Americans are not ready for socialized medicine

[ERCougar]

I think there are a lot of efficiencies to be gained by socializing medicine. However, I'm concerned that Americans just aren't ready for it. They've been spoiled for too long getting what they want, now. Wait until someone tells them no, you can't have your MRI of your knee because frankly, the government doesn't care if you're a future all-star of your city league over-40 basketball team. No, you can't have the newest blood pressure medicine because it costs 20x the amount of the old one that makes you a little more tired when you run. No, we're not doing another EKG today because you've been here 18 times this year for chest pain and it's never amounted to anything. No, we won't do a Vitamin B12 level to check out that tingling sensation in your toe. No, we're not going to keep your 80 yo father in the ICU for the next month hoping that he turns a corner.

I'm obviously talking about Americans with good insurance, but a lot of this applies to Medicaid patients, who in some cases, have the best insurance out there. But these Americans with good insurance are the ones in power and they're not going to stand for rationing. Any sort of socialized program akin to Europe or Canada is going to be extraordinarily expensive because of this.

[creekster]

If only we had monarchs.

[Tex]

Damn straight.

[BarbaraGordon]

Originally Posted by creekster

If only we had monarchs.

Wait til spring. They're migrating south this time of year.

[creekster]

Originally Posted by BarbaraGordon

Wait til spring. They're migrating south this time of year.

Some of them migrate to the Pacific Grove area next to Monterey. It is very cool to see thousands of them wintering there.

[Archaea]

Originally Posted by ERCougar

I think there are a lot of efficiencies to be gained by socializing medicine. However, I'm concerned that Americans just aren't ready for it. They've been spoiled for too long getting what they want, now. Wait until someone tells them no, you can't have your MRI of your knee because frankly, the government doesn't care if you're a future all-star of your city league over-40 basketball team. No, you can't have the newest blood pressure medicine because it costs 20x the amount of the old one that makes you a little more tired when you run. No, we're not doing another EKG today because you've been here 18 times this year for chest pain and it's never amounted to anything. No, we won't do a Vitamin B12 level just "to check it out". No, we're not going to keep your 80 yo father in the ICU for the next month hoping that he turns a corner.

I'm obviously talking about Americans with good insurance, but a lot of this applies to Medicaid patients, who in some cases, have the best insurance out there. But these Americans with Americans are the ones in power and they're not going to stand for rationing. Any sort of socialized program akin to Europe or Canada is going to be extraordinarily expensive because of this.

These is a key factor in "socializing" medicine, American penchant for consumption of medical resources. No proponent of socializing health care further will honestly discuss the rationing aspect because it is unpopular and every ninety year deserves quadruple bypass before the spine surgery, even though that ninety year has a drinking problem and smokes four packs.

Our consumption of health care far exceeds our ability to provide it to all. In France, the social cultural expectation amongst the populace is one of medications and avoiding surgery and expensive procedures.

For the US to experience the efficiencies of universal care will require a radical revolution of consumption and expectations. Obama and his kin are NOT purposefully educating the extreme changes which will be required.

[Ma'ake]

Originally Posted by ERCougar

I think there are a lot of efficiencies to be gained by socializing medicine. However, I'm concerned that Americans just aren't ready for it.

I agree, on both points, but there's just no way Obama (or anyone else) can do a HillaryCare (or Canadian or UK) solution. It simply won't work in the US, not now, likely not ever.

The two biggest problems areas in US healthcare are insurance and Rx $$.

Competition between the private & public sectors on health insurance will help drive costs down, overall, and force the private insurers to become more efficient. No matter how successful the public insurance plan(s) might become, there will always be a market for private insurance, for supplemental insurance if nothing else.

Expectations in other nations of a completely egalitarian system won't be a problem here. Americans are used to the idea of paying extra for expedited or premium service. It's that way in air travel, sporting events, etc.

If you're the 40-something athlete & don't want to wait for your MRI, there's nothing preventing your from ponying up $$ to have it done sooner, or paying the supplemental insurance to get expedited service.

Regarding Big Pharma, why shouldn't the American public get the same price the Canadian public gets? If there is cost shifting on research funding, end it, make the Canucks & others share the costs. Right now Big Pharma sticks it to the American consumer because they can.

[ERCougar]

Originally Posted by Ma'ake

I agree, on both points, but there's just no way Obama (or anyone else) can do a HillaryCare (or Canadian or UK) solution. It simply won't work in the US, not now, likely not ever.

The two biggest problems areas in US healthcare are insurance and Rx $$.

Competition between the private & public sectors on health insurance will help drive costs down, overall, and force the private insurers to become more efficient. No matter how successful the public insurance plan(s) might become, there will always be a market for private insurance, for supplemental insurance if nothing else.

Expectations in other nations of a completely egalitarian system won't be a problem here. Americans are used to the idea of paying extra for expedited or premium service. It's that way in air travel, sporting events, etc.

If you're the 40-something athlete & don't want to wait for your MRI, there's nothing preventing your from ponying up $$ to have it done sooner, or paying the supplemental insurance to get expedited service.

Regarding Big Pharma, why shouldn't the American public get the same price the Canadian public gets? If there is cost shifting on research funding, end it, make the Canucks & others share the costs. Right now Big Pharma sticks it to the American consumer because they can.

The market for supplemental insurance is not robust in Canada or Europe, to my understanding. It exists, but most don't take part.

It sounds like you're advocating a sort of expanded Medicaid with fewer benefits, with extra services covered by private insurance. I think I could go along with this. However, states have been free to do this for years (as it's the states that essentially control Medicaid), and few have tried, and the few that have tried have not been very successful. Perhaps it's impossible to do it on anything less than a national scale when you have employer-based insurance and multistate corporations involved--I don't know.

I agree that cost-shifting on drug research needs to occur and the market opened up. I think this is already occurring to some extent as well on an individual patient level.

I still think that the average American thinks that socialized medicine would offer them the same care they have access to today, but with no costs. That's not going to happen. We would have to cut back Medicaid benefits if we want to expand eligibility--Medicaid already goes beyond what represents a basic level of healthcare. In fact, the poor uninsured here probably have it better than what they would have in Canada. If you want to duplicate the cost-savings of socialized medicine, you necessarily have to ration care. I don't necessarily have a problem with that in most instances, but I'm telling you--many Americans are going to.

And you have to accompany it with tort reform--something the Dems don't want to touch with a ten-foot pole.

Even with those two measures, I'm still not sure we can reach the cost-savings, without addressing some of the deeper causes of poor medical outcomes--causes that have nothing to do with the healthcare system.

[Ma'ake]

Originally Posted by ERCougar

I still think that the average American thinks that socialized medicine would offer them the same care they have access to today, but with no costs. That's not going to happen. We would have to cut back Medicaid benefits if we want to expand eligibility--Medicaid already goes beyond what represents a basic level of healthcare. In fact, the poor uninsured here probably have it better than what they would have in Canada. If you want to duplicate the cost-savings of socialized medicine, you necessarily have to ration care. I don't necessarily have a problem with that in most instances, but I'm telling you--many Americans are going to.

And you have to accompany it with tort reform--something the Dems don't want to touch with a ten-foot pole.

Even with those two measures, I'm still not sure we can reach the cost-savings, without addressing some of the deeper causes of poor medical outcomes--causes that have nothing to do with the healthcare system.

Good points, all, which is why a pure Canadian style system won't fly. Incremental changes can be made, but people will have to adjust their expectations to a different equilibrium. There is no free lunch, and like you allude to, there are lifestyle problems that exist no matter the system.

I read somewhere the Canadian Supreme Court recently ruled it is permissible for providers to accept private payment, ie, patients could move up in line with extra $$ in hand. That alone tells you how far apart the two nations/cultures/systems are.

Probably the biggest pushers of a cost competitive govt payer option are businesses, especially those who compete internationally. Detroit & other big employers are getting hammered by health costs.

[ERCougar]

Originally Posted by Ma'ake

Good points, all, which is why a pure Canadian style system won't fly. Incremental changes can be made, but people will have to adjust their expectations to a different equilibrium. There is no free lunch, and like you allude to, there are lifestyle problems that exist no matter the system.

I read somewhere the Canadian Supreme Court recently ruled it is permissible for providers to accept private payment, ie, patients could move up in line with extra $$ in hand. That alone tells you how far apart the two nations/cultures/systems are.

Probably the biggest pushers of a cost competitive govt payer option are businesses, especially those who compete internationally. Detroit & other big employers are getting hammered by health costs.

Agreed. I'm comforted by the fact that there are very smart people working on this whole issue and that every plan that has been seriously proposed seems to be more incremental than radical. I hope Americans have enough patience to see this occur; I do have to say that I'm nervous about a Democratic president and congress with a very strong mandate.

One issue that I see being ignored is the socioeconomic differences between us and Europe (or Canada). The poor obviously have worse healthcare outcomes, and I'm not at all convinced that it's entirely an access to care problem. African-Americans also have a higher prevalence of both hypertension and diabetes, even after controlling for socioeconomic status. These are very expensive diseases, probably the most expensive out there, if you include the cardiovascular and renal complications. Europe has a lower proportion of both poor and AA's, and that must play a role in lower costs and better outcomes.