This is Just Smart - Socialized Medicine

[emmiedahl]

I wanted to create a separate thread rather than diverting the convo on the "This is just stupid" thread. Here is one of my pet peeves: discussing whether we can afford socialized medicine.

My opinion, which is based in a high level of fact in this case, is that we cannot afford not to. The US spends an appalling amount of money on health care. A lot of this is due to an inefficient and unequal system. We are paying more for less care. We spend more than developed countries and get a worse outcome.

I found this PBS documentary today and had to share. It is about different communities in the US that are spending less and getting better outcomes even though they have average levels of income, poverty and population health risk. The difference is in how they care for the community.

http://video.pbs.org/video/2198039605/

[chiccy]

My opinion, which is based in a high level of fact in this case, is that we cannot afford not to. The US spends an appalling amount of money on health care. A lot of this is due to an inefficient and unequal system. We are paying more for less care. We spend more than developed countries and get a worse outcome.

http://video.pbs.org/video/2198039605/

I don't have the energy to participate in a full-fledged debate on this issue, but I wanted to raise one thing. (I do support universal health care in general, but I have some objections to it. The positives outweigh the negatives, in my view; still, drawbacks are part of the picture.) One reason that U.S. outcomes per dollar do not seem to exceed Europe's/Britain's is that we pour resources into treating difficult cases with a high likelihood of death, such as premature babies and late-stage terminal illness. In short, we try very hard to save lives even where the chances are slim. This substantially affects our outcomes per dollar. These practices are generally much less common in the countries with socialized medicine.

While I can understand the argument that we shouldn't try to save such lives at all costs, there is also an argument that we should. (The arguments on both sides are obvious: it is a pure question of utilitarianism versus deontology.) That's not my main point. My main point is that this is a big reason for why our outcomes look worse. If this significant factor were controlled for, I imagine our outcomes per dollar might meet or exceed those of the E.U.

[emmiedahl]

Do you have evidence that other countries do not offer treatments like this for potentially terminal cases?

[debrand]

Do you have evidence that other countries do not offer treatments like this for potentially terminal cases?

Emmie, I've read similar arguments by conservatives. Apparently, they believe that socialized countries are killing their weak off. There is no proof of this but it doesn't keep them from repeating the information.

People who repeat these facts don't automatically understand that they are not true.

[Anxious Girl]

Not all feminists want men to be lower than them. Feminism is about gender-equality. Don't judge a book by it's color, wich means don't judge a person by what they wear, their race, or what you assume their gender to be. Respect people, even if they don't present themselves in what you think is presentable.

[JesusFightClub]

Emmie, I've read similar arguments by conservatives. Apparently, they believe that socialized countries are killing their weak off. There is no proof of this but it doesn't keep them from repeating the information.

People who repeat these facts don't automatically understand that they are not true.

This. I am confused.

The NHS has no such policy of abandoning the weak to die. The nearest I can think of is that sometimes doctors have said "It would be cruel to keep this baby alive" in cases of terminal conditions apparent at birth (and I am not talking about "the wean looks a bit off, ken", but cases where the condition is utterly tragic and any kind of sustained life isn't possible).

I differ on this from the general policy, though t'aint important. What is important is that Americans don't go about the place believing "death panels" and culling the weak are daily events in a universal healthcare system. They are not.

[Austin]

Oh, we have death panels. They're called "insurance companies".

[Kelya]

Oh, we have death panels. They're called "insurance companies".

and the same people who rail against socialist medicine tend to love giving all sorts of privileges and tax breaks to these companies.

[emmiedahl]

I think a lot of lies have been passed around about why we cannot have socialized medicine because Republicans know that they have no good argument against it. Where logic fails, fear often works.

I admit to having fear about how socialized medicine would be handled because I deal with the government quite a bit and viciously hate every moment.

But the cost? Socialized medicine will cost less because it always has.

[Witsec7]

Thanks for the link Emmie. Oregon Gov. Kitzhaber (a physician) now has a bill in the legislature to mandate patient centered care for OHP recipients. I use public health, since I'm uninsured and not eligible for medicare. Our local public health also uses patient centered care My visits there cost me $225 for one hour, if I went to our medical monopoly in town, I would get 15 minutes (on the outside) for a cost of apx $575. Naturally via the monopoly I'd also be routed to a variety of specialists for tests that really wouldn't impact my choice of treatment, or outcome.

I was due a follow up visit to PH for lipids, bp and blood sugar. Public health called me in advance of my due date and advised me that these tests would be offered for free to seniors by our local hosp in Feb at no charge. My contact NP told me to have the results sent to PH and also provide them with copies of by BP and blood sugar logs, and I'd get a no charge call back with recommendations. As it stands all is good, I had positive outcomes because I learned what I could do to positively impact my health. It required me to be responsible for diet and exercise and logging my BP and BS.

On the opposite side of the spectrum is my soon to be X. He has medicare for seniors and a cadillac supplement he pays dearly for. He has at least 3 on demand MRIs annually, and complains because he exceeds his policy limits. He has consults at least once a month with specialists because he is not managing his conditions and takes zero responsibility for his outcomes. I don't think that he would change his behaviors to make patient centered health care an affordable option for him.

Sorry for the ramble. But this was an important video to watch, and I think sharing of our experiences helps us all better evaluate whats happening in health care today and envision a new direction for the future.

[bananacat]

The United States has the highest infant mortality rate among first-world countries. For every hopeless baby that we're pouring money into, we're letting a bunch of others die because they lack even the basic care. So it's not all about heroic measures and trying just so gosh darn hard to save everyone. Clearly there is more to it than that.

[Witsec7]

The United States has the highest infant mortality rate among first-world countries. For every hopeless baby that we're pouring money into, we're letting a bunch of others die because they lack even the basic care. So it's not all about heroic measures and trying just so gosh darn hard to save everyone. Clearly there is more to it than that.

I would think our infant mortality rate has more to do with pre and ante natal care and under served populations.

[3 is enough]

Proof that the death panel argument is just a b.s. scare tactic:

My father was diagnosed with stage 4 liver cancer. The oncologists did not give him a time frame, but basically told him to get his affairs in order. He was given the option of chemo, even though he was 72 years old, and living in a country with evil socialized medicine (Canada). Sadly, he only lived 3 1/2 months after his diagnosis, but he got excellent care. My mother was left with a bill for $22 for the phone in his room.

[Witsec7]

Friend of mine had an adult leukemia, Kaiser ins. he did some chemo with negative outcomes (his disease didn't have a high survival rate). I think the family had a total out of pocket for 2.5 years of illness, hospitalizations and care that came to about $100. It was his choice to stop treatment, not the providers.

The conservatives argue death panels and never recognize that it was Geo Bush as the TX gov. who made futile health care laws mandatory in TX.

[fluttershies]

As a British person, the cost of calling an ambulance alone just astonishes me. It wasn't until a friend from Alabama told me about when she had a severe strep infection and was very very ill and her husband still drove her to hospital to avoid ambulance costs, that I realised why they always drive to the hospital on US tv shows.

I love my NHS so much.

[alaeangelorum]

This. I am confused.

The NHS has no such policy of abandoning the weak to die. The nearest I can think of is that sometimes doctors have said "It would be cruel to keep this baby alive" in cases of terminal conditions apparent at birth (and I am not talking about "the wean looks a bit off, ken", but cases where the condition is utterly tragic and any kind of sustained life isn't possible).

I differ on this from the general policy, though t'aint important. What is important is that Americans don't go about the place believing "death panels" and culling the weak are daily events in a universal healthcare system. They are not.

^ ditto. I find the lies spread about socialised medicine quite unsettling.

I've never spent any time in hospitals in the US so I don't know how far attempting to save people with terminal conditions goes, but I can't think of any situations in the NHS where there is a curative treatment that has been trialled & proven to be effective is denied. There are some cases where some expensive drugs which would prolong life by a couple of months have not been approved on the NHS because the cost is considered far too unreasonable, but there aren't too many. We also don't tend to leave premature babies to die unless it's thought that it would be futile and therefore cruel.

What I have heard (and you know what this could be as true as the NHS leaving people to die stories) is that US medicine seems to be very trigger-happy on investigations, partly due to fear of litigation. I am sure this pushes up the cost of healthcare.

ETA: and to echo the sentiments of the poster above me - I love the NHS. It's amazing. I read stories on the internet about people not being able to pay for healthcare (eg Razing Ruth and her leg) and I feel very lucky that if I got admitted to hospital tomorrow all my treatment would be free.

[ilovetchotchkes]

Oh, we have death panels. They're called "insurance companies".

I know of 2 people personally that literally died from a lack of health insurance. One was a veteran :shock:

Another, a family member (also a veteran), had his wife not had supplemental insurance would have bankrupted the family with his cancer care.

And yet... people in my family still scream about "death panels". One of them is married to the child of aforementioned family member. :?

[Elle]

Emergency care for ONE emergency costs a hell of a lot more that providing a year's worth of preventative care to a dozen people. We can afford socialized care and would probably save money.

[Elle]

I would think our infant mortality rate has more to do with pre and ante natal care and under served populations.

We've also got the second highest maternal mortality rate. There is not only a correlation between the drastic rate in c-sections, but evidence pointing to an incredibly high rate of them being the cause of more maternal deaths than anything else. Hemorrhage is the #1 case of maternal death, and most of those are from c-section complications. Anesthesia has incredible risks. But since it's the most common surgery in the US, many people presume it's completely safe.

There's a problem with babies being electively delivered too soon because of the fallacy that 37 weeks is full term. Between 37 and 39 weeks, a baby's chance of life-threatening complications drops in half, yet many mothers want their babies born at 37 weeks. I have a friend who's got an elective scheduled for 37 weeks at a hospital that is booked solid for how many c-sections they can handle for the next few months. Babies are born too early by choice, their lungs aren't properly developed, they have a higher rate of seizures and other neurological problems.

For all the basic care people can't get, any attempt at limiting c-sections to cases when it's truly medically indicated (none of this "the baby might be 5 pounds and that's too big to be born vaginally" crap, which is what my friend was told), and no elective c-sections before 39 weeks without damned good cause, is met with resistance and screaming about women's rights. In anything else, if something is elective we don't get to have it. With birth, it's seen as a right, whether or not you've got insurance. And then if you have a baby with lung problems, the NICU will be covered by insurance or tax payers.

Every day in the US, more than 2 women die, and the #1 cause has been tied to c-sections. If a third of pregnancies needed c-sections, then humans would have died out. Also, curiously, hospitals in the US with lower rates of c-sections have fewer maternal and neonatal deaths and fewer babies ending up in the NICUs....

So money is wasted while problems are created. You can get an elective c-section at 37 weeks with it covered by taxpayers and the likely NICU stay covered as well, because of your CHOICE, but good luck getting a gall bladder removed before it ruptures and is an emergency that could kill you.

I've got a medical problem right now that could be taken care of with a dose of antibiotics, but I can't afford the tests out of pocket to confirm the diagnosis, so am hoping it gets better on its own, or else I'm going to eventually end up in the ER where it will cost more. But if I were pregnant, I could get a c-section for the asking.

[BayLee_10]

I do have socialized medicine in the USA, the problem with that is one has to be over 65 to get it, Medicare. I also have Tricare for Life since my husband is retired from the Army. I receive great care and low co-pays for medication. Why Obama did not just call his plan Medicare for All is beyond me. Medicare works. My opinion is that if we can fund (ridiculous JMO) wars, 2 at a time, bail out banks and businesses, plus many, many other expenses we can damn well afford to educate and provide health care for Americans.

[Mama Mia]

As a small employer I think it would also greatly benefit the economy to have universal health care. We have less than 20 employees in our small social service non-profit. People do not make very much money bu we have managed to keep up excellent insurance coverage - and it is so incredibly expensive ! We could switch to a much cheaper PPO with a high deductible - but no one would be able to afford to use it, so what is the point ? Having universal health care would mean a much smaller portion of each persons wages would go to pay for healthcare through their taxes. We could maybe even give small raises, because we would have more money to pay salaries if it weren't for the highly expensive health insurance. Raises mean more purchasing power for our employees, which is also good for the economy. The only ones who win with the current system are the insurance companies.

[Elle]

I do have socialized medicine in the USA, the problem with that is one has to be over 65 to get it, Medicare. I also have Tricare for Life since my husband is retired from the Army. I receive great care and low co-pays for medication. Why Obama did not just call his plan Medicare for All is beyond me. Medicare works. My opinion is that if we can fund (ridiculous JMO) wars, 2 at a time, bail out banks and businesses, plus many, many other expenses we can damn well afford to educate and provide health care for Americans.

The people who are against a socialized system for all are those who see Medicare and Medicaid as being for lazy leaches. Of course the irony is Jesus wouldn't have withheld medical care based on an inability to pay, and really, most people who are sick are at least temporarily out of work, even if for a few days, making it difficult enough to pay the bills with less pay, much less expensive medical bills.

[Sola]

I don't have the energy to participate in a full-fledged debate on this issue, but I wanted to raise one thing. (I do support universal health care in general, but I have some objections to it. The positives outweigh the negatives, in my view; still, drawbacks are part of the picture.) One reason that U.S. outcomes per dollar do not seem to exceed Europe's/Britain's is that we pour resources into treating difficult cases with a high likelihood of death, such as premature babies and late-stage terminal illness. In short, we try very hard to save lives even where the chances are slim. This substantially affects our outcomes per dollar. These practices are generally much less common in the countries with socialized medicine.

While I can understand the argument that we shouldn't try to save such lives at all costs, there is also an argument that we should. (The arguments on both sides are obvious: it is a pure question of utilitarianism versus deontology.) That's not my main point. My main point is that this is a big reason for why our outcomes look worse. If this significant factor were controlled for, I imagine our outcomes per dollar might meet or exceed those of the E.U.

You might want to check out the thread I made in Ask Me Anything. It's the Ask the Mum of a Micro Preemie thread. That will give you an idea on how preemies are treated under the NHS in the UK.

[formergothardite]

Sola, do you mean they didn't refuse to save your baby because it is too expensive? LOL I used to believe this because that was what I was always told that with NHS they wouldn't treat you if it cost a lot of money.

[Sola]

No, they didn't! Shocking isn't it!

The unit my daughter was in is at a woman's hospital. This hospital is at the forefront of fetal and maternal medicine in the UK. The NICU (we call it SCBU in the UK) she was in is one of the best in the world. They take the most difficult cases and the most premature of all babies. I was lucky because I live in a nearby town so got referred there when I started having difficulties at 18 weeks. I am proud to say that I got some of the best care in the world. For free. On the NHS.