, hospitals, pharmacies, etc. and the direct cost of health care is brought down for everyone. The U.S. government can pay for such a program by repealing many corporate and business tax breaks that lengthen and complicate our tax code.

Barnett

Lauren, what in the world are you talking about? Our share of world GNP may have gone down, but that's because the rest of the world has gotten much richer and better at economic production. World GNP (or more correctly, GDP) has increased substantially, along with our own GDP. GDP per capita has increased considerably as has overall wealth, median income, purchasing power, and so on.

Jerry

OK, let's at least stop putting the word socialized in quotes; that is exactly what it is called when government takes over the health-care system in a country. Why would anyone believe that our government is capable of doing this? People need to stop worshipping at the altar of Washington, D.C., and expecting government to fix all of the problems in their lives. Do you really think our government can maintain a massive database of millions of health care records? Hell, we can't even get the CIA and the FBI to use one single database. Our government cannot, and should not, be in the IT business; they have done an absolutely awful job of this in the past. I find it amazing that anyone would think they could do it now. It seems that there are some people who will push this whole government takeover of health care thing no matter how much compelling evidence is presented to show that our government is simply not capable of doing it. Even if it were capable, it is still morally wrong to use physical force to make one person pay for another person's health care. Our government can't do anything right; look at the disastrous situation at our government-run hospitals. Look at the disaster our government has made of Social Security. Look at what a disaster they have made of the war with Iraq. Based on these things alone, why in the hell would we let our government take over 1/3 of the American economy, and make it infinitely more powerful?

Jared Rhoads

The real question is not, as Dr. Swartz claims, "How will we finance [a universal coverage plan]?" That question takes for granted the conclusion that it is proper for government to involve itself in health care in the first place, which has not been established and cannot be established by reference to any rational definition of government.

Dr. Ghate's solution to restore individual rights places the debate where it belongs: Should man survive by extorting goods and services from others, or by trading with them voluntarily?

Jared Rhoads
Director
The Lucidicus Project

Steve

I think you are all afraid of suffering a little pain, getting old, and dying. I've read the majority of posts, and no one has asked the most fundamental question of all: How much health care can we afford? The amount spent on health-care technology and the delivery of this technology and improved methods is tremendous. Can we afford it?

Early in the discussion, the comparison to the electronics industry was used. A personal computer that is three times faster than anything built, could withstand a 100-foot drop, and could recognize my voice with great accuracy could be produced and sold within a year. Of course, we won't see it, because it would cost $50,000 and no one will buy it. But in health care, the money keeps pouring in, because we all have a "right" to access any great discovery. Why? Where do we draw the line?

By the way, any MD that is for total government health care, please get in front of the line for limiting your salary to $95,000 a year. If you think that is unfair, talk to the teachers who work just as long and hard as you.

Margaret

A nationwide survey by the authoritative Pew Research Center found that 65% of Americans support "government health insurance even if taxes increase." Even among those identified as social conservatives, 59% support a tax-financed government system. For other groups, the percent supporting were: populist conservatives (63%), conservative Democrats (73%), and "liberals" (90%). Only one group, enterprisers (libertarian conservatives), did not provide majority support (24%). (Pew Research Center, "Beyond Red vs. Blue," 5/10/05.)

Since some people would not want universal health care, they can opt out while the majority of American workers can choose to pay higher taxes with universal health care. In my opinion, this can be administered by the local and state government, which usually can make better decisions on the local level than the federal government. Furthermore, employers would not have to offer health insurance as an employment benefit. Instead they could offer higher wages and have access to a higher-level playing field with the rest of the industrial countries that have universal health care.

Mark

I lived in Canada for 35 years, then Europe for two and the USA for the last 12. Being upper middle class means that I have had good health care through my U.S. HMO but I did not have any problems in Canada or Holland either.

My complaint about the Canadian system was just that there should be some co-pay (since initiated), because we would always get too much medical attention. Doctors always wanted to refer you to specialists to double-check even if they were 99.5% sure you were fine or their diagnosis was correct. It does not cost you anything, so why not? They take no risk, their brothers in stethoscopes got some business, and the government pays anyway. This drives up the cost, and there used to be little acting as a regulator. As previous posters stated, regardless of the stories you may hear about Canadians' having to wait for a special test or flying to the USA for immediate treatment, ask the population if they would trade for the US. system, and you will hear laughter.

Doctors in Holland do not make high salaries. They have a good high-tech medical system, but they also have local GPs who work out of their house and support a few blocks around them. They make house calls and know the patients personally. Education is not expensive, so they just need the grades and aptitude to become a doctor. They also need the desire to help people, because they won't get rich. Again, few people would ever consider switching to the U.S. model.

I chose an HMO in the U.S., because it seemed the closest to Canadian care. No paperwork or administrative hassles and costs as long as you were using their own facilities. When they didn't have the equipment of specialist, they could send you to another facility and they worried about it, not me. So far, no problems and I am satisfied. I am very right wing (a Libertarian conservative in fact) on financial issues, but in this case, I see government involvement being necessary in the long run. All the research I have found on health-care cost shows that multiple administrative layers and systems plus the legal system supporting law suits against "rich" doctors and companies are primary contributors to the outrageous health-care costs in the USA. I can afford it, but the idea that 50 million people below my means may have to choose between their children's health and all of their life savings and assets bothers me.

A single government-regulated health program for high-cost procedures seems like a reasonable step. Yes, my taxes will go up some, but my employer will save a lot and I can get some of that back in higher wages or other benefits.

Charge back substantial amounts to people with lifestyle-induced problems if you want. Smokers, the obese or too thin, recreational-drug users, and heavy drinkers can all share some additional financial responsibility, and I won't complain.

I do get tired of hearing fanatical tirades from both sides of this debate coming from people who really don't have much experience or knowledge beyond the anecdotes they choose to listen to.

random

Oddly enough, no one seems to ask why a surgery can cost $250,000 or the price of a 2,000-square-foot house in an upscale suburb of a nice city.

When companies want to know why something is expensive and how to fix the issue, they don't fall into hysterics, rely on anecdotal information, or pound their chest about how they're the best company in the world and every other company's way of doing things is wrong and stupid. Instead, they do an audit and track down what makes up the costs of the product or service they're buying; they're getting down to its very basics.

Why do you have to pay a quarter of a million for surgery? What are the drivers? What makes up the costs? What sets that cost? Why? How can it be controlled or modified? Is it the doctor? The patient? The insurance companies? The lawyers? The government? All of them stumbling over one another with conflicting, duplicating policies? Why does a hospital room cost $1,200 a day and a pill cost $15?

Until someone does a full cost analysis on what really drives the costs of health care rather than make non sequiturs--such as "if the government is paying for 60% of health insurance in the U.S., it must be the government's fault that it's so expensive because the government always sucks eggs--or indulging in paranoia or nationalistic rhetoric, we'll be stuck with the problem of ever-more expensive health care because nobody wants to put in the time for an honest analysis of the situation.

Drive-by punditry is a form of entertainment for the politically fanatical. It's not an analysis or a solution. In fact, it's an antithesis of one.

Brad - USCorporateWellness.com

Obviously, as a national corporate wellness company, we've got a dog in this fight, but I'm glad to see that the majority of readers appear to "get it." Going to a national health-care system only shifts the dollars; it doesn't effectively address the problem. Until we consistently create ways for individuals to take personal responsibility through encouragement, tools, and accountability, the costs will continue to climb. And national plan or not, the dollars are still there.

Prashant

"Nationalizing" already brings up the fear of a Venezuela-type takeover of oil company installations.

Onkar: I have one question for you: How many people enjoy going to the doctor's or the dentist's? Most people go when they actually fall sick. Most people would rather spend time with family, work at improving their business, or volunteer for a good job. Only people whose doctor recommends a $2,000 liver test would go for it; regular people who can't tell where Washington, D.C., is on a world map are hardly smart enough to ask for something like that on a whim.

Maybe, Onkar, you like to go and visit your doctor instead of spending time with your family.

Jack Lohman

The costly middleman insurance bureaucracy consumes 31% of health-care costs without ever laying a healing hand on the patient. A Medicare-for-all system could extend first-class coverage to 100% of the population for the same dollars we are spending today. If the politicians were not receiving $100 million from the health-care industry, we'd have fixed health care long ago.

Jack Lohman
Business Coalition for Single-Payer Healthcare

Joe

Here is an innovative idea. Let the marketplace exists but on one condition: No medical insurance company can borrow money from the stock market nor can pharmacy companies borrow money from stock market.

Daryl

I want to clear up one of the most misleading arguments against universal health care/socialized health care, based on my personal experience with Britain's NHS, the Irish system, and America's health-care system.

It's extremely misleading to claim that socialized medicine restricts choice, or that "Big Brother" tells you what to do. It's not as if the government replaces the insurance company and decides which procedures and treatments you can and can't have, quite the opposite in fact. Yes the government is involved in setting up the system and distributing funds, but your health and your health-care decisions are yours to make, with the advice of your doctor. And you can go to whichever doctor you choose.

Compare this to a market- and insurance-based system in which your insurance company can approve or deny claims and thereby approve or deny your right to treatment.

It's simplistic and very 1950s Red Scare to argue that free market equals choice and socialized medicine equals restriction. The only choice missing in socialized medicine is the freedom to choose an insurance company, but that's only because you don't need one anymore.

Shawn

I think there there some additional things we need to look at:

- People are dying and not being treated because they have no health insurance.

- Companies like GM, Ford, and Chrysler are losing money because health-care costs in the U.S. are out of control. This is making U.S. companies less competitive year after year, and eventually companies will move more operations off shore where it is more cost competitive and health care costs are much, much lower.

- Quote from the movie Sicko: "If you can afford to kill people, why can't you afford to help people?"

- Living in the U.S. is becoming extremely expensive with health-care insurance premiums, student load debt soaring, and real estate costs out of control.

We need to come up with a solution now. Otherwise, this country will be left with no companies that want to operate here, people dying because they have no health insurance, and an unproductive workforce that is stressed with health-care costs. We need to end our narcissistic and selfish ways. Otherwise it will come around and bite us in the rear end while the rest of the world leaves us in the dust.

Socialist Frog

The "basic" French health insurance is compulsory with a regulated price proportional to earnings for the middle class--independent of the individual health risks. The prices of the basic treatments are heavily regulated. People buy extra insurance as they like and can. The quality is rather good (for instance, life expectancy is higher than in the States).

Of course, the situation is far from perfect. Because of the aging population, medical progress, overconsumption by the patients, and overprescription by the doctors, the GNP share of health keeps increasing (though it is much less than in the U.S., partly because highly skilled workers are paid less in France than in the U.S.).

Most French think that providing this safety net is maintaining our society the way we love it. Of course, that's a political choice and other choices are possible.

Some economic theory for the "extreme free marketers":

A. As game theory (for instance) shows, having the choice is not always in your interest. As for the insurance of people with differing risks, it is well-known that freedom will lead to:

1) healthy people refusing to contribute, and some of them then free-loading in the ER; and
2) the ruin of the insurance companies that are the slowest in pricing out riskier people and therefore will get all of them.

B. Health care is an informational nightmare:

1) People won't reveal how risky they are--even if they know it.
2) Doctors won't reveal how good they or the treatments they recommend will be for the given patient--even if they know it
3) Let us not even speak of the complexity of the provider/insurer/patient relationships, which is attested to by the fastest bureaucracy in the world.

Finally, it is a strange to read free-marketers suggesting that economic freedom requires forbidding many people from buying what they want--that is, health insurance.

Graham

What if you didn't have to worry about getting sick? I mean, even those of us with health insurance can't be 100% sure we will receive the benefits we are entitled to. Why? The companies have a vested interest in increasing profits. Many of them are bound by law (by their shareholders) to increase profits. You could actually hold stock in a company that will deny you coverage.

Think about that for one second. We are weighing a company's profits against the welfare of our population. This is insane. Wake up and do something. To contact your government officials:
http://www.usa.gov/Contact.shtml

Mark

Why should socialist, Marxist, and Communist be forced to stop at the total socialization of medicine?

Why not put the United Nations in charge of truly universal medicine without borders?

Just think of a world where auto insurance, property insurance, life insurance, and every other type of insurance is run by the government.

What about a world where the government completely controls the press, religion, the allocation of financial capital, and real estate?

Just think of what socialization has done for Russia, China, and North Korea.

Heaven on Earth?

Where can I get an insurance policy that protects me from the harm caused by the government?

After medicine is socialized in this country, going to the DMV will be like Disneyland.

Daryl

Mark,

The difference is that health care is an essential service, like the police and the fire department. It's a ridiculous McCarthy-type step to assume universal health care is one step toward land redistribution.

The "socialization" of medicine has nothing to do with "socialist, Marxist, and Communist" forces. Problems in Russia, China, and North Korea come from totalitarian governments.

Many, many countries, like Britain, France, Italy, and Spain, have "socialized" medicine and democratic systems that in some cases work better than those of the U.S.

Michael Pierone

France is being billed as the best health-care system in the world. Just one problem: It isn't.

How about a real-life example? In August 2003, 15,000 elderly died in French hospitals because of a heat wave.

A heat wave? You can't walk into an American hospital that doesn't have air conditioning, but apparently you can die from heat in a French hospital quite easily. How does the World Health Organization give a top rating to a country whose hospitals can't keep 15,000 elderly from dying in one summer from heat?

I guess France's socialized medical program can't afford modern medical devices like air conditioners even though they spend upward of 9% of their GDP on health care. I regard 15,000 deaths of elderly patients from heat in French hospitals as a rather severe failure of the French health system.

France's health-care system may be better than ours, but I'd avoid being sick and elderly there in the summer.

Daryl

In defense of the French health-care system--which I'm not holding up as perfect--that heat wave was off the charts. The absence of air conditioners wasn't because the health-care system couldn't afford them; it was because they never thought they'd need them. It was the same across the whole country, not just in hospitals but in people's homes, too.

The reason you can't walk into a U.S. hospital (or office, apartment building, etc.) without seeing air conditioning is because it's generally hotter in America, and people routinely use air conditioning. I'd never even seen--much less needed--an A/C unit until I moved to the U.S.

So yes, the heat wave exposed many problems with French health care and the government's response to emergencies (e.g., the government was too slow in declaring a state of emergency and too many health-care workers were on simultaneous vacation), but it's misleading to say "France's socialized medical program can't afford modern medical devices like air conditioners even though they spend upward of 9% of their GDP on health care." It was a crisis they never thought they'd have to face.

Still, 15,000 deaths was a failure, and the French viewed it as such and took steps to be better prepared should there be another heat wave. But 18,000 Americans die every year because they're uninsured, so surely America should consider that a failure of the system and take the appropriate steps.

Jack

Where is all the money going? Not on new drugs, because as we know, insurance companies will not pay for them. Not on new surgeries, not to the health-care providers. Look at insurance company profits and what they pay their CEOs: up to a billion, yes, a billion dollars to United Health's last CEO. The system is riddled with corruption and volumes of stupid paperwork insurance companies pay staff to read and file. Of course everyone can have access to health care in this country, but only when insurance companies are prepared to curtail their outrageous profits.

Phoenix

There are numerous things wrong with our current health-care system. I don't know about you out there, but my income has not gone up 67% or 76% as the cost of medical things has in the last few years. In fact, right now I am unemployed yet expected to pay $600 per month for insurance that only covers 40% of the cost of any care I get. Yet I guarantee you the CEOs of these insurance companies get their money and benefits. We pay for these CEOs' salaries. I guarantee you they do not work harder than their employees do, yet we pay them like they do. If they did not have employees to do the work, they wouldn't even have a job.

The CEOs should lower the cost of our care, pay more for the medical procedures we have to have, and take a substantial cut in salary, based on their actual performance. U.S. citizens deserve to have a reasonably priced health-care system, better customer service from these insurance companies (they need to realize that without us they would not have a job), a medical person who actually makes the decisions about the medical care we need (instead of decisions based on the approval of a nonmedical clerk or nonmedical CEO), better priced premiums, and total elimination of "preexisting conditions" from all insurance. These are just a few things on my chest about our health-care problems.

Me

Onkar, are you nuts? Maybe if the industry would stop selling us crap we don't need, we wouldn't demand and consume it.

Malagent.com

RE: Maybe if the industry would stop selling us crap we don't need, we wouldn't demand and consume it.

Maybe if people stopped demanding and consuming junk they don't need, the industry would stop selling it.

Just because something is advertised does not mean you have to buy it. I see many drug advertisements, and I don't use any of them. A lot of other people do use them though.

David

Onkar:

"When a person can consume medical services without needing to consider how to pay for them..."

Are we supposed to run a cost/benefit analysis on all of our health needs? Even the unexpected ones? What if someone has a heart attack or breaks a leg or has a major car accident? How realistic is it for people to just say that they won't receive treatment because they can't afford it? I cannot imagine someone saying, "You know, I think this bone sticking out of my leg will eventually heal itself. Besides, I need to pay rent this month."

Health care is not a regular good or service, so the same market forces shouldn't apply. I've never heard of any persons dying because they couldn't afford an iPhone or a car wash.

Heather Shirley

Will free health-care for children increase population growth?

I believe the No. 1 priority of the globe should be to protect the habitability of the Earth's land, air, water, and atmosphere. I believe the second priority of the globe should be to aspire to end terrorism and wars. In my view, the third priority should be public health.

I am against any form of Universal health-care system (free health care for young people) in our country for a couple reasons:

1) People who are planning a family should be planning on their budget as well. Their budget should include how many children they themselves can afford to pay for, not the taxpayers.
2) It may be possible that people who are planning families will produce more offspring if the health care is free. I do not think a population growth is needed at this time, even though the elderly are holding on to life longer than ever and they rely on the younger to do daily basic toileting, etc., for them.

I am opposed to any universal health-care plan.

-Heather Shirley

Justin

It's so sad to read this. We Americans are lazy. We put trust in those making the most compelling arguments rather than question their motivations. The most compelling arguments are the most compelling because they are backed by boatloads of money, the boatloads of money that are being squeezed out of us through health-care/insurance costs. Their goal is to get us so dizzy that it is much easier to just agree with them. And they are extremely successful at this. Just ask why so many Americans voted for Bush. Are we learning our lessons? I don't think we are.

Socialized health care is the answer. The opponents are either bought, lazy, or uneducated--which unfortunately accounts for the majority of Americans.

So go ahead now, you Sean Hannitys, accuse me of being unpatriotic. Put your spin on it.

Joe

According to the BLS webpage, real earnings have declined by roughly 25% in the past 30 years. Have you ever heard of a concept called inflation? Of course GDP, GDP per Capita, and median income will increase, but this does not mean that the value has increased along with the meaningless number.

LAW

In response to Heather Shirley...

What you stated does make sense, but you neglected to mention all of the unplanned pregnancies that can be avoided because that uninsured 19-45-year-old population can now go to the MD and get the birth control that they otherwise believed they couldn't afford.

Simon

I understand that this is a complex issue, but isn't anyone worried about what will happen to people who cannot pay for health care? Does anyone worry about a possible future in which for some, a healthy life will simply be too expensive and therefore for many it may be cheaper to simply die? Do we really want people to wonder if they can afford to live or not? Sure, sure, "if we abolish government interference, then everything will be great," but what if it isn't? What is our fundamental commitment to? The health of our economy or the health of our people? Of course we all want both, but in the interim period before we've found that happy medium, what/who are we willing to sacrifice? Our standard of living or our compassion? Onkar said that people were "consuming" health care. That's an interesting euphemism. So is that what we'll tell people one day? That they simply need to lower their "consumption" of healthy lives? According to Onkar, people have become so healthy that it's the economy that's basically become sick? Maybe we should privatize all social services? Me pay for the local fire dept? No way, my house isn't on fire. Yours? Well I guess your homebuilder shouldn't have used so much wood. A brave new world indeed.

NRK

Mr. Ghate says people should be responsible for their own health care. So I am sure Mr. Ghate supports a living wage, say $20 to $25 an hour, so everyone can pay for that health care. I, for one, think if you work, you should have health care through your employer just like you have unemployment insurance, Social Security, etc.

We should also look at some of the cost controls that the Europeans have on health care, i.e., maximum annual payments to doctors (prevents doctors from becoming millionaires), fixed fees for service without any surcharge (stops doctors from charging more than insurance pays for a procedure), no payment based on the local average for a procedure (prevents doctors from raising fees to bring the average up), etc.

For those on government insurance, the government should negotiate a best price for non-service items like drugs.

FDMOM

Why is it okay to heap "blame" onto employees and their allegedly bad behaviors? Why do we expect medical insurance to cover every doctor visit instead of preventing catastrophic financial loss? How long can employers attract the best and brightest if health care costs continue to increase?

Is this how it was supposed to be? It's generally accepted that approximately 20% of individuals account for 80% of the overall costs, plus 50% of U.S. bankruptcies can be traced to medical expenses. Personally, I'm not optimistic that things will improve anytime soon, but blaming each other doesn't help.

We're among the lucky with decent coverage. Still our personal outlay exceeds $20,000 annually (increasing every year our daughter lives). So many here assume that they'll always be healthy or that their children will not have issues. Guess what--expect the unexpected. Our oldest daughter (12) is one of 450 worldwide. Based on what some have written here, we should pay for everything ourselves. How can we? We max out our medical FSA by April with prescriptions and medical copays. The bags for her feeding pump cost $15 each ($450 a month); her food, $4 per can ($725 a month); oxygen "rental," $800 a month; that feeding pump, $2,000, plus now we're being charged $300 for a "tune-up" or faced with getting a new one (latest insurance battle); we change her feeding tube button four times a year at $250 each (should be more often). We do it ourselves instead of going to the doctor (though we certainly could).

Insurance pays 80% of its "negotiated rate" while we're stuck with the rest. I'm okay with paying our share of logical costs. Who out there can tell me that those are logical? Last winter, her two-day hospital bill (not PICU mind you) was close to $10K. What is that? For us, it's actually cheaper to go out of network after a certain point each year so we're 100% covered.

I worry every day that I'll lose my job and we'll be bankrupt in less than six months despite what my husband earns. Those earning half-million dollar salaries are vulnerable, too.

I know many physicians who also struggle with medical coverage for themselves and employees and families.

This issue is universal to Americans. I'm sure my own health would be better if I didn't live with this incredible stress all the time. It's hard enough raising a family, but add in special-needs individuals and see what happens. I'll fight to the end so that our daughter receives everything medically necessary: including supplies, therapies, and medicines, all of which extend her life and her dignity. This is the "lottery" we won and believe me, we did "win." And so did this country--it's a better place because of this special person. Some of the cold-hearted, only-the-strongest-can-survive types could learn quite a bit from the special-needs population (of any age).

Sorry for the rant, but this is a topic that is near and dear to me. If I could quit my job and lobby for better health care, I'd do it in a heartbeat. If my legacy was having made this world a better place, I'd be very satisfied.

Concerned

My concern is for the people out there who cannot afford basic health insurance or those of us who pay for basic health insurance but still can't afford the deductibles and copays. Universal health care does not mean the government will force everyone to use it; it only gives those who can't afford private health insurance a chance for better health and quality of living. You people with money would still be able to purchase private health insurance that would allow you more freedom and more choices, but that's what your paying for. Those of us who are doing without would gladly sit in a doctor's office for one or two hours for appropriate and quality health care. Think of someone other than yourselves. The numbers for uninsured have increased so significantly they cannot be ignored. I make an average living, but after health insurance, life insurance, dental insurance, eye insurance, FICA, Social Security, federal taxes, state taxes, comp., etc., I am well below the poverty line, but I make too much for assistance. Does that make sense to anyone out there? I, for one, would gladly sacrifice my time for quality health care. As it is now, with insurance, I can't afford my monthly meds, and they are all very common meds, but even with my insurance, it would cost me $200 a month. I can't afford to be healthy. So quit thinking selfishly of how this could hurt you, but think more about who this could benefit. Stand behind your neighbors instead of in front of them, beating them down.

sue

Anything that promotes some basic level of universal health care, including wellness coverage, will save money in the long run. It will keep people healthier and more productive. It will also prevent the phenomenon where uninsured people wait to get treatment until they have a (very expensive) health catastrophe that has to be covered by charity care at public expense.

Joachim W

It's depressing to see how so many Americans have forgotten their legacy of freedom. To quote Dr. Leonard Peikoff: "Is this what is left of the noblest experiment in human history?" I myself live in Sweden but dream of getting to the U.S. (and I'm going to). I don't care about politics in Sweden. It's a ridiculous poor-ass country anyway that would be nothing without the ability to buy all the innovations that the U.S. economy creates. But when the "mainstream" ideas in the U.S. don't seem very different from the Swedish mainstream ideas, I'm saddened and scared. Creds to the people who do defend liberty anyway.

Why can't people understand that capitalism is superior at producing everything? If one advocates for universal health care, it makes no sense not to then also advocate for universal computer coverage or universal food coverage. I can tell you that the Swedish health care system is not working, and has very long waiting lines. Our previous Prime Minister Goran Persson had to go to a private clinic in order to avoid waiting for more than a year for hip surgery.

Resident

As a physician, I don't like the idea of being enslaved to take care of someone else who may not give a hoot about their own personal health or for that matter, care to budget and save for emergencies. Socialized medicine is an excuse for a country that can't learn responsibility, especially one that values hard work and bringing yourself to the top on your own.

I never grew up with lifestyle needs (an iPod, expensive gym shoes, cell phones, etc.) and my family was able to do fine. We diverted money toward real needs and learned to deal with it. Somehow, a total gross income of 50,000 was enough. Maybe it helped only having one child in the house versus having multiple kids who you can't afford. Heather Shirley's post is one to note that people need to have fewer kids. Population growth is essentially the core of the health care burden. More dollars wouldn't be needed if there wasn't an increasing number of baby-boomers.

Numbers are always being thrown out by politicians so they can get votes (the bottom line). I never see them address how many don't have it but can afford it by reducing their other lifestyle factors. Children are my only exception, because I can't expect them to be held accountable for what their dumb parents do.

Steven

At my dentist, a young Hispanic mother walked in with her son in pain from a bad tooth. She was told that she could not be seen without paying $200, and to come back when she has the money. They did, I think, give her a prescription for pain meds and antibiotics.

That's the "market" for you.

For "RESIDENT"

"Children are my only exception, because I can't expect them to be held accountable for what their dumb parents do."

Do you count the "dumb parents" who were horrible enough to unknowingly pass along their recessive genes to produce the one great kid (out of 3,000 live births) "lucky" enough to have a life-threatening or fatal genetic disorder?

Life doesn't always work out as planned. I couldn't have prepared or saved enough money to "anticipate" our expenses for a single year. Emergencies and unavoidable things happen, and most of us should be prepared but cancer, too? Chronic disabilities? Don't think so.

I hope that chip on your shoulder eases before you finish your residency. I'd kick you out of my daughter's PICU room so fast with an attitude like that. We find and use doctors who partner with their patients. Families can be part of the team if allowed. (Plus, we usually know more about the specific disorder than the residents and often department heads.)

Dr. Sanjay M. Udoshi

Dear Onkar,
Your views are indicative of a clouded intellect and a complete lack of domain expertise altogether. My advice to you is to leave this debate to those who have truly studied it, such as those with MDs and PhDs related to health care and the science of health delivery. The adage "Physician heal thyself" is truly apt in this debate, and an overwhelming majority of physicians of my generation are in favor of an NHS style paradigm shift for the U.S. With the war budgets at trillion-dollar levels for what should have been a police response to the scourge of terrorism globally, it is truly asinine to assert that we as a nation cannot afford education, infrastructure, and health care as fundamental rights and provisions for all our citizens. The argument that we cannot afford these things holds no merit whatsoever. In short, Onkar, wake up.

Dean

In response to "right to have health care."

If you feel that people do not have a universal right to health care, why stop there? Why not have a "pay per need" for everything?

Why should we have the "right" to have police, the fire department (for us in California, we should be happy we have this), the military, the sewer/water/garbage and city departments?

You can see this is illogical as is the lack of universal health care.

The reason we have all of the above is to have society as a whole be far healthier, and to have all help pay for the services. This should carry over to health care as well. Having everyone on a universal system means less paperwork, fewer mistakes (remember the USA is one of the worst western counties when it comes to mistakes because of the lack of universal record system), more doctor time with patients and not with paperwork, and a lower cost for everyone.

It makes sense to have everyone covered--this should be thought of as a basic human right.

Be humane and have everyone covered.

Alexandria German

I live in Peoria, Illinois, and I'm a freshman at Richwoods High School. I think that people who are uninsured should just shut up and deal with it. It's not the government's problem.

Jenny

As Michael Moore stated in Sicko, there are several insurance lobbyists for every member of Congress. And we shouldn't expect a lot to change on the policy front, because their money makes the Washington world go round. What I don't understand is, why aren't other U.S. companies--saddled with huge health-care burdens for their employees (the auto industry in particular)--out there hiring their own lobbyists, pushing for a plan to alleviate some of their astronomical costs?

Zanne

I may not know the answer, but first I think we need to agree on the problems that exist and the ultimate goal.

The problem with health care as it stands is that there is no incentive for complete care or preventative care. The goal is not the best treatment. The goal is the most profit.

Those "elective" tests and yearly "unneeded" doctor visits that you don't want to pay for could curb diseases that cost far more to treat than preventative tests and screenings. It could also prevent a lot of pain and suffering. Not that that could possibly be enough incentive to provide it.

The health care industry obviously needs another incentive to give the best care for the least cost for everyone--instead of the least care for the most profit for themselves (as it currently stands). Unfortunately, Americans themselves do little to support prevention, as most would rather pop a pill than exercise and eat decent food.

One main issue in the U.S. today is its mental health problems. By this I mean stress, anxiety, depression, and all those issues that are plaguing the American people and lead to the worst health problems out there. These are also major reasons why people aren't motivated toward self-care. America is overworked and overmedicated. In a capitalist world, people work to increase monetary profit at all costs, and the biggest cost they pay is the quality of their own lives. Cost of health, cost of moral standards, cost of self-respect, cost of a neighbor's life--are these costs worth a bill of any amount?

We need to work toward a higher quality of life, and I don't mean living in huge houses, driving expensive cars, and every other superficial attempt made to cover self-loathing (gee, I wonder why that exists...).

Bottom line, health care should do what its name implies. Money should be a secondary issue here. And I'm disgusted by the idea that the right to hoard money should come before a person's life and health. I don't know what the answer is. But I do know that somehow the ultimate goal of the health care industry has got to change to improving the health of people, not the weight of a purse.

JRC

- There is no First World country with a more expensive system. On average, ours cost 2x's as much.

- There is no First World country with outcome measures as poor as ours. (Longevity, infant mortality, patient satisfaction, etc.)

- There are no official statistics regarding the number of Canadians who get care in the U.S. The survey research that is available indicates that Canadians rarely come to the U.S. for care and prefer their system to ours.

- A single payer system is not necessarily socialistic, e.g. Medicare (whose overhead is less than 3% compared to CIGNA, whose overhead is 34%)

Paying twice as much for less quality is not a conservative way of using our health care dollar.

Chris

Americans really need to quit buying into the urban myth/legend that Canadians are always coming to the U.S. for treatment.

It's been a hot-button topic here in Canada in recent years, and there have been a lot of researchers scrambling to pin down the actual numbers.

Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States.

Indeed, the numbers found are so small as to be barely detectable relative to the use of care by Canadians at home.

Milko

True free-market policies should fix our problem here, starting also with limiting vultures'--I mean lawyers'--possible gains in lawsuits, not half-assed remedies or government intrusion attempting to be the provider/payer.

Researching this I even found this Spanish site with a poll about it, and more discussion in the forum. I thought it was interesting.
http://www.MedicosCubanos.com

Charity

All this "I don't want to pay for someone else's health care." Well, we already are, except we're paying that and the profits and paperwork, too. In my state, 55% of our health care is funded by our taxes (that's Medicare, state funded care for poor and all the workers, city and state) who get their health care paid by our taxes. Pretty much the rest of the state health care is funded by anyone with an insurance premium. For those who do not know how insurance works, let me enlighten you. We're stuck in risk pools (fragmented because keeping us seperate works best for them) and as the monies in these pools decrease as more and more people can no longer keep up with skyrocketing premiums and deductibles, the money in the pool obviously lessens and the companies raise rates for everyone in the pool to make up for the monies lost, and then you have a whole new set of people who can no longer afford it, and then the vicious circle is repeated. So let me ask you people whose main objection is paying for someone else. You'd rather pay Larry Glasscock's $75 million dollar salary and then his $43 million retirement package?

Heather

Health care is not free--ever. It would be more expensive under universal health care. Get government out of it. Give it back to the free market. Trust people will make their own priorities and know what to do with their own money. How many people who don't have health-care coverage truly can't afford it? Do they just put their priorities in other places and then blame the government for not giving them health care?

Barclay Reynolds

We say we are a Christian nation. If true, then who is the one to say who gets care and who does not? What is a free market? Where does this almighty live? Do people pray to "the free market"? (Probably.)

So who among you will stand at the hospital door and say "Not you" to the sick? Would Jesus do that or take the poorest one first?

Tim

Are you crazy? No way I do not want universal health care.

I do not want my "personal rights" given to me through Roe v. Wade, to be dictated to me by some guy or girl setting policy in Washington, D.C.

Take a look at the health-care system in the northwestern states. The doctors, politicians, and insurance companies came together and decided what medical procedures would be covered. Almost 800 items were listed, and 500 were said to be okay. What about the other 300 items? Sure, I would not want many of the plastic surgeries to be covered, but what if my wife wanted an enhancement? Nope, against the law, go somewhere else to have that done. My personal insurance does not cover birth control. That means my chances of having a $12,000-plus-a-year baby bill is possible for the insurance company.

Most important of all is how the discussion of universal health care will affect your taxes. Under the new federal ideas, everyone has to pay.

This question does not include religious beliefs; they should be on the side like an order of fries.

I still say no to universal health care. How about we look at how much of our tax money goes to other countries, to fund them? Maybe we could use that to fix our own problems at home instead of trying to fix the world.

Wes

I am from Canada and recently broke my leg. It required a plate to be surgically implanted in my leg to help correct the injury. I am at best an average-earning person. My friend who is from California pays $400 to $500 a month in premiums and pays slightly less (maybe $100 dollars a month) in deductions than I do. We earn only $1,000 dollars difference in income each year. My leg cost me $30 dollars for my crutches; that is it. My friends son, who had the same injury, only had partial coverage and still had to pay nearly $800 on top of what the insurance covered. What kind of system is that? I am not worried about needing a major operation that will ruin me financially. My neighbor's brother who still lives in the states had a heart attack. He had to sell his home to pay the bill and now lives in a crappy rundown old-age home. People complain about paying for their neighbors' health care, but what if you needed that help? If you don't care about yourself, what about your son or daughter? Would you want to watch someone die because you were too cheap to come up with some money to help them? Hospitals only have to stabilize people; they don't have to cure or fix them in the states. By the way, those complaining about wait times in Canada, I waited two days to get my surgery. Any emergency surgeries are done right away. Only rich spoiled people who are too "important" and impatient to wait, go to the states to jump the line. Our system has its issues like any other, but at least I will take our system over the American system any day. By the way, the only people who benefit from the American system are high earning members of the insurance and prescription drug industry. My taxes aren't much, and possibly even less than yours. I am sad to say the biggest problem is that your political system allows too much intrusion from the wealthy elite. Campaign contributions are barely regulated and therefore politicians can be bought off easily. Not to mention, back opponents of politicians who oppose them to the point that they would lose re-election. Personally, I think the American political system has reverted from a democracy to a authoritarian regime that hides under the veil of a democracy. Unfortunately, all the elites that wanted to keep power after the American Revolution found a way to do it. They corrupted the democratic system from within and set it up to serve them.

I am not being Anti-American. There are a great many things about your country, including your military and patriotism. Unfortunately, I think you have forgotten many of the values that once made the country great (example: caring about your fellow American).

wes

I wanted to add something that compares paying car insurance to paying health insurance. My part of the country in Canada has a single vehicle insurance provider. To get a light vehicle driver's license costs $25 (including the mandatory driver's training course). My insurance on a vehicle (2002 Chevy Silverado) costs $750 a year. Geez, doesn't sound like the government screwed that up. You might say that people suffer from reduced coverage. Well, no one is getting rich off an injury. Legal costs and high insurance pay outs have steadily increased the costs of American car insurance. Yes, people who get hurt might not get reimbursed as much as they like. They do, however (thanks to a publicly funded system), get their medical costs covered for however long they need, including physiotherapy and chiropractor appointments (through in most part, our public car insurance program). Wow, so my car insurance and health coverage(joking here about health payments since there are none) cost me $700 to $800 a year. If our public car insurance company makes an above average profit, we get a check in the mail. Or, that extra money is used to keep taxes low and pay for other public services, such as health care (must be joking? No). It isn't perfect, but I have no qualms about using this system. This system also creates simplicity, because big businesses know where to go and how to get an answer without talking to 20 different companies or departments. Since it is a low profit system, costs for consumers are kept quite low, because we don't have to worry about making someone rich or maintaining a high profit margin. Like I said earlier, a public system can work when you have a good political system. Unfortunately, a system that enables corporations to buy up politicians and keeps the elite in power can't possibly benefit any average person for the most part. It just has the power to manipulate them into thinking it does. The American government hasn't done a good job with finances just like the socialist governments. Think about it, Americans are in more debt per capita than any other country in the world. The answer to the American system is to either get rid of the two party system or to create a democratic setup similar to that of Canada, France, or the UK. Now I know you probably want to jump all over this, but think about it. These countries are all doing significantly better than the U.S. financially right now. Big corporations bought up politicians to create a credit system that would get them a bunch of money while sticking it to the average person. Unfortunately they went too far and are now feeling a big crunch. Who do they want to bail them out? The government. They will, too, because they are all on their payroll. When was the last time the government paid off your debts? Not gonna happen.

Wes

One last comment about Tim's response. In most universal (if not all) health care systems, plastic surgery is not covered, unless to repair something that is a birth defect or caused by an accident. Tummy tucks and physical enhancements are not covered (for example). Quit going to war, and there would be a lot of money for universal health care. No need to raise taxes then.

Carmine Lisella

I can only say one thing to the "socialized medicine is God" crowd--do you want your physician to be a civil service worker?

wes

I don't care if my physician is a government employee (civil service worker). In Canada, they already are, and that doesn't seem to be such a big deal. People need to get over their distrust of government, although I do see why no one trusts the American government. Not exactly instilling trust in anyone.

marshall jones

Is it unethical for a hospital to refuse to treat someone who is having a heart attack?

Randy Childress

I have taken on this assignment out of personal necessity. I was diagnosed with Type I diabetes about 21 years ago and through no determined fault, became a rather brittle diabetic having experienced some incredible incidences that scared the crap out of me when they happened. Low sugars, seizures, constant testing, and constant care is a way of life, and I have tweaked it to where it has become my everyday concentration and focus. Health care coverage has always remained a constant with good coverage, bad coverage, and in-between coverage with a focus on pharmaceutical coverage and co-pay. I am getting older and I am currently on a Cobra coverage plan that expires in February of 2009, and my choices are rather limited for the future. If I don't get something that I can afford and allows me the peace of mind not to pay $2500.00 a month for my medical supplies, I am facing a rapid decline in my health, and death.

I know it sounds dramatic, but I tend to down play the reality of the whole scenario and now find myself every day wondering when the curtain will finally fall on my one-act play.

Employers at small companies are stretched to the max, and I have always worked for privately owned corporations (for the most part), and depend on their generosity and compassion to assist me in staying insured.

It is a real crap shoot in this country, and I sure have my selfish reasons for wanting universal health care in the United States. I have a great stake in the process and I just can't afford to continue jumping from expensive insurance because small business sometimes does not have the quantity of people needed to spread the risk.

More to come from a guy who is really scared.

Brett

I think that if we socialize health care, then we should also socialize food, shelter, and livelihood. Since we're having the central government create one set of paperwork, we could also have them set limits for food consumption, ensure that everyone has a minimum level of home to live in, and also distribute jobs and set wages for people in those jobs.

Oh wait, that sounds like Russia and China, two countries whose socialist policies so failed their citizens that they had to convert to capitalism to compete in the global market.

Look folks, far too much government intervention is causing the problems with our health care system today. The only way to fix it is to allow the free market to work, and eliminate price controls. When you have oligopsony in the market (small number of buyers), you have a situation of imperfect competition, resulting in a small group having control over setting pricing. Competition, and only competition, will bring down pricing. Adding a larger or more bureaucratic buyer in the marketplace will do nothing to improve pricing; it will only make matters worse.

Oh, and for all those who feel that health care is a right, consider this: A right is something that can be enforced by government, which ultimately means through physical force or coercion. In other words, doctors would be forced to provide their service at gunpoint, and failure to do so would result in loss of life (capital punishment) or liberty (jail). Now, since the Declaration of Independence states that all men have certain inalienable rights, those rights being life, liberty, and the pursuit of happiness, the "right" of universal (socialized) health care stands in complete contrast to the founding principles of our nation, and therefore could be considered nothing but immoral and a violation of our Constitutionally protected freedoms.

No Joke

I've only read a couple of the first entries, and in response to Joe's post about how well the UHC has worked in other countries, I'm currently doing a research paper on this topic and Canada has an average of a three-month waiting list to see an ENT. Frankly I don't want to have to wait that long because I do Scuba diving, and ear infections are a "thing of the trade."

Irene Sanders

In regard to this topic: I propose something never before done anywhere in the world. Let's make the learning of biology, chemistry, and medical science mandatory for every student in public and private schools from age 9 on to 18.

I personally feel that I should be totally capable of being independent of anyone outside myself for my health care. I feel that I should be able with such knowledge, which is to be equal to that of the education of a U.S. physician, to treat myself. After all, don't you physicians say that no one knows my body like I do? Did I not live with it for years? Do I not know all about my family's history so that I can save paper by not having to have a nurse write down my history every time I come into the office? Also, this is a very "green" idea. This will prevent paper usage and allow people to do as psychologists suggest, "taking back my power." I should therefore be able to pass a competency exam once every year to stay up to date on my skills in chemistry so that I can prescribe my own medications. Or better yet, I will be able to make my own medications. Let me learn about DNA, and all about heredity, chromosomes, etc. I can therefore do treatments and research on myself. This will result in true self-responsibility. If I am wrong, I cannot sue myself. I will make ever-so-sure that I do a very good job, or I will end up "cooking my own goose" so to speak. This will eliminate many needs for lawyers who practice tort law, eliminate insurance companies, and eliminate the need for pharmaceutical companies. I will be able to eliminate profit and overcharging. I will reduce greed in my own world. But what about those who are mentally retarded and those with Down's Syndrome, and the elderly who are totally incapable of remembering who they even are? Well, let us put it this way, shall we--maybe we should be very, very, careful about taking good care of our bodies when we are young? Oh, by the way, did you notice that I eliminated the need for Social Security, too. Perhaps, when I find my cure for my bipolarism I can actually feel more efficient on the job because I can now smile at others.

clisella

Zora is so right. Not often do we hear about the quality of medicine under universal protocol vis a vis who will be doctors. The question I always ask my friends who are more "sensitive" than me is "do you want your physician or surgeon to be a civil service worker?" This is a capitalist society (and thank God), and in this environment you will only get the best by paying the best. Health care in this country has always been better than other countries---via rich doctors. And another thing--we need to stop using the Clinton-manufactured 47 million number as it applies to millions of illegal aliens and young folks who chose not to be responsible enough to buy care. For the others, we can figure out a private system to minimally insure them. Don't forget that people who are destitute are now treated within a private system while under socialized medicine we all will be treated as underclass citizens. Universal health care is just one more way for government and big government types to control every aspect of our lives. Health care is a responsibility, not a right.

LB

To the person who said that just because there are police and fire departments, would crime and arson increase? These two issues aren't even related. There are negative consequences for starting fires and committing crimes. Going to the doctor for every little sneeze is why we have MRSA. Think: This issue is all about personal responsibility. I am tired of hearing how "we can't afford health insurance," but we have purchased all our toys. I have seen homeless people with new cell phones. And in case you haven't noticed, everything is going up in price. Health care for all is a beautiful notion that looks good on paper just like Communism, all for one and one for all. Too bad human nature gets in the way. Entitlement doesn't jibe; someone must pay. And no, I don't want to pay for health care for a person who runs around doing drugs, smoking, and sleeping around. So, we'll keep the freedom of choice for lifestyle, you say? Well, when you go to get help for the Hepatitis C and AIDS you acquired from a risky lifestyle and your Social Security number is put into the large database accumulated by this great government system, good luck getting the best care as you will be identified as a liability and that translates into being expendable or in layman's terms "not worth saving or even helping." What does this sound like to you? Oh yeah, I remember "the most good for the most people." Only when government is involved it is the most good for the best people. Think.

LB

Just as France is not usually hot in the summer as may be the case in many parts of the U.S., our ideals as a society are so much different, too. What is important here may not be so in France or Canada or Germany, so why are we comparing this system to ours? It is not only if it will work financially but can we make it work out of our self-indulgent, entitled, greed-riddled, man-is-an-island mind set?

Kenny G.

Insurance companies are in business because in the aggregate, they win and everyone else loses. That is, they pay out less than they take in. Why do we talk about health care and include a financial institution (they sell stocks and bonds nowadays as well) in the discussion. Let's talk about health care without talking about moving money around. That's just a third party involved in moving Jello around on a plate and keeping some of it for the effort.

Maybe the market can take care of heath care and insurance against catastrophic loss. It is amazing to me how many people pay $500 a month--$6,000 a year--and never spend that much health care in a year, yet they think they are getting a deal.

I think a good idea would be to have universal catastrophic coverage (bought for every citizen through taxes), but pay for everything up to $2,000 to $4,000 per family per year. If a company wants to foot that 2/4 bill each year as a "subsidy" to an employee to attract the best and brightest, that is their prerogative. Let's just get some skin in the game for everyone. I have a catastrophic plan now to protect my financial assets in case I get a serious illness that will cost me hundreds of thousands of dollars. Odds are I will never get that illness. In the mean time, I ask for a discount on all my medical procedures and only get the ones that are absolutely necessary. I don't order things I don't need, and the doctor needs to talk me into those many times.

Kenny G.

Health care in the U.S. is private, except for military health care. It is not nor ever will be government run. All the doctors in the U.S. are not government employees. U.S. taxes paid for having things constructed is not having government running the construction industry. That said, do we want taxes collected to pay for services that not everyone uses but might use? Gee, let me think, does that ever happen? Of course.

1. I don't drive on I95 from Miami to New York, but I bet some of my taxes are used to keep it maintained.

2. I don't use the national park systems, but all those folks visiting Yellowstone can thank me for a part of that bench to view Old Faithful.

You get the idea. Oh yeah, and finally: I have paid (with taxes) into the unemployment insurance system forever and never used it.

So, can we collect some taxes and provide a minimum of a few thousand dollars each year for each and every citizen and in addition, possibly buy a catastrophic insurance contract for that person as well? Maybe an insurance company or two might bid on the business from the government trough. There are a huge number of companies already doing business with the U.S. government, including some insurance companies providing insurance for all kinds of government employees.

deb

What is sad is to read the comments of highly intelligent people pointing the finger at what is/is not the answer but not offering a plan to implement the must-needed change in our country. There is no such thing as perfect or everyone will have coverage. There will always be someone to fall between the cracks. We just need to make our cracks thinner and less often.

We all are guilty of not being the healthiest, wanting more than we need, and wasting (probably more than any other country) too many resources--time, energy, food, not recycling, etc. We must pull together for the sake of mankind. Not everyone will be happy, but there is a solution that can work to better our situation. We can either stand proud and solve this problem--or we can continue to complain and watch others laugh/hate/move away from a country that offers an opportunity to be better. Why are we not doing this? Are we still acting like kindergarten children?

A concerned citizen

The U.S. is not a socialized government. Universal health care is simply another way of saying socialized medicine. We should not turn to socialism to solve the problem. We should regulate the markets less and appreciate how good our health insurance really is. Stop complaining.

Trish

Should we write, debate and eventually pass a 28th Amendment to the Constitution? Until we do, health care will not be a right afforded to every citizen in our country. Instead it will remain what it is--a privilege attainable by the wealthy, a benefit provided solely at the discretion of an employer, a government subsidized insurance plan for the elderly or a charitable gift provided based on the goodwill of others.

Value and cost
Our health care system is now extremely expensive, costing us over a trillion dollars a year and consuming 13.2 percent of our gross domestic product in 2000. Over the years as the costs and complexity of health care rose, we responded by developing interim methods to fund health care for most of the citizens. Now, even as the capability to relieve suffering and prolong life is growing, the financial ability to provide these services to all of our citizens is steadily declining.

The disconnection between valuable health care and the financial ability of every citizen to access that healthcare brings into focus the essential question of health care as a right or a privilege.

Health care funding
The answer is found in a series of interesting and temporary solutions to funding health care that developed over the past 100 years. Prior to the turn of the century, health care was almost exclusively paid for directly by cash by the consumer. Fortunately, health care was very affordable and accessible to virtually everyone. Physician office visits were 25 cents and house calls 50 cents.

Uninsured growth
Employers are steadily retreating from full coverage for all employees to a position of shared coverage for a smaller number of employees. Not even tax advantages are sufficient incentives to continued support as the costs continue to spiral upward in excess of inflation and eclipsing almost all other portions of the economy.

Because of the haphazard development of funding and financing health care in this country, a large and growing number of individuals are in the precarious situation of being unable to access and afford basic health care. This situation arose not by intent but by a sequence of circumstances in which the methods of paying for health care were devised in attempt to match the pace of health care development and rising costs.

The funding mechanisms often came late, were ill conceived and only offered temporary solutions. These stopgap measures allow us to defer addressing the issue of whether health care is a right or privilege.

As long as most of our citizens have most of their health care needs met, we are satisfied with putting off the difficult and basic question. As the costs for health care again rise beyond the ability of the current funding system, we can again look for a stopgap interim solution or we can take this opportunity to lay a solid foundation for the future and declare health care a right for all citizens.

Implications
If basic health care is declared a right, two issues will need immediate attention: content and funding.

We must first decide what are the goods and services that constitute basic health care. In the process of defining a basic health care package, we will inevitably deal with issues of quality, cost, value and access. A system built on strong values and principles should be more enduring and satisfying to the nation than our current system that has little foundation and is held together with Band Aids and bailing wire.

Where will the money come from to support a universal health care system? The politicians will assure us that the country does not want any more taxes. Undoubtedly, giving access to health care to everyone will cost more overall. Will the decision to make health care a right be decided on a purely financial basis?

Ultimately, providing more health care will cost more money. But currently it is costing more money each year even as fewer citizens are able to access health care. Are we willing to invest more money in universally accessible, measurably high quality, health care serves to build a stronger, healthier nation?

As a nation, we have little hesitation in paying more into a health care system that provides us with measurable increases in the quality and quantity of our lives. Our health care system has been able to provide those benefits for a relatively small societal investment in the past.

Only recently has the relative size of the investment increased and the return on the investment faltered. If we can focus our investment in health care on those modalities that improve measurable quantity and quality of life endpoints, it will be possible to again improve the return on our investment.

For example, if we are able to add on the average one year of productive quality life to every citizen--and if that extra year meant that the average person could stay in the workforce until age 66 earning income and contributing to the tax base and not taking social security benefits--there would be a considerable return on the societal investment.

Even as we define the health care goods and services that must be afforded to every citizen, we will have to redefine the manner in which we fund health care. If we find that health care is a right, then it will become the clear imperative of our government to provide the funds to support health care benefits for every citizen.

We are so accustomed to the current system of public and private funding that we have difficulty envisioning a radically different method of funding. In the process of finding universal funding, we may find that the old and failing systems of marginal taxes on employee wages for Medicare, matching state with federal tax contributions for Medicaid and employer funded health insurances become obsolete. We may find that HMOs and insurance as a means of paying for health care also become unnecessary.

We may discover that a specifically designated, single health care tax may simplify, clarify and provide greater efficiency than the current mixed bag of taxes. We may find that it is more beneficial to the economy for employers to provide higher wages and other benefits than making the enormous contributions to health insurance.

It is time to answer this question clearly as an amendment to the Constitution and begin to build a system that supports what we know to be our true belief.

If it is our belief that health care is a right, we should declare that belief in a clear, unequivocal and enduring manner. Once health care is declared a right, we will be able to address the issues with much more purpose and clarity and find ways in which to allow the American health care system to find its place among the systems that support our other unalienable rights.

Meoff28

The 800-pound gorilla in the room is not the health care debate. It is basically the difference we all see between two trains of thought. Democrats believe in a Utopian world where everything is fair and unbiased. Republicans realize that this is never going to be the case. Essentially, Democrats are the dreamers and Republicans are the realist. I really think that this is the difference between the two parties.

Eugene

I'm a physician. Health care is not perfect, but it's better than in other countries for a significant number of people in the United States. Nothing in life works good for everybody. We need to make small adjustments instead of destroying a whole system. Before I moved here, I saw social medicine in Soviet Union and I hope none of you will ever see it here. But the main thing it's not about would patients get better care or not or would it be easier for me to work or not? The main thing is that it's a very destructive plan for the whole country. We will go down slowly but surely starting from taxes going up and number of businesses and people able to pay those taxes going down.

Let's say if you are on the ship in the ocean and the whole ship is sinking. Would you care as a patient about how good the doctor on the ship is, or as a doctor how much money the patient would pay you?

Meredith

I agree with the physicians. Competition and deregulation is the only way to keep the best quality of health care around. Is it about money? Maybe. Either way, a skilled physician should not be a DPS worker. Skill follows money as well it should--worked hard for it. As do I. And not the people who would be utilizing this new free service that I am paying for (not using) while also paying for my private health care.

Regina

Thank you for all of your well thought out responses. It really helps me get a better grip on what is going on. You all have very good points and after carefully trying to see both sides, I side with freedom. Freedom from government regulation and control of my health care which reaches too far into my personal life. Socialism, aka "communism" (according to Wikipedia), is not the answer to a broken system. These two definitions go hand-in-hand. You don't tear down the whole house to remodel the living room. Let's work to improve the existing structure. I am an "out-of-pocket" payer and it is scary to think about those catastrophic events that could force me to sell my house to pay for medical care, but I would rather go on paying out of pocket than conform to this idea of nationalized health care and risk not getting the health care I might need one day when I need it. I lied what someone said about being our brother keeper. I may choose to be my brothers keeper and help him if I can, but I would never impose that on anyone else.

jelle

I am a Dutchman (Europian). In my country we have universal health-care. I pay 100 euro per month to a commercial insurer. The insurers make enough profit to extend their trade to America, such as Aegon. The difference between America and Western Europe is that we consider health care as a right. Furthermore, that it the primary task of the government to look after us as a people. This meant free access to education, also university (1500 euro per year), health care (1200 euro a year), and socially security. Without these rights we would pay no more tax and rebel. And by the way, I have not seen a doctor in 8 years

Rick

First--we do have universal health care (in emergency rooms everyone gets treated), very expensive and we all share the cost.

Second--I have several Canadian friends who live in the US and they all maintain their Canadian citizenship just for the health care.

Third--the first major sticking point is the $40 million (no 46, now 52?) Americans with no coverage. Surely any plan that would include them would bring the economy to its knees.

Of course the last I heard some 60 million has already been spent on advertising the different sides of the debate. This money could have been invested in a fund or directly distributed to the 46 million or so with money left over for half a helipcopter or so.

Politicians, CEOs and fund managers all play the shell game with our money. Their purpose in life is to move money from here to there and back (taking a cut for each move).

With government, less is more.

Billy Boy

LAW,

I am 15. I would consider myself liberal. However, I would like to help you correct your logic: (What an arrogant teenager.)

Birth control can easily be picked up at your local Wal-mart in several tangible forms. It is not necessary for teenage girls to visit their doctors about shots or expensive prescriptions. I am well aware of the fact that I can reduce unplanned pregnancies by both remaining abstinent, or, if for some sick reason completely desperate for sex, I have a pretty good chance of finding adequate supplies with 75 cents at a gas station.

If you know anyone that has difficulties with this, send them to me or any other non-outcast in our failed public school system.

Don't be an idiot.

Austen

The con article is making powerful assertions with no proof.

Mallory King

Obama's trying to kill our population off. Sending people to war and not lettin elderly people get hospital treatment. HES A SOCIALIST.

T. Brown

The one positive thing that I can say is thank God for America and the freedom for all of you to freely express your opinions.

Now on the issue of universal healthcare both sides have valid points. Of course it is not fair for one citizen to foot the bill for another. And the use of the word socialist like it's a curse word shows a limited historical and world view. The reality is many people that do not have health insurance have to wait until a minor illness becomes a major one, then goes to the emergency. The care received in emergency is exuberant in comparison to preventative care. When that happens the emergency care system is overwhelmed because it wasn't designed for that or basic care. Those patients needing acute care are forced to share the time, resources, and services of emergency care facilities lowering the care received by those who need it most.

On the side of those that do not want universal coverage that is because many benefit from the pain of others including uninsured so there is no vested interest in helping your fellow American.

The reality for both sides is that adequate health care for most contributes to an overall healthier society for all because people receive the preventative care they need before it becomes an astronomical problem.

From the standpoint of business owners a healthy work force means increased productivity because your workers are not sick but can't be seen by a doctor as a result of a lack of health insurance. There are fewer sick days taken because your workers are healthy, which ultimately increases morale and productivity thus higher revenue.

Last, those"socialist" countries are more innovative in their approach to healthcare by making it available to all. If we used our bargaining power we could effectively force the hands of the Insurers as far as pricing.

For those of you that are insured, your opinions on this are not preventing your premiums from going up every year just because you consider universal care a "socialist" policy. Only the investors, owners, and stock-holders benefit off of this current US healtcare catastrophe. So next year when your premiums increase another 40%, let's revisit this topic. Or the next time your on a subway, train, plain or shuttle on your way to work and that guy coughing next to you passes along some antibiotic resistant strain of bacteria because he is sick and has no health care, I hope your coverage protects you.

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