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Author Topic: Discuss: American healthcare ruminations!
Princess Leah
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quote:
But really, since your position seems to be that it's impossible for someone to know if they are healthy or not, I'm extremely curious to hear how you'd solve the healthcare problems in this country.
I was unclear. Obviously there are standards and measurements that can determine whether your cholesterol or blood pressures is high, etc etc. What I mean to say is in the context of setting national standards of health for the workforce, and then rewarding or not rewarding a company based on how many of thier workers meet those standards, any measurement of health is meaningless because of the infinate number of variables. It's unfair to the companies and it's unfair to the people who work there to make their personal lives into something that affects the company's profit. Do you not see how risky that is?

quote:
Doctors know what is, and isn't a healthy level of the "good" and "bad" varieties of cholesterol. Doctors can tell you if you are at risk for, or have, diabetes, congestive heart failure, a pulmonary embolism, hernia, types of cancer, gout, osteoarthritis, back pain, stroke, carpal tunnel, sleep apnea, asthma, depression, and many, many more problems that all have a direct link to obesity.
Right. What are you trying to say here?

quote:
Is it your claim then, that medical science is arbitrary? That when doctors say "hey, your cholesterol is above such and such, keep it down," that they are just picking arbitrary numbers? Are you aware of the fact that there is an entire profession dedicated to figuring these things out, diagnosing problems, discovering their source, and fixing them? You'll note a healthy degree of sarcasm there, because I don't feel my ideas are being treated fairly, and I think you are misrepresenting them in your attacks.
Yes, I'm aware of the fact. Are you aware that fixing problems takes work, money, and effort? Not just willpower. Not just desire. Not just a quick and simple dose of medication. Health isn't simple. You can't just rate a person on a general health scale of 1 to 10, and base rewards on those ratings. A measurment of health is arbitrary because there are so many things that affect it. Depending on which factors you pick to measure it by will put people on different sides of the healthy-unhealthy line.

quote:
Doctors know when you are, and aren't healthy. And maybe at the end of the day, it'll come down to a report card from your doctor to know where you stand.
We're discussing health care reform and you're suggesting another generalized, oversimplified form? Just to satisfy my own curiosity, have you ever had any medical problems? If you're not comfortable answering on the forum, you can email me, and if you're not comfortable answering at all then please don't feel obligated.

quote:
You seem to be operating under the assumption that my idea is to find all the fat people, and punish them for being fat, and force them to either lose weight at any cost, or suffer the consequences. Is that an accurate assesment of your perception?
I'm operating under the assumption that your idea is to find all the workplaces that for one reason or another, some of which are based purely on chance, hire people that are found unhealhty based on some impersonal survey of certain factors, and then punish those workplaces. Since your first post you've made it perfectly clear that you're not trying to target fat people. I understand that. I still think, based on my understanding of what you're proposing, that it's a bad idea.

quote:
When you have more time, I'd like to hear your ideas. And I'd like to hear your specific criticisms of this specific part of my idea. If it is impossible for us to create a national standard of what is healthy, how are we ever going to have a healthy nation?[/QUOTE

We're never going to have a healthy nation. Get over it.

[QUOTERecognizing the fact that we are all different, there's still a recognized level of where test results should be. If there wasn't, there'd really be no point in ever having tests done in hospitals.

And those test values are useful in treating an individual, not basing government funding to companies on.

quote:
To get to the specifics of your question:

Health isn't immeasurable, and therefore isn't arbitrary, and isn't chance based. It's a science, with thouands of professionals around the country whose job it is, to decide who is, and isn't healthy, and how to turn the latter into the former.

Perhaps we're actually in agreement, but getting bogged down in semantics.

Here is how health is measurable: You can test my pancreas function and see that I'm diabetic (Type 1). You can test my cholesterol levels and see that they're fine. You can test my Hemoglobin A1c and see that my average bloodsugar is over the recommended level. Basically, you can take an individual and find what is wrong with them.

Here's where health is not measureable: when you're trying to compare health. My friend is also diabetic (type 1). Her cholesterol is not fine. But her Hemoglobin A1c shows that her bloodsugar levels are excellent. Her BMI shows her to be obese, but she's an internationally known athlete. Who's healthier, her or me? Would we both be labeled "unhealthy" based on your national standards? Probably. Are we? It's hard to say. For diabetics, we're both doing reasonably well. For a "normal" person, we're not doing so hot. What do you do here? How would the system you propose deal with this?


quote:
I admit to not having the kinks worked out, hell, I'm not in Congress, and I'm not a medical health professional. Are you? Having a goal is step one, and you leave me flabbergasted when you dispute the aims of my goal.
I don't think I'm disputing the aims of your goal at all. We absolutely need to have preventative healthy care and we absolutely need to encourage health. I just vehemently disagree with the method you proposed that we've been arguing about forever.

Here's what I think: I think money needs to get out of the picture. I think that the income disparity between surgeons and high-demand specialists, and general practitioners and professionals in non-lucrative specialties needs to dissapear. I think that health insurance coverage needs to be more comprehensive. I think that we need more health care professionals. I think we need to have much more regulation on malpractice suits. I think drug companies should be forced to lower thier prices. I think patients need to be treated as individuals, without doctors and hospitals having to worry about wasting time on cases that won't get them out of the red.

And I admit that I don't know how to make it happen. I have some ideas that I hate because they involve government regulation, and that means more bureaucracy and probably more efforts to standardize things. Which I'm against, as you may have noticed.

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pH
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quote:
What I mean to say is in the context of setting national standards of health for the workforce, and then rewarding or not rewarding a company based on how many of thier workers meet those standards, any measurement of health is meaningless because of the infinate number of variables. It's unfair to the companies and it's unfair to the people who work there to make their personal lives into something that affects the company's profit.
That's the part that was confusing me. I wasn't sure if Lyr's plan was to reward companies that OFFER gym memberships and such or to reward companies based on the percentage of employees that met X health criteria. If it's the latter, that scares me to death.

-pH

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mackillian
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quote:
ospitals are starting to only receive 40-50 cents back on every dollar of medical charges they deliver
Have you ever seen what a hospital actually charges insurance companies?

Here's an interesting thing. Providers either participate with a health insurance plan or they don't. If they're participating, then they agree to a contacted rate and are paid that contracted rate. They can bill whatever they want, but it's the fee that they agreed to that's given as payment.

Now, if a provider is non-participating and an insurance plan has benefits that will pay for non-participating provider services, then the non-participating provider is paid the UCR (usual and customary rate) for their geographic location. The insured is responsible for the difference.

However, if it's emergency care, then the company will pick up the tab (even if it's out of network and the insured as no out of network benefits, like in an HMO or EPO).

...if you have any questions about how health insurance works, I'll be happy to answer them. I just won't tell you what company I work for. [Wink]

There's a lot going on on both sides. Health insurance is incredibly complicated. The system is very broken. I say this as a person with a chronic illness that requires daily maintenance medication, a person who can never, ever have her insurance have a gap in coverage, a person who has to consider the health insurance plans of jobs, and the first panic at the thought of losing a job is losing healthcare coverage. If I can't pay for my medications, I become a much less productive member of society.

And the current trend of moving away from managed-care networks (HMOs, EPOs, PPOs) and towards HSAs isn't a good trend at all, especially if you have a chronic illness.

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pH
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quote:
However, if it's emergency care, then the company will pick up the tab (even if it's out of network and the insured as no out of network benefits, like in an HMO or EPO).

You go tell that to my student health insurance. Go!

-pH

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BaoQingTian
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I think I've hit on why you're having problems your plan. National health care is almost by definition a socialist institution. Your plan is all about personal responsibility. Getting the two to work together is rough.

I think that's why I have such a hard time thinking of a good plan too. I'm all about personal responsibility, but also don't want money to be a barrier to those who need health. I suspect you're the same way.

Flaming Toad on a Stick spelled out a few of my worries about a national health care system. Whenever I try to think about implementation of a national health care plan, I always try to think of a way to avoid the pitfalls of other plans. It's hard though. [Smile]

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Sterling
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quote:
Originally posted by Lyrhawn:
quote:
Originally posted by Sterling:
Gee, it would be nice if the uninsured didn't end up going to emergency rooms when their conditions become urgent and end up costing ten times as much.

Best way to fix that is to make sure everyone is covered, and to keep a focus on preventative healthcare.
Oh, I quite agree. And a lot of the latter issue (doctors having the same visit time to deal with simple and complex issues) could be dealt with if so many patients were able to see doctors more than once a year or less.

The most significant difficulty I see (well, once you get past the pharma and insurance lobbies, of course) is that some people will always try to game the system. Narcotics seekers, questionable disability claims, and the like. Still, I don't doubt that even with such problems, we could get more out of the system with universal coverage than we do now... Paying more for health care than anyone, and getting less for it.

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Lyrhawn
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quote:
Originally posted by Samprimary:
Really, any poor health trends which aren't a fault of the profit-motive system and our lack of universal coverage are merely an unhelpful exacerbation of an already serious issue. We'd be attacking peripheral issues if we only focus on Healthy People Bonus™ ideas.

Good thing no one is suggesting we do that then.
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mackillian
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quote:
You go tell that to my student health insurance. Go!
I can't tell 'em, but you can. I can tell you how to tell them.

You gotta speak their language. And I now know their language.

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pH
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quote:
Originally posted by mackillian:
quote:
You go tell that to my student health insurance. Go!
I can't tell 'em, but you can. I can tell you how to tell them.

You gotta speak their language. And I now know their language.

They don't listen! They send forms! I DON'T UNDERSTAND FORMS! And then they send the forms AFTER they say oh, too late for you to send in the forms now.

And I WENT TO THE ER. I don't understand why they're even asking for a referral form. If I could have gotten a referral at the time, I probably wouldn't have gone to the emergency room. GAH!

-pH

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mackillian
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IM me [Razz]
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Lyrhawn
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BQT -

Thanks [Smile]

Leah -

I'm going to answer your post as honestly as I can, and then at the end, I'm done discussing the tax incentive part of the plan. At this point I'm willing to kill it entirely, because I think the other parts of my plan are more important really. It was really just a random idea that I tossed into the mix, but I'm very, very stubborn by nature. [Smile] Anyway, the goal I'm shooting for is personal responsibility, preventative care, and ending obesity related illnesses, for this SPECIFIC part of the plan, and this is the first thing that jumped to mind as a possibility. I'm open to any and all alternatives. With that in mind, and almost just for fun:

quote:
I was unclear. Obviously there are standards and measurements that can determine whether your cholesterol or blood pressures is high, etc etc. What I mean to say is in the context of setting national standards of health for the workforce, and then rewarding or not rewarding a company based on how many of thier workers meet those standards, any measurement of health is meaningless because of the infinate number of variables. It's unfair to the companies and it's unfair to the people who work there to make their personal lives into something that affects the company's profit. Do you not see how risky that is?
So we change it to make it work. Base the system on individual improvement, and not a national standard, or a combination of the two. Some things work pretty much across the board, such as cholesterol levels, others are person specific. So you check someone's health every year, if they got better, there you go. No comparisons to other people, and really, people NEED to be getting yearly checkups, too many people (especially us stubborn men) don't, and problems result. If they have to go anyway, and their doctor will know them better than anyone else's, that doctor is the best peson to make that judgement call. Keeping in mind that some things are incurable, and that you can't really control them, there'd have to be some give on what you can do to change your own health, and those will be the factors. People wouldn't be punished for things beyond their control.

I think there is potential for risk there, but I'd like to fully explore the problems, and see if a fix can be made before just dismissing an idea. The tax break isn't going to be millions upon millions of dollars. The point isn't to give a windfall of money to companies, it's to encourage, and help offset the cost of, companies offering extra benefits to their workers, and encouraging them to lead healthy lifestyles. If they CAN'T, then there's no backlash. No one is going to get fired. Safeguards can be put in place to make sure of that.

quote:
Right. What are you trying to say here?
My point, was that doctors can tell you when your weight is a major cause of your health problems, what you are at risk for, and what you already have, and how reducing your weight can either eliminate or decrease the likelihood of getting, these problems. That was in response to some of your earlier statements about the arbitrariness of the whole thing, and what looked like you disputing the drive to end obesity in general.

quote:
Yes, I'm aware of the fact. Are you aware that fixing problems takes work, money, and effort? Not just willpower. Not just desire. Not just a quick and simple dose of medication. Health isn't simple. You can't just rate a person on a general health scale of 1 to 10, and base rewards on those ratings. A measurment of health is arbitrary because there are so many things that affect it. Depending on which factors you pick to measure it by will put people on different sides of the healthy-unhealthy line.
This paragraph makes me thing you haven't REALLY read the rest of what I've said. The focus of this part of the plan is entirely on a combination of personal effort, government encouragement and private companies to spend money, time and effort to try and solve the problem without government stepping in to say "Hey, you're fat, fix it or suffer the consequences." I'm going to take your comment as sarcasm and move on.

quote:
We're discussing health care reform and you're suggesting another generalized, oversimplified form? Just to satisfy my own curiosity, have you ever had any medical problems? If you're not comfortable answering on the forum, you can email me, and if you're not comfortable answering at all then please don't feel obligated.
I was being flippant. But just for the sake of curiousity, if your doctor doesn't know how to make you healthier, and he/she is unable to tell you when you've become more or less healthy, then how do you ever hope to keep yourself healthy?

I have asthma, and when I was younger (haven't heard anything about it since) I had a heart murmur.

quote:
I'm operating under the assumption that your idea is to find all the workplaces that for one reason or another, some of which are based purely on chance, hire people that are found unhealhty based on some impersonal survey of certain factors, and then punish those workplaces. Since your first post you've made it perfectly clear that you're not trying to target fat people. I understand that. I still think, based on my understanding of what you're proposing, that it's a bad idea.
Yeah, I'd call that a mischaracterization of the plan being discussed, which is why this post will be my last response to it.

quote:
And those test values are useful in treating an individual, not basing government funding to companies on.
The two don't automatically cancel each other out. So you're againt any sort of national healthcare in general?

quote:
Here's what I think: I think money needs to get out of the picture. I think that the income disparity between surgeons and high-demand specialists, and general practitioners and professionals in non-lucrative specialties needs to dissapear. I think that health insurance coverage needs to be more comprehensive. I think that we need more health care professionals. I think we need to have much more regulation on malpractice suits. I think drug companies should be forced to lower thier prices. I think patients need to be treated as individuals, without doctors and hospitals having to worry about wasting time on cases that won't get them out of the red.

And I admit that I don't know how to make it happen. I have some ideas that I hate because they involve government regulation, and that means more bureaucracy and probably more efforts to standardize things. Which I'm against, as you may have noticed.

From what you've said there, it looks like we agree on pretty much everything. But I'd still like to hear your ideas.
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MightyCow
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I think one thing that would fix a lot of problems is if insurance companies weren't allowed to refuse coverage to "pre-existing conditions." That seems like such a horrible way to work the system. Why is it that a new company is required to cover you, as long as you have insurance covering your condition, but if you ever lose the insurance, a new company can refuse to cover your condition?

To me, it just looks like a loophole made to allow health insurance companies a way to deny expensive patients. Sure, they're a business, they don't want to cover an expensive patient, but those patients are the ones who need the insurance the most.

In fact, I think that's the crux of the problem with private insurance companies. It is in the companies' best interests to try to help its customers as little as possible, try to make its service as complex and difficult to use as possible, and try to serve only the customers who need the least amount of help.

The system needs to be changed so that health insurance companies have a strong financial incentive to make their service BETTER, help patients MORE, and work with patients, instead of against them.

I want my insurance company to call me up and ask how they can help me fill my claim, rather than forcing me to call them begging them to pay even some of it.

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pH
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You don't think the problem would be exactly the same with public healthcare as well? In terms of trying to get by spending the least amount of money possible, I mean.

-pH

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Lyrhawn
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I think it'd be a little different at the very least. They have different aims.

Private insurance companies are trying to get money, and answer to shareholders.

Public insurance would be trying to keep people healthy, realizing that keeping everyone healthy as best as possible is what lowers the cost of healthcare. And they answer to the public at large.

Private companies don't need to worry about keeping EVERYONE healthy, they don't care if another company has healthy people being covered or not, it's all competitive. There's a different focus I believe. I think a public, national healthcare system (with the option for better private care, whatever that might be), would in the long run end up much cheaper than a hundred different private companies.

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pH
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They also answer to the public at large concerning how much they spend, though.

-pH

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Tresopax
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I think one issue largely ignored in the health care debate is the negative effect that a employer-based system has on innovation in general in our country. Employer-based health care places a double-whammy on entrepreneurs who want to go out on their own, or operate independently. For one thing, it would mean losing the health care benefits of being a part of a larger company, and needing to provide your own health care. For another thing, it typically means going through the expense of setting up a health care plan for any employees you may want to hire. End result: people are less likely to develop new enterprises, and more likely to stick with established organizations. I think this is one of the hidden benefits of universal health care - if we can detach health care from employment, it will promote innovation as a whole across the economy. Small business owners will be freed of a significant cost that could prevent them from getting of the ground to start out with.
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scholar
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On the preexisting coverage, insurances making things difficult issue, I have had the same insurance for almost 2 years now. Right now, they are being throwing a fit about paying for my drs bill because it is a "preexisting condition". My condition- pregnancy. Apparantly, I am now an elephant.
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twinky
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I noticed something back on page one that went unchallenged, and I think it needs to be addressed:
quote:
Originally posted by Jhai:
While the US spends more on health care than other nations, it seems that most of this extra cost is due to our poor general health (lack of exercise & diet). The US health care system is more productive than nationalized systems in getting us well - that is, better output of health given the cost.

There's some evidence to suggest that this may not actually be the case.
quote:
Now an article published in the Journal of the American Medical Association casts that assumption into doubt. Comparing the health of middle aged Americans and their counterparts in England, the authors make the startling discovery that across the board, the Americans are less healthy. It's a sad fact that minorities have worse health outcomes than non-hispanic whites, so the study only looks at that population group, but despite this the English still come out on top.

Worse yet, these findings held true regardless of socioeconomic status or education level. Poorer English patients might be expected to have better health than their US counterparts due to their National Health Service, but well-off Americans only fared as well as working class English. The differences can't easily be explained away by risk factors either, which are broadly similar between the two nations.

I must admit I'm a little fazed by this study myself. Not so much at the lower end of the socioeconomic ladder, where the NHS would be expected to help out, but the findings that the richest portions of society in the US are worse off despite the almost limitless medical technology and facilities at their disposal is quite shocking.

Added: Also, my employer subsidizes gym memberships as a taxable benefit for up to CDN$400 annually, which basically covers my YMCA membership. I've noticed this kind of thing in my industry before (I'm a fairly recent chemical engineering graduate, but have a variety of internship experience), and think it's a very positive way to promote employee health.
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Lyrhawn
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Twinky -

I'm confused. Doesn't your second quote back up the first one?

pH -

Yeah, that's true, but you can't ignore the other benefits, they are tied to cost. If it's cheaper in the end, the people have less to complain about.

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TheHumanTarget
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I thought that you couldn't be denied medical coverage under an employers benefits for pre-existing conditions (because of HIPPA laws). I know that there are usually waiting periods before certain coverages begin, but I've never heard of anyone being outright denied.

quote:
There needs to be a cap on punitive damages. People makes mistakes. I know those mistakes hurt real people, but there's a ripple effect. A doctor in a difficult surgery does the best he can, but the patient still comes out a quadriplegic. In response, the family sues the doctor for millions of dollars. His insurnace, and the hospital insurance pay for the suit, but his premium is jacked up so high that he can no longer afford to practice medicine. The end result is that his collective knowledge is lost from the medical profession.

Spoken like someone who's never been involved in a serious medical malpractice situation. A cap would do more damage than good. A better solution (which is gaining ground in many states) is to have patients sign an agreement indicating that in the event of something happening, a mediator (paid for by the state, I believe) will attempt to reach a reconciliation prior to any lawyers being involved. This allows both parties to reach an equitable arrangement without bogging down courts.
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Lyrhawn
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I used to work for people that did this sort of thing for a living.

You can still be awarded the money necessary to pay for any damages done to you, separate from punitive damage. Punitive damage, which includes pain and suffering, shouldn't be millions upon millions of dollars. I've seen some pretty ridiculous cases over the years.

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TheHumanTarget
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quote:
Punitive damage, which includes pain and suffering, shouldn't be millions upon millions of dollars.
I disagree. Punitive damages should absolutely be whatever the court feels like awarding, especially in situations where gross negligence or incompetence is involved. I still prefer the mediator method of resolving these kinds of issues, but in situations where it cannot be settled amicably, then it's up the courts.

quote:
I used to work for people that did this sort of thing for a living.
Trust me when I tell you that things look entirely different when you're actually involved.
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twinky
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quote:
Originally posted by Lyrhawn:
Doesn't your second quote back up the first one?

Only if the "starting" level of health is so staggeringly low that there is actually some proportionality between the differences in health outcomes and expenditures. You would expect such a difference in pre-treatment health to show up in the risk factors, but my snippet above notes that they're "broadly similar." As an example, say the risk of an American having a heart attack is comparable to that of a Brit having one (I don't know if this is the case, but it's the sort of thing I would expect to be covered by "broadly similar" risk factors); what the study suggests in such a context would be that after treatment, American heart attack victims have worse health outcomes despite the fact that more money is being spent on them, per capita, than on the Brits. Since they had the same risk of having a heart attack in the first place, this can't simply be attributed to the American having been less healthy to start with.

Obviously that's a completely hypothetical example; I'm just using it to help make my point clear. The basic sentiment I'm suggesting has gone unchallenged is that the vast sums of money spent in the U.S. health care system buy Americans better care -- that is, that the average may be low, but the peaks are high. The study described in my snippet above suggests that this is not the case.

In terms of expenditures, here's some OECD data to chew on. Check out the linked Excel spreadsheet, there's lots of useful and interesting data there. I've compiled two datasets from 2004 here, health care expenditures as a % of GDP and health care expenditures per capita, in USD:
code:
2004	        % GDP	Per Capita	
Australia 9.6 3120
Austria 9.6 3124
Canada 9.9 3165 e
Czech Republic 7.3 1361 e
Denmark 8.9 2881 e
Finland 7.5 2235
France 10.5 3159 e
Germany 10.6 3043
Greece 10 2162 e
Hungary 8 1276
Iceland 10.2 3331 e
Ireland 7.1 2596
Italy 8.7 2467
Korea 5.6 1149
Luxembourg 8 5089 e
Mexico 6.5 662
Netherlands 9.2 3041 e
New Zealand 8.4 2083
Norway 9.7 3966
Poland 6.5 805
Portugal 10.1 1824 e
Spain 8.1 2094 e
Sweden 9.1 2825 e
Switzerland 11.6 4077 e
Turkey 7.7 580
United Kingdom 8.1 2508 d
United States 15.3 6102


e: Estimate
d: Differences in methodology

The extent of the "differences in methodology" isn't clear, though, so we have to take the U.K. figures with a grain of salt. However, the U.S. tops the list in both per capita and % GDP expenditures. Again from my first link above:
quote:
The US currently:
  • Ranks only 23/30 in the most recent OECD assessment for life expectancy
  • Ranks only 24/30 in the OECD survey for infant mortality, only beating those bastions of medical care, Poland, Mexico, Hungary, Turkey and the Slovak Republic. Sweden delivers premature babies at around the same rate as the US, but their mortality rate is almost half
  • Again comes 24/30 when it comes to disease adjusted life expectancy (years lived free of disease).

Historically, this sort of thing has been addressed by noting the high number of uninsured Americans, or by suggesting (as Jhai did) that Americans are less healthy to start with. But the study in my first link controlled for these things, and still found that even wealthy Americans fared no better than working-class British.

This suggests strongly, to me at least, that something is wrong with your system.

However, all of this is not to say that our system here in Canada is without problems, nor that the U.K. system is the embodiment of perfection.

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Samprimary
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quote:
This suggests strongly, to me at least, that something is wrong with your system.

However, all of this is not to say that our system here in Canada is without problems, nor that the U.K. system is the embodiment of perfection.

If anything's wrong with our system, it's the 'moral hazard myth.'

quote:
Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world's median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.
Moral hazards and profit motives. I could open up a diabetic preventative care center in Boston, to coach and treat people diagnosed with diabetes so that they could manage their condition and not end up with costly, reactive surgeries.

Of course, insurance would not pay for this sort of preventative care, so I'd simply go out of business. But if I got into the business of lopping off the limbs of all the untreated diabetics in America that we consequently have, I'd be making money hand over foot.

Our system has bad prioritization that leaves us stuck playing catch-up with poorer nations. We have an infant mortality rate higher than some developing nations. It's no good.

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ClaudiaTherese
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Great article, Samprimary.
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Lyrhawn
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quote:
Originally posted by TheHumanTarget:
quote:
Punitive damage, which includes pain and suffering, shouldn't be millions upon millions of dollars.
I disagree. Punitive damages should absolutely be whatever the court feels like awarding, especially in situations where gross negligence or incompetence is involved. I still prefer the mediator method of resolving these kinds of issues, but in situations where it cannot be settled amicably, then it's up the courts.

quote:
I used to work for people that did this sort of thing for a living.
Trust me when I tell you that things look entirely different when you're actually involved.

People shouldn't get rich off accidents. I've seen some RIDICULOUS cases where people won millions and millions of dollars, over and above what they got for medical care, etc, stuff they would need to live their life with the impairment.

If there's negligence or incompetence, I have less of a problem with it, but if it was literally an accident, or if it just didn't go as planned, and nothing was done wrong by the doctor and the results still weren't as planned, those aren't a reason to sue for millions.

It doesn't just go for malpractice suits, which are always the largest. At least one dog bite case would come in a week. Some kid, or adult, would get bit by a dog, and regardless of the damage done, they'd sue. Now if the kid has some major damage of some sort, alright, compensation is due. But even if the bite just broke the skin a little bit, parents still sue for forty or fifty grand, and usually they get it.

I got bit by a dog when I was about 12 and I was on my paper route. It broke the skin, I went to the hospital, I got my tetanus updated, and I went home. I found out a couple years later at my job that I probably could have gotten fifteen or twenty grand for suing the guy's homeowners insurance. Does anyone really think that's fair?

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Mrs.M
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quote:
Infant-mortality rates are in the nineteenth percentile of industrialized nations.
This means absolutely nothing. Every industrialized country has a different way of counting infant mortality. In some of those countries, a stillborn baby that is less than 38 weeks gestation is counted as a miscarriage. In other countries, it's not an infant death unless the infant has taken a certain amount of breaths. This is a misleading statistic that is thrown around and it drives me crazy.

Additionally, the US has a huge number of women who use fertility treatments and the number of pregnancy complications among them is high. This has nothing to do with poor health care or insurance. Also, maternal age is rising and I'm sure that is a factor, though I can't speculate as to the degree.

I also want to add that every single preemie born in this country is covered by Medicaid. They'll even take over if your insurance tops out, which it frequently does with micropreemies. We have the most amazing neonatal technological advances and every year it gets better and better. All of the neonatologists and neonatal nurses I've ever spoken to are confident that we're very close to having 20-weekers survive in the near future (we're at about 22-weekers now).

quote:
Trust me when I tell you that things look entirely different when you're actually involved.
I have been involved and they don't look different to me at all.

75% of all OB/Gyns are sued. 75%! I very much doubt that 3/4ths of all OB/Gyns are guilty of gross negligence or malpractice. Even an unsuccessful lawsuit can raise insurance premiums and those costs are passed onto the patients. Not only that, but lawsuits have changed the way that medicine is practiced. Due to a wave of lawsuits in the late 80s or early 90s (I always forget), medical students are now taught, "When in doubt, do a C-Section." The suits alleged that doctors waited too long to do Sections, thereby causing complications and harm to the babies.

Lastly, I also think that requiring employers to provide insurance hurts both the employers and the employees. Dagonee summed it up beautifully in another thread, but I'm just too tired to look it up.

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Sterling
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quote:
Originally posted by Samprimary:
Of course, insurance would not pay for this sort of preventative care, so I'd simply go out of business. But if I got into the business of lopping off the limbs of all the untreated diabetics in America that we consequently have, I'd be making money hand over foot.

Don't hear a lot of free market economists admitting the "Invisible Hand" may be bearing a bone saw, do you... [Angst]
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El JT de Spang
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quote:
This suggests strongly, to me at least, that something is wrong with your system.
I wonder what the other possible explanations could be. The one that jumps out at me is lifestyle differences.
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twinky
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quote:
Originally posted by El JT de Spang:
quote:
This suggests strongly, to me at least, that something is wrong with your system.
I wonder what the other possible explanations could be. The one that jumps out at me is lifestyle differences.
Again, these were controlled for. As I've already noted, medically significant lifestyle differences would show up in risk factors.
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El JT de Spang
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That's not entirely true. From the AMA summary:
quote:
This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking...
Those are great, but I was specifically thinking about stress as a risk factor, which, as far as I can see wasn't controlled for. I'm not sure there is a reliable way to control for it. I read something years ago correlating workweek length and lifespan in first world nations, and it's been percolating ever since. I don't think that that is a primary or even secondary cause of our general poor health, but I wonder what effect our being a 'high octane' society does have.

Are Americans significantly more stressed than, say, Brits or Canadians? I have no idea. But I think it's possible.

The other risk factor that I didn't see controlled for is diet*. I think, no, I know, that Americans eat a lot more junk food and fast food than almost every other nation. That's not something that will be fully represented by the risk factor assessment, because (I'd guess) a substantial percentage of those who eat fast food regularly are not obese.

*Obesity was controlled for, but I'm mainly concerned about the skinny people who aren't as healthy as they appear. I'd guess America has more of that demo than anywhere else.

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twinky
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I'm not sure you're considering that the British diet consists primarily of fish and chips. And beer. [Wink]

I'm extremely skeptical that differences of this magnitude can be explained away by "lifestyle differences." We're talking almost 50% more in expenditures as a percentage of GDP than the next largest spender. Surely Americans aren't 50% less healthy in ways that can't be controlled for.

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El JT de Spang
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I am considering that. I don't think we fully realize what the various food additives in processed foods do to our bodies yet.
quote:
I'm extremely skeptical that differences of this magnitude can be explained away by "lifestyle differences." We're talking almost 50% more in expenditures as a percentage of GDP than the next largest spender. Surely Americans aren't 50% less healthy in ways that can't be controlled for.
As well you should be. I didn't say that the entire difference could be explained by the other variables I brought up, because I don't think it could be. But I wonder if there aren't serious contributing factors beyond America's shoddy healthcare system; factors that were outside the bounds of those studies. And I wonder what percentage, if any, those outside factors account for.

I'm just following the direction of the thread title and ruminating.

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twinky
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Ah, okay. I took your phrasing to imply that you were looking for alternative explanations to use in place of "something is wrong with the healthcare system," rather than in addition to it.
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El JT de Spang
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Oh. I didn't even touch on the healthcare system because I take it as a given that it's screwed up beyond repair. So, yeah, in addition to that.
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BaoQingTian
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El JT is on the right track. Fixing America's healthcare system would only do so much if other contributing factors are not fully considered. On the contrary, considering those factors would probably yield a better healthcare system with more emphasis and spending in smarter areas.

A tradeoff with national healthcare that I think people fail to consider is the varying amounts of freedom they would lose, depending on the nature of the system.

Economic freedom is one. Also, you may have the government influcing everything from your exercise habits to the foods you eat. By placing the burden of your health on society, you become subject to society's rules regarding your health.

It does need to be fixed, but it needs to be considered in far greater depth than I usually see it done. Heck, I've spent about 8 hours in the last few days researching a computer I'm building, trying to get the best gaming system for under $1000. Most people I discuss healthcare with haven't done much beyond read a Time magazine article, and this is for a multi-billion dollar system that would effect 1/3 of a million people.

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Lyrhawn
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quote:
Originally posted by BaoQingTian:
A tradeoff with national healthcare that I think people fail to consider is the varying amounts of freedom they would lose, depending on the nature of the system.

Economic freedom is one. Also, you may have the government influcing everything from your exercise habits to the foods you eat. By placing the burden of your health on society, you become subject to society's rules regarding your health.

I don't automatically agree, mostly because I don't think national healthcare will ever been the ONLY choice. There will always be private companies that offer a different kind of, or better service, with different rules, and you'll always have the choice to use them instead.

As far as exercise habits and foods you eat, you'll always have personal choice when it comes to those. If you make a poor choice and have to pay for it, monetarily or when you die from making those poor choices, that's your choice. The amount of exercise and good food needed to be healthy is different for everyone, so there'll never be more than federal guidelines for how much you need. We're not Soviet Russia.

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Samprimary
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quote:
I didn't say that the entire difference could be explained by the other variables I brought up, because I don't think it could be. But I wonder if there aren't serious contributing factors beyond America's shoddy healthcare system; factors that were outside the bounds of those studies.
Well, if you cut out what health issues are the product of a lack of preventative care, you get left with stuff like obesity and smoking and other clear and macro health issues.

We got examples of nations with greater obesity than the U.S. -- we also have a couple of very westernized, postindustrial gems with health habits which border on being worse than the United States -- the UK and Australia.

I'll go and see what comparable and contrastable data exists, see if I can't evidence anything for or against your claim.

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BaoQingTian
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Are you saying that in your plan people would have an option whether or not to 'pay into' national healthcare? Because if not, then you'll pay for national healthcare as well as private if you want that.

In regards to the second paragraph, there is a current sin tax on cigarettes. We're still free to use them, however, there is ~50% tax against them. There is data that shows that this tax is responsible for decreasing smoking.

Remember the fast-food tax thread awhile back? I don't think it's too far of a leap to think of the government levying extra taxes against junk food/fast food in order to partially recoup associated healthcare costs. In the case of cigarettes, the tax collected offsets something like 10% of the associated healthcare costs. It would make sense to either drastically raise prices on cigarettes to make the offset closer to tax collected.

If the price is increased to make the products reflect their true cost to healthcare, then they'd probably be unaffordable. And in reality, that's about as bad as making it illegal.

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Lyrhawn
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You already pay into national healthcare and for private, ever see the medicare tax on your paystub?

You still have the choice to use them. Sin taxes aren't new, and I don't think they are unfair. Smoking is bad for you, and it's bad for people around you, and the financial and physical well being of the nation. You have the choice to do it if you want, but if you do, you have to pay a lot for it, and you suffer the ill health consequences. That's exactly what I said.

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Samprimary
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The comparable data shows minimal comparisons to the American system's particular weaknesses. Australia has an issue with getting modern healthcare over amazingly rural areas, but they've got nothing compared to the non-universalized healthcare woes of this country.

There's an interesting thing that actually happened to me after I made this thread, and I didn't really want to bring it up before now. I was driving home from out of town when I was struck with chest pains which were so terrible that I could not breathe right or drive, and I ended up managing to pull up beside a policeman and ask for a ride to the hospital.

Once there, they ran a battery of tests on me, including a "less than stellar" EKG, followed by chest X-ray and blood checks and the whole gamut, to rule out any immediate health concerns. They found a heavy dose of enzymes in my blood corresponding to heart tissue damage, but eventually ruled out any heart issues (the first EKG had been an echo misprint, or something) -- at least I managed to worry them for a while!

After spending a night in excruciating pain (they got a urine sample to make sure that I wasn't a drug addict on a hideous crash) I ended up transferred to my PCP, who found out on subsequent days in subsequent visits that I had 1. GERD, 2. Ridiculously bad GERD, and 3. IBS. I'm now on an intense regimen to restore a malfunctioning, acid-burned stomach valve which I have apparently been blessed with via genetics.

Three perscriptions, three PCP visits, one ambulance trip, one night in the ER. Total cost for me was $85, all co-pay. I'm insured by my family. If I had not been insured by my family, I would not be insured. If I was not insured, then I would quite objectively have been financially wrecked by this, at least to the extent of having to quit college.

Colors my view of the subject matter a bit, methinks. Oh, by the way, GERD hurts so bad. So, so bad.

[ November 23, 2006, 03:37 AM: Message edited by: Samprimary ]

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pH
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quote:
Originally posted by BaoQingTian:
A tradeoff with national healthcare that I think people fail to consider is the varying amounts of freedom they would lose, depending on the nature of the system.

Economic freedom is one. Also, you may have the government influcing everything from your exercise habits to the foods you eat. By placing the burden of your health on society, you become subject to society's rules regarding your health.

I really, really worry about this, BQT.

-pH

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Lyrhawn
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I'm not entirely convinced that's a bad thing, to varying degrees.

It's a curious thing to defend the right of the individual to put a harmful burden on society, but to attack any measure of responsibility or burden that society might try and place back on the individual to balance the equation.

Making poor choices about your health often adds a negative burden to society, regardless of what insurance you have. Everyone still foots the bill.

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rivka
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So you won't mind the new soylent green diet?

Excellent. You can have my share. [Razz]

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AvidReader
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"Making poor choices about your health often adds a negative burden to society, regardless of what insurance you have."

I'm with you, Lyr. One of my big complaints with accross the board national coverage is the number of people who treat their bodies terribly and then go to the doctor for a magic pill. People eating McDonald's twice a day. People staying stressed all the time. People getting antibiotics for the flu cause they don't want to take a day off. My 300 some odd pound friend who smokes, won't eat a vegetable, and won't exercise is going to end up with diabetes or a heart attack.

I like the idea of refunding the health departments to be primary care providers for the poor. They used to do it. I'm sure they could do it again. (They also offer free and low cost child vaccines, so our low vaccine numbers should have nothing to do with cost. It might still be related to the perceived autism link.)

I like the idea of coverage for people who have things go catastrophically wrong. I watched a show on TLC about a girl born with Treacher-Collins Plus who basically had no face. I have no problem with my tax dollars going to help build her one. I don't remember how many millions of dollars they said she had required by age two, but she was only about 5% done. No one can plan for that.

I remember it really hitting me on Little People, Big World when Matt mentioned he, his wife, and their son Zach couldn't get insurance because they're little. It's pre-existing, and all their surgeries have to be paid for out of pocket. That's not right.

Those are the kinds of things we as a nation should provide. Not so every hypochondriac with the sniffles can take a pill and ignore the stresses they put on their bodies.

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mackillian
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A lot of folks can't plan for chronic illnesses, either.
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BaoQingTian
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quote:
Originally posted by Lyrhawn:
I'm not entirely convinced that's a bad thing, to varying degrees.

It's a curious thing to defend the right of the individual to put a harmful burden on society, but to attack any measure of responsibility or burden that society might try and place back on the individual to balance the equation.

Making poor choices about your health often adds a negative burden to society, regardless of what insurance you have. Everyone still foots the bill.

I hope you don't think I'm defending the right of the individual to put the burden on society. That's not my point at all.

My point is simply that if we want a national healthcare program, we better be prepared to give up some freedoms for it. If you've considered it, and don't think it's a bad thing, fine. I just think a lot of people don't think about it that way.

I'm really not too keen on paying for someone's bypass surgery cause they loved those big macs, or paying for cancer treatments for those who smoked their whole lives. A lot of the same people that really push for national healthcare would cry bloody murder if you made their big mac cost $9.

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pH
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quote:
Originally posted by mackillian:
A lot of folks can't plan for chronic illnesses, either.

Or mental illnesses. I mean, I can see so much potential for abuse. The state-run mental facilities are bad enough already though. People get lost in the shuffle a lot. I'd be really, REALLY uncomfortable with the government having ANYTHING to do with my care.

-pH

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mackillian
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I think chronic illness also has the component of making sure to always, always, always be covered by health insurance. No gaps in coverage ever or you're screwed. At least with government insurance, that problem would be alleviated.
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AvidReader
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I wouldn't consider chronic illness to be a poor choice. It's one of those things that just happens. You can't plan for it, why should we as a society mind picking up the tab?
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