Single payer health care questions

[bilby]

There are pros and cons for both systems. Among other things, the trouble with single payer in the hands of government is that it does become a political football. That can and is dangerous for patients. The NHS in the U.K. is proving to be unsustainable. Lots of people are starting to supplement their medical care with insurance.

Again, I know I am exposing my ignorance, but haven't people, or at least some people who could afford to do so, supplemented their government provided health care insurance with private pay insurance? It seems as though I've known about the private pay insurance for a long time. I could be wrong

Why do you say that the NHS is unsustainable in the UK? What factors are contributing to make it be unsustainable?

Deliberate underfunding by political ideologues who would prefer to see hospitals that make rich people even richer than hospitals that make sick people well.

There is literally not one other thing wrong with the NHS. The UK can easily afford it, just as it has for seven decades; but the unbroken succession of right wing governments since 1979 have been a fucking disaster.

 

[Toni]

Again, I know I am exposing my ignorance, but haven't people, or at least some people who could afford to do so, supplemented their government provided health care insurance with private pay insurance? It seems as though I've known about the private pay insurance for a long time. I could be wrong

Why do you say that the NHS is unsustainable in the UK? What factors are contributing to make it be unsustainable?

Deliberate underfunding by political ideologues who would prefer to see hospitals that make rich people even richer than hospitals that make sick people well.

There is literally not one other thing wrong with the NHS. The UK can easily afford it, just as it has for seven decades; but the unbroken succession of right wing governments since 1979 have been a fucking disaster.

OK, that's what I was wondering: is it underfunded or are costs just outstripping what would be considered generous funding? And if that is a function of medical professionals being paid outrageous sums of money or too many people who are too sick (boomers are a thing in GB as well, I believe and we're not getting any younger).

 

[Loren Pechtel]

Again, I know I am exposing my ignorance, but haven't people, or at least some people who could afford to do so, supplemented their government provided health care insurance with private pay insurance? It seems as though I've known about the private pay insurance for a long time. I could be wrong

Why do you say that the NHS is unsustainable in the UK? What factors are contributing to make it be unsustainable?

Deliberate underfunding by political ideologues who would prefer to see hospitals that make rich people even richer than hospitals that make sick people well.

There is literally not one other thing wrong with the NHS. The UK can easily afford it, just as it has for seven decades; but the unbroken succession of right wing governments since 1979 have been a fucking disaster.

I don't think that's exactly what's going on. Look at the economics of it: You have two sides: Those who need expensive health care (and those close to them) and those who don't.

The latter group far outnumbers the former. Both groups vote. Isn't it obvious that you would have a pressure towards lower funding?

 

[Toni]

Deliberate underfunding by political ideologues who would prefer to see hospitals that make rich people even richer than hospitals that make sick people well.

There is literally not one other thing wrong with the NHS. The UK can easily afford it, just as it has for seven decades; but the unbroken succession of right wing governments since 1979 have been a fucking disaster.

I don't think that's exactly what's going on. Look at the economics of it: You have two sides: Those who need expensive health care (and those close to them) and those who don't.

The latter group far outnumbers the former. Both groups vote. Isn't it obvious that you would have a pressure towards lower funding?

Really, what you have is two groups: One group which needs expensive health care or cares about those who do and another group who doesn't need expensive health care --YET.

It sounds to me like what you are saying is that a lot of people are not well educated about health care, and their present and potential future needs and the needs of those they care about. I agree.

The thing about expensive health care is that the need can and does arise quite unexpectedly. My very clean living husband (non smoker, no recreational drugs, very moderate drinker, semi-vegetarian (after years of being a vegetarian) regularly exercises and is still fit enough to referee college soccer games) was diagnosed with a cancer. Not a skin cancer. To say that this was unexpected is a vast understatement. Fortunately, it was found early--and only because he had access to an extremely good and extremely alert medical practice. He was asymptomatic. And fortunately, we are well covered by insurance so our out of pocket was laughably tiny.

My mother unexpectedly and unpredictably experienced a traumatic brain injury. It happened in a blink of a eye. It was expensive, very expensive, even though our family had very good insurance (80/20 coverage), with just the first two months of her care exceeding our family's annual income. She did nothing wrong, nothing to bring this on, no lifestyle changes would have made any difference at all. For the rest of her life, she required more health care than another person her age would have required, which was tragic. And extremely expensive.

Two very quick and easy examples from my family's life. Neither was caused by any lifestyle changes, foolish behavior, anything preventable or knowable.

Either could happen to anyone.

Including you.

 

[TSwizzle]

Not sure what your point is. People get sick all the time. In the U.K. people have access to healthcare. The service used to be second to none. It's still very very good most of the time. However, it has been neglected and the service is a bit patchy. It will get worse. But it doesn't judge people's lifestyle. If you get sick you see a doctor eventually who will treat you.

 

[bilby]

The biggest driver of increasing health cost to the NHS (and all universal health systems) is increasing longevity.

Old people cost a lot to keep. Stupid young people might object to this; but smart young people have an ambition to one day be old people themselves.

Personally, the last time I spent a night in hospital was in a maternity ward (not bad for a 47 year old - I have been very lucky). I have put in FAR more in taxes than I have ever taken out. But I intend to live forever (or die in the attempt); and I fully expect to need a health system in the next three or four decades, that is not underfunded, particularly as I intend to retire before then, and won't be in a position to fund the treatment from my income at that time.

Universal health care is an excellent investment for the healthy. Only a fucking moron would vote against it because they are 25 and bullet proof - and it is to some extent the job of a government to protect the people from their own shortsightedness (and not only by subsidies for spectacles).

 

[Toni]

Not sure what your point is. People get sick all the time. In the U.K. people have access to healthcare. The service used to be second to none. It's still very very good most of the time. However, it has been neglected and the service is a bit patchy. It will get worse. But it doesn't judge people's lifestyle. If you get sick you see a doctor eventually who will treat you.

Just that it is a short sighted ideology to object to paying for health care for those who need it.

Those young and healthy people also have babies which is expensive, even for extremely healthy parents. Sometimes newborns, infants and children need very expensive care.

 

[Toni]

The biggest driver of increasing health cost to the NHS (and all universal health systems) is increasing longevity.

Old people cost a lot to keep. Stupid young people might object to this; but smart young people have an ambition to one day be old people themselves.

Personally, the last time I spent a night in hospital was in a maternity ward (not bad for a 47 year old - I have been very lucky). I have put in FAR more in taxes than I have ever taken out. But I intend to live forever (or die in the attempt); and I fully expect to need a health system in the next three or four decades, that is not underfunded, particularly as I intend to retire before then, and won't be in a position to fund the treatment from my income at that time.

Universal health care is an excellent investment for the healthy. Only a fucking moron would vote against it because they are 25 and bullet proof - and it is to some extent the job of a government to protect the people from their own shortsightedness (and not only by subsidies for spectacles).

I'm wondering if it is truly longevity or if it is how we live our lives (increasingly less active, without reduction in caloric intake--and yes, I'm including myself) coupled with how hard we are (sometimes) willing to fight to keep people alive, even when it is pretty obvious that their ability to enjoy their lives or sometimes, even to actually experience their lives is impaired to near non-existent. I'm not advocating for death panels, but I am thinking of what I want for myself. I helped to make final end of life choices for each of my parents. My mother lived for many years as a disabled person, with significant cognitive impairment, but thankfully, relatively little physical health concerns. A knee was replaced, which was one of those situations that was necessary but in the end, not helpful as it pushed her further into dementia and she didn't really recover well after that. The alternative would have forced her into skilled care some years earlier. It was really, really hard to decide what would serve her interests and also to balance it with the costs (at this point emotional/physical as Medicare and Medicaid paid her medical costs for the most part) to those who loved her. I do not begrudge her a single second of the work or worry on my part or my siblings, but I was not her primary care taker, so that's an easy stance. The sibling who was her primary care taker has paid a permanent price for the care she devoted to my mother. I'm quite determined that my own children will not be faced with any similar situation. My father died relatively quickly but I am certain that the cost of his last (brief) hospitalization exceeded the cost of all of the medical care he had received in his life up to that point. He would not have agreed to the hospitalization if he had realized how ill he was. He would have chosen to die at home.

 

[bilby]

The biggest driver of increasing health cost to the NHS (and all universal health systems) is increasing longevity.

Old people cost a lot to keep. Stupid young people might object to this; but smart young people have an ambition to one day be old people themselves.

Personally, the last time I spent a night in hospital was in a maternity ward (not bad for a 47 year old - I have been very lucky). I have put in FAR more in taxes than I have ever taken out. But I intend to live forever (or die in the attempt); and I fully expect to need a health system in the next three or four decades, that is not underfunded, particularly as I intend to retire before then, and won't be in a position to fund the treatment from my income at that time.

Universal health care is an excellent investment for the healthy. Only a fucking moron would vote against it because they are 25 and bullet proof - and it is to some extent the job of a government to protect the people from their own shortsightedness (and not only by subsidies for spectacles).

I'm wondering if it is truly longevity or if it is how we live our lives (increasingly less active, without reduction in caloric intake--and yes, I'm including myself) coupled with how hard we are (sometimes) willing to fight to keep people alive, even when it is pretty obvious that their ability to enjoy their lives or sometimes, even to actually experience their lives is impaired to near non-existent. I'm not advocating for death panels, but I am thinking of what I want for myself. I helped to make final end of life choices for each of my parents. My mother lived for many years as a disabled person, with significant cognitive impairment, but thankfully, relatively little physical health concerns. A knee was replaced, which was one of those situations that was necessary but in the end, not helpful as it pushed her further into dementia and she didn't really recover well after that. The alternative would have forced her into skilled care some years earlier. It was really, really hard to decide what would serve her interests and also to balance it with the costs (at this point emotional/physical as Medicare and Medicaid paid her medical costs for the most part) to those who loved her. I do not begrudge her a single second of the work or worry on my part or my siblings, but I was not her primary care taker, so that's an easy stance. The sibling who was her primary care taker has paid a permanent price for the care she devoted to my mother. I'm quite determined that my own children will not be faced with any similar situation. My father died relatively quickly but I am certain that the cost of his last (brief) hospitalization exceeded the cost of all of the medical care he had received in his life up to that point. He would not have agreed to the hospitalization if he had realized how ill he was. He would have chosen to die at home.

I agree that there is far to much focus on keeping people alive, rather than doing what is best for them; And I strongly support the most basic human right, the right to make an informed decision to choose to stop living.

The very phrase 'death panels' describes something that simply doesn't exist - Americans have been told that they do, and that they are scary; But in reality, 'death panels' are like the ghosts in an episode of Scooby Doo - when you pull off their costume, underneath you find a Republican trying to frighten people into continuing to give him their money.

The closest real-world entity to a 'death panel' is the medically unqualified people at insurance companies who determine that people are not covered for treatment that the doctors think is medically necessary. Such financial decisions are not a feature of UHC systems, wherein the people who decide on what treatments can be offered are doctors, who use their best professional judgement to decide what options to offer to patients, based on medical, not financial, considerations.

The phrase 'death panel' is a clear indication that the user of the phrase has been exposed to the rantings of liars.

 

[J842P]

The biggest driver of increasing health cost to the NHS (and all universal health systems) is increasing longevity.

Old people cost a lot to keep. Stupid young people might object to this; but smart young people have an ambition to one day be old people themselves.

Personally, the last time I spent a night in hospital was in a maternity ward (not bad for a 47 year old - I have been very lucky). I have put in FAR more in taxes than I have ever taken out. But I intend to live forever (or die in the attempt); and I fully expect to need a health system in the next three or four decades, that is not underfunded, particularly as I intend to retire before then, and won't be in a position to fund the treatment from my income at that time.

Universal health care is an excellent investment for the healthy. Only a fucking moron would vote against it because they are 25 and bullet proof - and it is to some extent the job of a government to protect the people from their own shortsightedness (and not only by subsidies for spectacles).

Ironically, at least in the US, the older you are, the *less* likely you are to support it. It is a testament to the effectiveness of decades of right-wing propaganda.

 

[Loren Pechtel]

I don't think that's exactly what's going on. Look at the economics of it: You have two sides: Those who need expensive health care (and those close to them) and those who don't.

The latter group far outnumbers the former. Both groups vote. Isn't it obvious that you would have a pressure towards lower funding?

Really, what you have is two groups: One group which needs expensive health care or cares about those who do and another group who doesn't need expensive health care --YET.

It sounds to me like what you are saying is that a lot of people are not well educated about health care, and their present and potential future needs and the needs of those they care about. I agree.

Yup--I'm saying people are voting their experience rather than logic. They're looking at the system, it's done what they needed without any big problems, they think it's ok. Only when something expensive and chronic comes along do they realize the true situation.

The thing about expensive health care is that the need can and does arise quite unexpectedly.

Agreed.

Either could happen to anyone.

Including you.

You're trying to convince the wrong person.

 

[Loren Pechtel]

Universal health care is an excellent investment for the healthy. Only a fucking moron would vote against it because they are 25 and bullet proof - and it is to some extent the job of a government to protect the people from their own shortsightedness (and not only by subsidies for spectacles).

The problem isn't voting for or against it, the problem is the funding level.

 

[Loren Pechtel]

Ironically, at least in the US, the older you are, the *less* likely you are to support it. It is a testament to the effectiveness of decades of right-wing propaganda.

The older you are the more likely you are to have chronic health issues and thus more likely to understand the downsides.

 

[Toni]

The biggest driver of increasing health cost to the NHS (and all universal health systems) is increasing longevity.

Old people cost a lot to keep. Stupid young people might object to this; but smart young people have an ambition to one day be old people themselves.

Personally, the last time I spent a night in hospital was in a maternity ward (not bad for a 47 year old - I have been very lucky). I have put in FAR more in taxes than I have ever taken out. But I intend to live forever (or die in the attempt); and I fully expect to need a health system in the next three or four decades, that is not underfunded, particularly as I intend to retire before then, and won't be in a position to fund the treatment from my income at that time.

Universal health care is an excellent investment for the healthy. Only a fucking moron would vote against it because they are 25 and bullet proof - and it is to some extent the job of a government to protect the people from their own shortsightedness (and not only by subsidies for spectacles).

Ironically, at least in the US, the older you are, the *less* likely you are to support it. It is a testament to the effectiveness of decades of right-wing propaganda.

I don't know that I necessarily agree with that. I am more convinced now than I was when my parents died. I do notice a generational divide: my grandmother clearly felt it was her duty to live as long as she possibly could do. Mercifully, she did not live after her stroke and resolve never was tested. Among people my parents' age, there was this kind of resolve: you MUST keep going as long as you could. I think that it was at least in part to absolutely needing to be hard as nails to survive childhood, much less adulthood and old age. Without that determination, a lot of people did not make it that long. This was an age where ill health was sometimes suspected of being a character defect.

The other thing is that I've sat at the deathbed of more than one person I loved and while I longed for their release, it is truly hard to know that it will be the final goodbye. I think young folk haven't had that experience yet. Oh, maybe with a grandparent but we all expect we'll lose our grands. It cuts closer when it's a parent. And a child? Really hard. Hard to give up if you aren't sure you've given them every chance at a recovery and decent life.

That said: I really do not want heroic measures, and have finally convinced my family that I mean it.

 

[T.G.G. Moogly]

Ironically, at least in the US, the older you are, the *less* likely you are to support it. It is a testament to the effectiveness of decades of right-wing propaganda.

The older you are the more likely you are to have chronic health issues and thus more likely to understand the downsides.

Those old people already have government subsidized healthcare so it's natural for them to feel comfortable in opposing something for others that they already have. I know several members of my family who are stupid, right wing morons with government pensions and healthcare and oppose anything liberal. Yes, morons.

 

[Loren Pechtel]

The older you are the more likely you are to have chronic health issues and thus more likely to understand the downsides.

Those old people already have government subsidized healthcare so it's natural for them to feel comfortable in opposing something for others that they already have. I know several members of my family who are stupid, right wing morons with government pensions and healthcare and oppose anything liberal. Yes, morons.

Those over 65 do, plenty of older people that aren't 65.

If I believed it would actually work as it's supposed to I would vote for it in a heartbeat. I'm opposed, though, because I would expect the same thing we always see--too much corner-cutting.

 

[Tom Sawyer]

If I believed it would actually work as it's supposed to I would vote for it in a heartbeat. I'm opposed, though, because I would expect the same thing we always see--too much corner-cutting.

That is a risk. The main problem with any kind of UHC system in America is that it would be run by Americans. These are the people who voted Trump to be President. One cannot trust them to do things.

 

[J842P]

Ironically, at least in the US, the older you are, the *less* likely you are to support it. It is a testament to the effectiveness of decades of right-wing propaganda.

I don't know that I necessarily agree with that. I am more convinced now than I was when my parents died. I do notice a generational divide: my grandmother clearly felt it was her duty to live as long as she possibly could do. Mercifully, she did not live after her stroke and resolve never was tested. Among people my parents' age, there was this kind of resolve: you MUST keep going as long as you could. I think that it was at least in part to absolutely needing to be hard as nails to survive childhood, much less adulthood and old age. Without that determination, a lot of people did not make it that long. This was an age where ill health was sometimes suspected of being a character defect.

The other thing is that I've sat at the deathbed of more than one person I loved and while I longed for their release, it is truly hard to know that it will be the final goodbye. I think young folk haven't had that experience yet. Oh, maybe with a grandparent but we all expect we'll lose our grands. It cuts closer when it's a parent. And a child? Really hard. Hard to give up if you aren't sure you've given them every chance at a recovery and decent life.

That said: I really do not want heroic measures, and have finally convinced my family that I mean it.

I'm not sure if you meant to respond to me, but I was referring to polling results on the subject:

http://www.pewresearch.org/fact-tan...y-democrats/ft_17-06-23_healthcare_age_640px/

 

[Toni]

I don't know that I necessarily agree with that. I am more convinced now than I was when my parents died. I do notice a generational divide: my grandmother clearly felt it was her duty to live as long as she possibly could do. Mercifully, she did not live after her stroke and resolve never was tested. Among people my parents' age, there was this kind of resolve: you MUST keep going as long as you could. I think that it was at least in part to absolutely needing to be hard as nails to survive childhood, much less adulthood and old age. Without that determination, a lot of people did not make it that long. This was an age where ill health was sometimes suspected of being a character defect.

The other thing is that I've sat at the deathbed of more than one person I loved and while I longed for their release, it is truly hard to know that it will be the final goodbye. I think young folk haven't had that experience yet. Oh, maybe with a grandparent but we all expect we'll lose our grands. It cuts closer when it's a parent. And a child? Really hard. Hard to give up if you aren't sure you've given them every chance at a recovery and decent life.

That said: I really do not want heroic measures, and have finally convinced my family that I mean it.

I'm not sure if you meant to respond to me, but I was referring to polling results on the subject:

http://www.pewresearch.org/fact-tan...y-democrats/ft_17-06-23_healthcare_age_640px/

No, I get it. I see a generational shift between people in my age group (boomers) compared with the generation before us. For people of my grandparents' day, there was no safety net, no societal or governmental help. If you did not do it on your own, you did not make it. You died, your children died. The end. My parents grew up during a time when there was tremendous need and very little help from the government. Taking help from the government was weak and lazy and being weak and lazy would lead to your death or worse, the control of your life by the government.

I think that instead of the generational differences being due to decades of right wing propaganda, it is more a case of people knowing what they lived.

For those 18-29, a great many have not yet become responsible for their own healthcare. They are accustomed to those decisions being made for them. And in the next categories, people are not yet willing to face that decisions are made for them by the health care they have 'chosen.' Or more likely, was chosen for them.

 

[Toni]

If I believed it would actually work as it's supposed to I would vote for it in a heartbeat. I'm opposed, though, because I would expect the same thing we always see--too much corner-cutting.

That is a risk. The main problem with any kind of UHC system in America is that it would be run by Americans. These are the people who voted Trump to be President. One cannot trust them to do things.

Exactly my fear.