[adambard]

Can I be the first non-US citizen in this thread express my incredulity that anything less than universal health care is tolerated? "Barbaric" is the term that seems to strike me whenever I hear of it, hyperbolic though it may be.

[ds9]

You're a little too harsh in saying "tolerated".

Opinion polls have shown for decades that a majority favor a system more like those of Canada or Europe - here it's called "single payer". But the interests of the majority have little relevance here.

The "single payer" alternative is considered so radical in USA that it's mentioned in the corporate media only apologetically, as if it were advocacy of leprosy. When they can't avoid mentioning the obvious, the rejection of it is euphemistically explained by saying that it is "politically unrealistic" - before a quick change of topic. The "talking points" the owners provide for their followers call it "socialism", and the latter, in US political culture, is an epithet like "child molester".

The ugly reality this charade is designed to avoid acknowledging is that the US is ruled by what has lately been called "the one percent" - and there is nothing the majority can do about it. Voting for one of the practically identical, freak-show, major-party candidates is made useless by the two-party system; the increasingly hollow pretence of democracy mocks any thought of reform.

Of course it's barbaric. It is also perfectly rational on the part of the rulers: their families need not worry about getting first-quality treatment of any health problem, and from their view the rest are disposable labor whose costs are still too expensive.

What, exactly, would you propose we do about it? Protest in the streets? People can't afford to lose their jobs, nor even time away from their daily responsibilities. Write to Congresspeople? Pointless for those who can't afford lobbyists. Revolution? No one has a realistic plan. It's almost miraculous that Obama managed to (temporarily?) install a plan that even purports to help - and it forces citizens to pay the insurance industry, whose presence in the healthcare system is exactly what keeps 30-40 percent of the population an illness or injury away from destitution.

You're obviously in a better place (news of which does not penetrate the info-tainment here, BTW), but it's rather naive to suppose that we in the US chose this situation. For us, it will get worse before it gets better.

[sliverstorm]

Yes, yes, Americans are practically drooling Cro-magnons for not having universal health care. We know, we've heard it countless times before, and I'm not sure it contributes anything to the discussion other than a smug sense of self-superiority for the non-American readers.

[a3n]

As an American I agree, it's terrible not having universal healthcare. What's the point of being a large body if we don't take advantage of that? And if we don't, we really aren't anything except individuals. Nothing wrong with being an individual, but we can be and accomplish so much more together. Apart, we're just living in the same place.

[markost]

Did you reply to the wrong comment?

[Frozenlock]

Can I be the first non-US citizen to say that universal health care is, by definition barbaric?

Adjective Savagely cruel; exceedingly brutal. Primitive; unsophisticated.

I fail to see how, when a group decide to take from the minority, it could be seen as anything else than barbaric.

It saddens me to see one of the last first world country coming closer to the universal health care trap. Sure, the US medical fees are insanely overpriced, but you don't solve a problem like this just by hiding the costs in a social program.

[maratd]

> It saddens me to see one of the last first world country coming closer to the universal health care trap.

We're still quite a ways off and there's been quite a bit of pushback on the small steps Obama took. It's entirely possible the whole thing will be scrapped during the next presidency.

[__--__]

I hope so. It puts an unusual amount of financial pressure on small companies who are trying to make that step into big companies. I know of quite a few companies who are artificially keeping their employment count below 50 to avoid the costs of obamacare.

[dkuntz2]

Is it really any different from traditional insurance? Don't most insurance companies take money from all their clients, and use it on a fairly small number of those clients?

I personally don't see the "trap" you reference. I'd really like to understand your position there...

[Frozenlock]

Traditional insurance will/can reject some individuals. For example, you don't take an insurance against theft AFTER you've been stolen hoping that they will reimburse you.

In addition, insurance companies can target a certain demographic to offer lower prices: An insurance for office workers will not be the same as an insurance for football players.

This is a really key point. Market forces push insurance to offer specialised coverages that match your risks. Start smoking? Hey, we're going to bump you in the next bracket...

And in case the only insurance offered are a clear rip off (extended warranty kind of thing), you can always walk off and say "no thanks".

Now, imagine a new government program that decides to accept everyone because capitalisms is obviously flawed and full of greedy people.

The cost of such an insurance will be, for certain individuals, higher than what they would be with a targeted coverage. (The office workers for example.) Those individuals have now every incentives to leave this insurance and either take a private one, or even take none at all.

This causes the remaining few in the government insurance to have higher premiums, causing even more people to leave and check for alternatives.

The only way to prevent this exodus is to force everyone to stay with a single, monolithic insurance coverage. Even (especially!) those who are healthy.

Let's assume that you are OK with the concept, because without the government, the sick, single moms and children are facing certain death...

Because this super insurance is working outside of the market, you can't evaluate the value it provides. (If you force someone to buy an ice cream cone $36 at gunpoint, is it really worth $36? Maybe, maybe not...) This in itself is a huge problem, because you never know when you are wasting too much resource to try to solve a problem. Would this money better spent financing schools? Perhaps it would be better to distribute better food to poor families? Again, it's outside the market so you'll probably never know. While there's an infinity of bad/suboptimal ideas, there's only one or a handful good. Now pick one and 'hope'. Throw in a little political games in it, and you'll probably never end up with what you were expecting to begin it.

But there's yet another, more 'local' problem. Now that you have your too-big-to-fail insurance, how can you keep it in check? Should it cost $1k to process a claim, or $10k? When is your administration too big? You can compare yourself to some other insurance companies, but that's assuming you didn't wipe out the entire market (which you have to, eventually, to prevent the exodus). Even with comparison, you never have a decisive proof that it's too big. How do workers react, when you try to resize an industry, without the proof that it needs to be done? If, in addition, it's a government subsidized industry, good luck ever making it smaller.

The end result is a "service" that not a single soul knows how much it should cost, but with a constant pressure to increase the funding.

Also, this is without taking into consideration some pharmaceutical firms' lobbying. Imagine how happy they would be, if none of their consumers were the payers! (It's already a problem in the U.S. IMO; people use drugs but just forward the bill to their insurance.)

These problems only grow with time. While a government insurance might be "not so bad" in the beginning, every structures and forces around will deteriorate it. And before you know it, you won't ever be able to talk against any of its part, because then you'll be a greedy capitalist that wants to leave the poor and sick die a painful death.

This is the trap I'm talking about. When you're in it, there's no way out.

[iopq]

I don't accept anything less than universal food care, universal shelter care, universal clothing care, and of course universal marriage care.

[purplelobster]

Ironically, you're close enough to the truth. The only thing that stands in the way of dignified living for everybody is people like you. There is enough resources in this world (especially the US). Why should kids everywhere live in poverty, starve and not be given the same opportunity under the same conditions as more fortunate kids (well fed, good schools) because their parents couldn't find or hold down a job? Instead, kids grow up hungry and can't focus on school, and even if they want to, they live in a poor neighborhood with bad schools, perpetuating the situation for yet another generation.

[LekkoscPiwa]

because we all know that then all kids would be hungry and not educated not only the poor ones. Somehow socialism always ends up making everyone equally poor and not equally rich.

I read recently that in Canada waiting time for some surgeries are 6 months. For everyone. People who can afford and people who can't afford. Everybody screwed over. But of course that's what socialism is all about - making all people equal. In their poverty.

[throwaway9848]

What a bunch of nonsense. If you look at aggregate numbers, people in socialist countries on the average are healthier and live longer. And the children of Canada, France, Britain, Norway, and so on do not go hungry. Amazing!

I don't even agree with a lot of western European style socialism, but it sucks that because of people like you we can't even have an honest, adult conversation about it. Thanks loads.

[alexqgb]

Well said good sir! Your grasp of basic facts about the world is truly impeccable. Why, I myself just got back from Sweden where I had a layover on the flight from Mozambique. Or did I stop in Mozambique on my way back from Sweden? Now that I think about it, I can't be sure! I mean, honestly, who can tell them apart? Not me! Or you!

[taylodl]

Did you check out the author of what you read and what agenda they may have had? Plus the term "some surgeries" is pretty vague, indicative of hand-waving.

But consider the alternative - without insurance or money your waiting time for surgery is...forever.

All health service is rationed. Our system simply doesn't ration it to those needing it most, instead rationing it to those with the most money. You can see the effects of our system with all the new "designer hospitals" they're building these days. By focusing on the affluent we're pricing health care out of reach of those of modest means. There are reasons health care costs in the United States have been rising several times more than the rate of inflation for the past 30 years. And none of those reasons paint a good portrait of our health care system.

[disbelief]

You might want to base your opinion on more than one thing you read somewhere. I have a friend who was diagnosed with cancer in Canada and was in surgery with one of the top surgeons in the country in under a week. That plus a lengthly stay in the hospital and all of the drugs associated with cancer were 100% covered by our healthcare system. How is this poverty?

[victorf]

Because your taxes are so high that people who might otherwise be able to afford a private jet now cannot? Not having a jet is quite embarrassing and really harms the jet-less that have to fly in merely first class.

[victorf]

Of course the proper way to order surgeries is to give priority to the wealthy persons so they can quickly get on with creating jobs. Lazy poors aren't going to do anything significant anyway, so they can wait eight or nine months and it doesn't matter.

I cannot imagine raising taxes any further, if a wealthy child's parents couldn't afford to send him to a private school imagine what a terrible education he will have! He might even end up poor himself, which, I'm sure we can all agree, is a fate we should reserve for the already poor.

[dkuntz2]

You know, your first paragraph sounds strikingly similar to the premise of an episode of Star Trek: Voyager, Critical Care (http://en.memory-alpha.org/wiki/Critical_Care_%28episode%29)...

They also found the idea silly.

[victorf]

(The Voyager doctor was a pretty good character)

It is absurd. Everyone complaining about the wait is asserting implicitly that they need to be allowed to get their healthcare before anyone they are able to outbid.

Personally, yes, I want everyone poorer then myself to wait until my surgery is done. But that's because I'm not so far down. Is it what's best for society? Most likely not.

Probably ideally for healthcare you would live in Canada where it is not the worst cost to health ratio of all the western countries, but you're also able to nip down to the US and cut in line in a pinch.

[mason55]

There's a huge difference between socialism and a minimum living standard

[dnautics]

you don't understand what it means to be a minority. We don't get anywhere near equal quality coverage and are basically forced to subsidize better medical care for white folk. For years, my father was prescribed a drug (simvastatin) that actually did damage to his body because it's nearly universally assumed to be good for him (it is for most white people), and strongly subsidized by the government (he's a military vet).

I only found out because I got 23andMe, and I actually know biology. It was dismaying to find out that very few of the tests on 23andMe are useful for Asians like me (fewer still if you're hispanic and if you're pure African, the affymetrix chip they use is basically useless). As we move into an era of personalized medicine, we'll be subsidizing better healthcare and better outcomes for some ethnic groups over others.

The faulty assumption behind universal healthcare is that a one-size-fits-all prescription is good for everyone, but there are some really ugly disparities that no one talks about; and these disparities serve to reinforce preexisting social inequality. While I'm lucky to be in a minority group that's likely to live a long time - if we have it, a lot of universal healthcare coverage will wind up being plowed into gerontological care costs, which tend to be super-expensive; so in a way, it's a subsidy for rich white people.

Now, I do think the american healthcare system is awful. In particular being able to be put into permanent lifelong debt from healthcare costs is only one small step above barbarism. But I don't think that universal healthcare is the solution we're looking for. Obamacare is even worse, it combines the worst parts of universal healthcare with the worst parts of the crony capitalist system we have, and I won't be surprised when it turns out to be an even bigger albatross on the shoulders of this country.

[sliverstorm]

It sounds to me like your father's issue was not that he was not white, but that he had a rare genetic condition...

There was even a study that found on the whole, simvastatin is equally helpful across races: http://www.ncbi.nlm.nih.gov/pubmed/16709304

[dnautics]

Oh, it reduces his cholesterol level[0]. But he has at least one allele that increases the risk of myopathy when taking simvastatin (Assuming there were no milkmen - I do look quite a bit like him - I'm homozygous, and this allele is not terribly rare).

The part about being asian is that asians tend not to catabolize statins as effectively, so his plasma levels are probably higher, since I found out he was taking a full "white person dose" despite advisories that simvastatin should be given at half dose for asians.

[0]I also recall hearing somewhere from a biochemist that while statins decrease cholesterol levels in asians the effect on coronary heart disease (which is what your really care about) is attenuated, and that there may be a secondary mechanism for CHD in asians... But I cannot find the source he was quoting.

[dnautics]

ah, I found it, after all these years:

http://www.ncbi.nlm.nih.gov/pubmed/21160131

as a bonus, here is the review on why asians should take less statins (hepatic enzyme clearance, probably a cyp450):

http://www.ncbi.nlm.nih.gov/pubmed/17261409

[sliverstorm]

That's not a consequence of being non-white so much as it is a consequence of your doctor being uninformed, which impacts people of all races.

I'm not saying it doesn't suck, I just take issue with your narrative of how race is the issue at hand, and how the medical system is bigoted towards minorities.

[dnautics]

It's not just the medical system. It's just reality. I live with it. I'm okay with it. I'd just rather not these disparities be magnified and exacerbated by universalizing something which shouldn't be.

>That's not a consequence of being non-white so much as it is a consequence of your doctor being uninformed, which impacts people of all races.

But it impacts minorities in the most general sense (i.e. not just color of skin) more than non-minorities. For fundamental reasons, studies are less statistically reliable, for starters.

I should remind you also that my father is being cared for under a universal system (the VA) I think that the unversality of it does play into the way that the doctors are informed.

[dbpatterson]

Universal health care has _nothing_ to do with treating all people alike. It just means treating them all.

[dnautics]

Fine. But government is required to treat all people alike. I think this is a reasonable requirement, given that you cannot 'opt out' of government. If you want to set up a private universal health care charity fund, I would happily cut a recurring check to help your cause, assuming some basic transparency and accountability. At least, if you mess up your charity and start, say, embezzling funds, I can opt out.

http://en.wikipedia.org/wiki/Equal_Protection_Clause

[nknighthb]

Your misunderstanding of the equal protection clause has no basis in reality. The government is absolutely allowed to treat different situations differently. There is no legally recognized interpretation of the constitution -- none -- that would require the government to give person A a treatment inappropriate for A just because it gave person B the same treatment which was appropriate for B.

[dnautics]

of course, the government SHOULDN'T give person A an inappropriate treatment just because it's what it would give to person B. Becuase that would be stupid. But what does it give person A? Perhaps it can offer person A nothing. Then, how is that fair and equal?

that's exactly why the only solution is the null solution.

Bottom line: we need to live in a society where people actually help each other and actually show compassion, not create rediculous byzantine bureaucracies that marginally help the rich and politically well-connected that are an empty simulacrum of compassion.

[nknighthb]

It is fair and equal under the law because the government is offering what it can to whom it can. If there is no treatment for person A, there's no requirement -- legal, moral, or ethical -- that one be given.

The "null solution" is absurd. It simply provides that the rich get treatment and the poor do not. That would be "fair and equal" only to a barbarian.

[robbiep]

>>As we move into an era of personalized medicine, we'll be subsidizing better healthcare and better outcomes for some ethnic groups over others.

I think you miss the point of universal healthcare. It is not that one group has a higher utilisation of the healthcare system and therefore should pay more - the principle is that everyone is guaranteed the same provisions for healthcare, regardless of their risk factors.

Personalised medicine contributes nothing to the concept of universal healthcare; except for the noble aim of enabling better treatment of people through understanding individual responses. ' The idea that someone should be restricted in their level of healthcare utilisation under a universal system is absurd; As is the notion that someone should be forced to contribute extra (apart from the incremental addition of a high income earner through increased taxation) due to a perceived increase in risk.

>>The faulty assumption behind universal healthcare is that a one-size-fits-all prescription is good for everyone,

Again, I feel like you are trying to talk about personalised medicine inside of the concept of universal healthcare. Forget about personalised medicine. What the US needs first is access that won't bankrupt. The fact is we don't know enough about personalised medicine to give people different treatments based on genetic characteristics. And we won't for years. Sure, you can look at 1 or 2 isolated instances at the moment (ACE-inhibitors and ARBs in Black people for instance) - but none of this matters when it comes to life-saving care, for which the treatment is going to be the same for everyone anyway, unless you happen to have some rare blood disorder in which case racial profiling and blood tests at the time of intervention will dictate management.

>> so in a way, it's a subsidy for rich white people.

How so? Because they live longer anyway? Because they are less likely to indulge in the risk factors that result in early mortality? Again, Universal healthcare doesnt discriminate. But since rich black/brown/yellow/white/green people pay a higher proportion of taxes anyway, shouldn't your argument here be that Universal healthcare is a tax on rich people?

Additionally, just because you are on a high dose of a Statin, in a high risk population, doesn't mean you are developing myopathy. CK levels should usually be checked after a month or 2 of Statin therapy in line with followup for new lipid levels, and in the absence of symptoms it can be fairly safely ruled that you aren't experiencing a complication of a statin drug. But you probably already know this.

[dnautics]

>is that everyone is guaranteed the same provisions for healthcare

You're missing my point. If those provisions are the same, that's exactly the problem. It's only worse if they aren't the same (because who chooses?)

CK levels warnings are only triggered when you are having a serious complication from the statin. When you have a lesser complication, like, "going to the gym sucks instead of making you feel good", and you aren't aware of what's happening, and it's making you fatter, and your quality of life is going down, then what?

[robbiep]

Again i'll have to insist you are missing the point. Not my point, although I am advocating it; but the point of universal healthcare is to enable everyone access to the same level of healthcare for free. (Or, paid for by the taxpayers if you insist).

The principle is not about ensuring that someone with a specific amino acid substitution receives a specific drug, because this is an example of the specific medical management of a specific patient. If you are going to continue to insist that your dad was treated inappropriately, and I have no reason to be able to assume one way or the other from my current position on the other side of the planet without a through examination of your father and his medical results, then what you are complaining about is not universal healthcare per se but in fact poor care by the treating physician. Which could happen under any system, anywhere.

[dnautics]

can you define for me what you mean by "the same level of healthcare"?

>universal healthcare ... poor care by the treating physician

These issues are entangled. I should let you know, that despite being in the US, my father is effectively being treated by a "universal healthcare" system - the VA.

[robbiep]

Access to life saving treatment when required, as required, access to free hospital and cheap/free out of hospital medication.

The issues are no more entangled than that 'healthcare providers' are a subset of 'healthcare' and within healthcare providers are going to be doctors administrating care that is not up to the best evidence. Universal healthcare is no defence against that, but either is any other form of healthcare. If you select your own doctor you have every chance of choosing one that may give you treatment against the best evidence.

It seems you are saying that universal healthcare means that you will get poor healthcare. I vehemently disagree with this proposition, not just based on your single anecdote but because I live in a country with a universal healthcare system and I have worked within it and in a few months I will be dispensing care from within it as a doctor. Every system has failures but this criticism isn't an indictment of the entire system

[Fomite]

For the record, if you don't think health disparities are a topic of intense focus in the healthcare research world, you're reading the wrong sources.

[krapp]

The rationale makes a twisted sort of sense when you realize that, to the people in power in the US, access to healthcare is no more a 'right' than is access to a luxury car. It's just another good, and suggesting otherwise is tantamount to legalizing theft.

[__--__]

And yet, our specialists are the best in the world and people fly in from all over the world to be treated by them.

I'm not saying our system is perfect or can't be improved, but "Barbaric"? You win the prize for the most ridiculously hyperbolic statement I've read all today.

[LekkoscPiwa]

the only difference is that in socialized medicine you wait for life saving surgery for months even when you have money to pay for it. So everybody suffers.

[robbiep]

No, if you need lifesaving surgery, you get it. And you don't get a bill that ends up costing a second mortgage.

Elective procedures - that's a different story. But it is location specific, and in many countries with mixed public/private systems you can pay through your nose if you like anyway

[dnautics]

who gets to decide what is lifesaving and what is elective?

[taylodl]

Currently the insurance company does, and since they were most likely selected by your employer whose objective was to hold down costs, what do you think that insurer's priorities are going to be? Plus, who's the customer in this situation? For whose business is the insurance company really working for?

[dnautics]

no doubt having your employment being tied to your insurance is a really, really bad idea, but may I remind that state of affairs is because of a government incentive put into place by FDR.

[markost]

I believe it was originally because of postwar wage/price controls, which led to employers giving health insurance to attract employees, which led to the IRS taxing health insurance, which led to Congress exempting health insurance from tax, which led to the current regime we have today, compounded by the McCarran-Ferguson Act as well as the HMO Act.

[taylodl]

You failed to mention the context of that government incentive - World War II. And the incentive you're referring to was put in place by the War Labor Board in 1942, during FDR's presidency. http://en.wikipedia.org/wiki/War_Labor_Board

[robbiep]

In australia if you're in a hospital and you need surgery, you get it. Today if necessary.

Nothing needs 'approval'. Because everyone has the same insurer (The government), if you present to a hospital you are triaged according to your risk and treated appropriately. No 'approval' and no 'rejection'. It just happens.

And if you have osteoarthritis of your knees and want surgery in the private system (which can generally happen on demand instead of - because it is an emergent/elective condition - some time between now and 12 months from now) then you can go ahead and organise that.

If you would like to read a media release by the College of Surgeons have a look at [1] which not only describes emergency and elective but talks about about how surgery is managed in the hospital.

whoops, missed the link. [1] http://www.surgeons.org/media/307115/sbm_2011-05-24_separati...

[sliverstorm]

It's like the line between "cosmetic" and "reconstructive". You would think it was a pretty clear line, and then discover it isn't.

[pvarangot]

In most systems, doctors.

[LekkoscPiwa]

yeah, like bribes to doctors so they actually perform this cancer tumor surgery to my dad instead of asking him to wait in line for months more. Seen a doctor? Has a belly and a family. Needs money. Simple. But some idiots believe in "free". There is no free. You pay a ton of money for healthcare in any system.

[mason55]

> There is no free. You pay a ton of money for healthcare in any system.

I'm confused. Is your argument that universal health care is more expensive than the current US system? Most studies have shown that to be false.[1]

I don't think anyone believes that universal health care is free.

[1] http://content.healthaffairs.org/content/21/4/88.long

[LekkoscPiwa]

go outside US and you will see that societies are concerned about people with deadly diseases like cancer having to wait months for surgeries. Because there arent enough doctors. Because there arent enough beds in hospitals. Because there just aeent enough medications. People have much more serious problems with socialized medicine than cost. ie waiting line of 6 months for prostate cancer surgery when every day counts. There are many much more important aspects of healthcare than affordability. Wouldnt you trade this 6 months waiting line for bankruptcy? Really?

[pvarangot]

You do realize saying "in socialized medicine" is as vague as saying "in every other country in the world" don't you?

There are 193 members states in the UN, of those 192 have a health care system that I would bet nearly 100% of americans would call "socialized medicine" in a poll. That includes countries like Sweden with completely state controlled top of the line healthcare, also England with state regulated prices for the private sector and also a top 5 in any reasonable metric health care system, or Panama/Argentina/Brazil with a mixed public and private not-top-of-the-line-but-reasonably-working system that includes very cheap private health insurance. It also includes Cuba, that has a very dfferent system than lets say Russia or Chile.

Your remark is as vague and irrelevant as saying "the only difference between HN readers and the rest of the world is that the former usually make vague and irrelevant remarks based on their personal beleifs".