NationStates Jolt Archive

Before I start I'd like to say that if you're one of those types who will respond to the OP title with a snarky comment like: "Simple, don't do it" or whatever, this thread probably isn't for you. But nevertheless, let me begin.

I know there are lot of generalites here who would love to see the US move into the modern age and implement a universal, nationalized health care system to replace the current system we have. One of the common objections to this, from both lefties and even righties is that such a system isn't feasible or simply couldn't work on the US level.

Feel free to suggest any additional problems and possible solutions, but here are mine:

1.) Taxes/budget deficit - The Republicans didn't have too much problem with deficit spending in their last few terms, but nevertheless this is a big issue. And no doubt a large scale system like public health care would require a tax increase, although I do think the burden should/would be shifted onto those who happen to make hundreds of times more than the average American...but some ways to alleviate the problem, I think, would be cuts to our already overbloated military budget and elimination of things like the War on Drugs (or reducing its scope). Of course, this could make a lot of people angry so..

2.) Political disunity/party politics - In order for something like this to work, we would need time to implement it effectively. This would take more than one term, and political division wouldn't help at all. If you have one party implementing legislation for the system, having the next administration removing legislation back and forth would just leave a patchwork of laws and whatnot and just clusterfuck of bureaucracy.

3.) The states - no doubt there's fierce obsession with states' rights in the USA, and I would imagine such a system like this would engender cries of states rights. So, how to get the states involved effectively in the system? Delegate some responsibilities to the local level, while having the federal level handle others?

4.) Insurance companies - ok, how to break the stranglehold they have over the health industry? One part would definitely be education and debunking of myths surrounding nationalized health care, but these companies certainly have the resources and political clout to block any type of progressive legislation.

It would be advisable if the US swallowed some of its pride and asked for help from nations that already have effective (or at least effective enough) systems in place. Look at examples of other countries that havent collapsed from universal health care and try to apply the logic in designing an American system and so on.

Thoughts/suggestions? Tl;dr (if this is the case and you just scrolled down to here it's still possible to offer input on the thread title's question really).

The US already spends more per capita than any other nation for healthcare for just a fraction of the population. Get rid of Medicaid, Medicare, and all the poor/child health plans and give every man, woman, and child the same deal Congressmen get.

Here is how it should be done in the US.
look at a families Income and number of dependents and age of the person(s).
an income below a certain amount should receive a certain amount of help.
This help in health care should be payed directly to the health insurance company by the government. The person can also elect to pay more into the insurance to get better coverage.
this provides health care, Choice of who will provide the health care and much of the money paid out will be taxable revenue of the insurance company and again capital gains for the stock holders. no it wont be all free covered by revenue but it will provide a cheap lunch.

First, instead of paying premiums to private insurance companies, the US citizens would pay into the national healthcare system. That way, we would get rid of the "middlemen" bureaucrats in the insurance companies, and patients would deal directly with MDs again. MDs are taking private insurance less and less because of the bureacracy and paperwork they create. If people want additional private insurance they can have it, but everyone would pay an amount into the national healtcare system, like SSI and Medicare is now.

Second, subsidize medical school in part for qualified MDs and nurses to lower their educational costs.

Third, require MDs and nurses (but MDs especially) to accept a reasonable salary in exchange for the semi-subsidized education they receive. In other words, they don't get to have 7 houses and 7 cars anymore.

Fourth, create/build or convert less-used hospitals so they act as "healthcare malls", enabling a patient could go see a dentist, eye doctor, GP, gynecologist all in the same building. That would lessen what MDs need to charge as they each do not have to pay high rents for private offices/suites.

Fifth, enact laws that preclude medical malpratice lawsuits except in the most egregious cases (leaving a sponge in after surgery). If you are getting free health care, you don't get to sue the people providing it.

Sixth, require the use of generic drugs only, unless medically necessary to use a "name" brand drug (or no generic exists). Reduce the time for prescription drug companies to recoup their investments in research and development so generic drugs come on the market sooner. Have them pay a small precentage of all US drug sales into the national healthcare system, whether by taxes or otherwise.

Right now, that is the best I can think of. I am disgusted with the present state of affairs in the USA--paying premiums to insurers who delay pre-op approval, pay only 50% of the bill instead of the 80% they are supposed to pay for and so on. They are self-perpetuating bureaucrats who are interested only in the bottom line of their books, not the patient.

The US already spends more per capita than any other nation for healthcare for just a fraction of the population. Get rid of Medicaid, Medicare, and all the poor/child health plans and give every man, woman, and child the same deal Congressmen get.

But, how does that help Congressman make Money? They'd lose all their lobbyist handouts...

But, how does that help Congressman make Money? They'd lose all their lobbyist handouts...

You know, lobbyists have a bad rep, but they perform an important role in government. And yes, I'm serious.

fuck the insurance companies, scrap whatever schemes you have now, take hospitals, etc, under public ownership, let the states manage their own admin, policy, etc, with a national framework and federal funding/buying.

since you're already paying insurance companies money anyway, that money going to taxes instead to fund such a system isn't that big a step.

You know, lobbyists have a bad rep, but they perform an important role FOR government. And yes, I'm serious.

There we go, lol

The US already spends more per capita than any other nation for healthcare for just a fraction of the population. Get rid of Medicaid, Medicare, and all the poor/child health plans and give every man, woman, and child the same deal Congressmen get.

^ ^ This ^ ^

I'm Canadian and I'm a strong supporter of the single tier national health care system. I say borrow our model and tell the insurance companies to blow it out their asses. Canada may have it's own problems with the NHS but we still pay pennies on the dollar for a much better system.

BTW, my insurance premiums in Canada are 23 dollars a month. What are you paying?

would a health care system divided to state level be too crazy?

The US already spends more per capita than any other nation for healthcare for just a fraction of the population. Get rid of Medicaid, Medicare, and all the poor/child health plans and give every man, woman, and child the same deal Congressmen get.What will the people who can't afford the deal Congressmen get do?

would a health care system divided to state level be too crazy?

In Canada responsibility for health care is split between federal and provincial governments. We have a 'crown corperation' Medicare (fedrally owned) which fulfills the role of an insurer. And Health Canada (http://www.hc-sc.gc.ca/hcs-sss/index-eng.php) (spit responsibility) builds, runs, and administrates hospitals.

so no I don't think it's impossible.

In Canada responsibility for health care is split between federal and provincial governments. We have a 'crown corperation' Medicare (fedrally owned) which fulfills the role of an insurer. And Health Canada (http://www.hc-sc.gc.ca/hcs-sss/index-eng.php) (spit responsibility) builds, runs, and administrates hospitals.

so no I don't think it's impossible.

we have the same in the UK, mostly. its a lot smaller over here, of course, but the NHS overall is split into regional NHS Trusts which administer the region, but buy and whatever with the national NHS. group buying and administration, policy, etc; regional policy, employing, delivery, etc.

SNIP

tbh not even the UK has the same system for every...area-country-thingy so I can't imagine running one organization for Texas much less the US

What will the people who can't afford the deal Congressmen get do?
The money we save from kicking those hamstringed plans should allow everyone to have free healthcare assuming we don't let drug company and insurance lobbyists to hamstring any new plans.

tbh not even the UK has the same system for every...area-country-thingy so I can't imagine running one organization for Texas much less the US

I'm not sure what you mean by 'system'. I'm pretty sure that all the different branches of it still fall under the same system. In Canada we have medicare and Health Canada which are responsible for everything. It's run from Ottawa but has offices all over Canada. Of course Canada is well known for it ridiculously top heavy and centralized bureaucracy.

admittedly, our implementation of an NHS is pretty shitty but in comparison to the private system in the states, or other failing two tier systems (germany), it's got a lot of merits.

I'm not sure what you mean by 'system'.

well for starters in Wales your medication is free whereas if you cross the border into England your suddenly paying for it (if you got the cash yadda yadda yadda)

admittedly, our implementation of an NHS is pretty shitty but in comparison to the private system in the states, or other failing two tier systems (germany), it's got a lot of merits.

I'd say Germany is more like the US in terms of things like population density than the Canada though eh?

The higher population density isn't a bad thing. It means more taxes.

would a health care system divided to state level be too crazy?
I think bringing it down to a state level would NOT work. Take a state like Arkansas, which is one of the poorest, it would have terrible healthcare. I think that is one very good reason for nationalized healthcare, to get some standardization and minimum care and provider standards in every state, for every man, woman and child.

The money we save from kicking those hamstringed plans should allow everyone to have free healthcare assuming we don't let drug company and insurance lobbyists to hamstring any new plans.
I think you are right. People in NYC pay anywhere from $2,000 a year plus for a single person, to $5,000 per year or more for a family, plus the insurance company only pays what it deems is "reasonable and customary" if someone needs surgery. This means they never pay more than 50% of the bill, if that, and the individual/family is stuck with the rest of the bill anyway, after paying high premiums for insurance. The whole system is a fraud and MDs don't take insurance anymore. They do not want to hire the bookkeepers and administrative staff to deal with the insurance companies. Thus, we should get rid of them. The government could set what it would pay, and MDs would have to take it.

well for starters in Wales your medication is free whereas if you cross the border into England your suddenly paying for it (if you got the cash yadda yadda yadda)

yeah but prescriptions are still subsidised in england. the welsh government have just put a priority on the price (or lack thereof) of medications. the funding still comes from national NHS.

if you think of the regions of the NHS as divisions or departments of a company, then it makes sense. they get given a budget, and work out what their priorities are and what best to do within their resources to best achieve their own goals and those of the national organisation.

First, instead of paying premiums to private insurance companies, the US citizens would pay into the national healthcare system. That way, we would get rid of the "middlemen" bureaucrats in the insurance companies, and patients would deal directly with MDs again. MDs are taking private insurance less and less because of the bureacracy and paperwork they create. If people want additional private insurance they can have it, but everyone would pay an amount into the national healtcare system, like SSI and Medicare is now.

Second, subsidize medical school in part for qualified MDs and nurses to lower their educational costs.

Third, require MDs and nurses (but MDs especially) to accept a reasonable salary in exchange for the semi-subsidized education they receive. In other words, they don't get to have 7 houses and 7 cars anymore.

Fourth, create/build or convert less-used hospitals so they act as "healthcare malls", enabling a patient could go see a dentist, eye doctor, GP, gynecologist all in the same building. That would lessen what MDs need to charge as they each do not have to pay high rents for private offices/suites.

Fifth, enact laws that preclude medical malpratice lawsuits except in the most egregious cases (leaving a sponge in after surgery). If you are getting free health care, you don't get to sue the people providing it.

Sixth, require the use of generic drugs only, unless medically necessary to use a "name" brand drug (or no generic exists). Reduce the time for prescription drug companies to recoup their investments in research and development so generic drugs come on the market sooner. Have them pay a small precentage of all US drug sales into the national healthcare system, whether by taxes or otherwise.

Right now, that is the best I can think of. I am disgusted with the present state of affairs in the USA--paying premiums to insurers who delay pre-op approval, pay only 50% of the bill instead of the 80% they are supposed to pay for and so on. They are self-perpetuating bureaucrats who are interested only in the bottom line of their books, not the patient.
Here, here!
You know, lobbyists have a bad rep, but they perform an important role in government. And yes, I'm serious.
Also very true.