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Bass
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Socialized Medicine?
« on: 2007-08-27 14:02:36 » |
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Okay my question is do you think that Socialized medicine is a good or a bad idea? I have heard arguments on both sides and have settled on one but would like to hear your opinions. I have heard that it raises taxes, makes lines and wait times longer at hospitals, gives more power to the government,and slows down discovery's in medicine. Yet the other side suggests that it improves lifespans, makes medicine affordable, assures even the poor have insurance, etc.
Currently I am leaning towards it being a bad idea just because I have been to the DMC and know that anytime the government runs something it seems to be slow and hard to use. Last figure I heard on socialized medicine suggested that it would make the government 19% bigger than it is now. Bigger government always seems bad to me.
Also from what I understand Wisconsin just started a state run socialized medicine. According to John Stossel "The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes."
http://www.townhall.com/columnists/JohnStossel/2007/08/08/let_wisconsin_experiment_with_socialized_medicine
That seems bad to me. Paying double state taxes plus a little more is not something I would like to do. I already give enough of my paycheck to the government.
Still I have never had socialized medicine, have you?
Bass
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Blunderov
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Re:Socialized Medicine?
« Reply #1 on: 2007-08-27 17:08:52 » |
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Quote from: Bass on 2007-08-27 14:02:36
...Okay my question is do you think that Socialized medicine is a good or a bad idea?
... Bigger government always seems bad to me..
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[Blunderov] I think that it would be a good idea for there to be social justice in medicine. Any system that can achieve this would be worth considering IMV.
"Bigger government always seems bad to me" interests me. It seems quite dogmatic sort of a statement. Why is bigger government always (a dangerous word) bad? What is bigger anyway? Bigger than necessary? I could agree that bigger than necessary would be bad but how much is necessary?
Perhaps Bass feels that bigger government is more expensive and is bad because this means higher taxes. ISTM though that the important question is really whether the taxpayer gets full value for his taxes or not. There are some "socialist" countries where the answer to this question is a resounding yes. In Germany its citizens may attend The National Film School free gratis and for nothing for instance. (I think the same goes for University but I stand to be corrected on this.) In Denmark just about everything is free including medicine. There are, it's true, myriad examples where such enterprises have turned out to be inefficient and of poor value but this is not always the case. The devil is I suppose, as usual, in the details.
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Hermit
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Re:Socialized Medicine?
« Reply #2 on: 2007-08-28 13:10:01 » |
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The trouble with Bass' position is that it contains so many embedded fallacies that it is very difficult to know where to start.
Competitive healthcare has a huge incentive to engage in adverse selection, in other words to try to contract with the healthy and to avoid the chronically ill. This massively increases the cost of healthcare, particularly in an aging marketplace. Which is exactly what the US is seeing. While there are potential cures, these all require effective government intervention - which is not seen in the USA. When you combine this with constraints on market entry, on market competitiveness and the entry to the country of medical professionals and drugs, all of which are practiced on a substantial basis by the US, then the cost of medicine does what it has done here, it escalates to the point where most of the population does not have access to effective health care. I say this without any doubt, because the one thing about what Americans think of as "health coverage" is that the minute you really need it, you discover that the limits built into it come into operation long before the bills stop. And if you can't afford to pay the difference, then the medical profession won't service you either - except in an emergency room. Which explains why emergency rooms are closing their doors meaning that waits for emergency treatment in the US are a bit like waiting for elective surgery in Canada.
Socially guaranteed access to effective medicine does not mean "big government" at all. The Swedes use a voucher system to guarantee free access to superlative competitive health providers - at a far lower cost per capita than the USA's broken and and horridly selective healthcare system. The results are visible in Sweden's infant mortality figures (2.76/1000 CIA) which run at less than 1/3 of the US (6.37 deaths/1,000 CIA), and life expectancy at birth (80.63 years) of nearly 3 years better than the US (78 years). But then, even Cubans have better access to healthcare than most citizens of the USA; at a small fraction of the cost per capita, not least because the Cubans, like the Soviets before them, recognizer that investing in "wellness" is far cheaper than dealing with endemic conditions.
Speaking of Sweden, recognized as the socialist system providing the most comprehensive service to its population, Swedish corporate tax, at 28%, is more than 10% less than the USA (39%) (Source: http://www.massmac.org/newsline/0405/article01.htm) and while effective personal tax rates in Sweden are a little higher than the US, Sweden has no people living at below the poverty level, while fully 12% of the US population was living below the poverty line in 2004 - and that number may have doubled along with the number of home repossessions. Unquestionably Americans work harder, for many more hours per week than the Swedes, for less disposable income, fewer perks, and greatly inferior healthcare. And like the Swedish consumers, who tend to have significant savings, as opposed to US consumers who tend to have significant borrowings, the Swedish government spends less each year than it gets in income.
I suggest that the numbers suggest that Sweden, the "Socialist Paradise," has a smaller and much more efficient government than does the USA. The CIA seems to agree (The following descriptions are both from the CIA factbook, not known for a "liberal bias"):
Sweden
Aided by peace and neutrality for the whole of the 20th century, Sweden has achieved an enviable standard of living under a mixed system of high-tech capitalism and extensive welfare benefits. It has a modern distribution system, excellent internal and external communications, and a skilled labor force. Timber, hydropower, and iron ore constitute the resource base of an economy heavily oriented toward foreign trade. Privately owned firms account for about 90% of industrial output, of which the engineering sector accounts for 50% of output and exports. Agriculture accounts for only 1% of GDP and 2% of employment. The government's commitment to fiscal discipline resulted in a substantial budgetary surplus in 2001, which was cut by more than half in 2002 due to the global economic slowdown, declining revenue, and increased spending. The Swedish central bank (the Riksbank) focuses on price stability with its inflation target of 2%. Growth remained sluggish in 2003 but picked up during 2004-06. Presumably because of generous sick-leave benefits, Swedish workers report in sick more often than other Europeans. In September 2003, Swedish voters turned down entry into the euro system concerned about the impact on the economy and sovereignty.
USA
The US has the largest and most technologically powerful economy in the world, with a per capita GDP of $43,500. In this market-oriented economy, private individuals and business firms make most of the decisions, and the federal and state governments buy needed goods and services predominantly in the private marketplace. US business firms enjoy greater flexibility than their counterparts in Western Europe and Japan in decisions to expand capital plant, to lay off surplus workers, and to develop new products. At the same time, they face higher barriers to enter their rivals' home markets than foreign firms face entering US markets. US firms are at or near the forefront in technological advances, especially in computers and in medical, aerospace, and military equipment; their advantage has narrowed since the end of World War II. The onrush of technology largely explains the gradual development of a "two-tier labor market" in which those at the bottom lack the education and the professional/technical skills of those at the top and, more and more, fail to get comparable pay raises, health insurance coverage, and other benefits. Since 1975, practically all the gains in household income have gone to the top 20% of households. The response to the terrorist attacks of 11 September 2001 showed the remarkable resilience of the economy. The war in March-April 2003 between a US-led coalition and Iraq, and the subsequent occupation of Iraq, required major shifts in national resources to the military. The rise in GDP in 2004-06 was undergirded by substantial gains in labor productivity. Hurricane Katrina caused extensive damage in the Gulf Coast region in August 2005, but had a small impact on overall GDP growth for the year. Soaring oil prices in 2005 and 2006 threatened inflation and unemployment, yet the economy continued to grow through year-end 2006. Imported oil accounts for about two-thirds of US consumption. Long-term problems include inadequate investment in economic infrastructure, rapidly rising medical and pension costs of an aging population, sizable trade and budget deficits, and stagnation of family income in the lower economic groups. The merchandise trade deficit reached a record $750 billion in 2006.
Somewhere in the archives are my medical proposals, but in short, a national health system relying on the provision of insurance of up to some fixed ceiling (perhaps $500,000 per person per year), which comes into operation only after an individual or household has spent over 20% of its annual income on medical expenses as measured by the use of a government backed medical expenses card. Anyone choosing not to use the card for all their medical expenses would not have government insurance.
Now the medical system would have a huge incentive to cut costs as it would have to persuade people to use their own money to pay for medical treatment unless the amount became exorbitant, and nobody need be without medical care. The administration of such a system would take much less effort than the government efforts attempting to monitor the current medical insurance providers - which would likely be put out of business, but I suspect that none but their employees would mourn them.
On a parallel track, I would welcome doctors from around the world, insisting only that they graduate from a 2 year residency program in the US before entering private practice. The residency program would be established to provide 1st line healthcare and emergency facilities in underserved areas. This would greatly improve access to healthcare and rapidly reduce its cost.
I would also reduce protection for new drugs and procedures to 10 years, and insist that sufficient information be provided and licensing conditions established to encourage multiple suppliers through establishing simple rules guaranteeing this as part of the FDA approvals process.
Hermit
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Bass
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Re:Socialized Medicine?
« Reply #3 on: 2007-09-19 20:08:28 » |
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Okay I've read these opinions, thought about them quite abit and I (a curious mind) have some questions about it all.
First Isn't socialized medicine in many ways similar to communism or socialism? Which seems to be what America tries not to be? It seems like this idea just tells people that they have to pay for their neighbors health coverage? What is the difference between me going door to door telling people they have to provide me with 20 dollars so that I can have enough money for health care (I guess maybe the difference would be I would have to kind of work for door to door money gathering?) Communism promises that everyone will have the things they need not capitalism, right? And if health care should be a right why aren't even more vital things like food, water, clothing, and shelter provided to people?
My second question do people call socialized medicine free? Someone has to pay for it right? I know Hilliary Clinton is suggesting that she can start her plan with only 110 billion dollars (making it one of the most expensive branches of the goverment.) wasn't this the same lady that was arguing that tax cuts would break this country? How do tax breaks hurt us while spending 110 billion dollars more on a government agency helps? I mean looking at the 2007 budget of the U.S. Medicare and Medicade made up 20% of our total budget. That is only a small percentage of our population that can get Medicare and Medicade so how would adding the rest of the population to this total make any fiscal sense? Can we sit around and complain about our debt on one hand while raising our spending on the other? I mean I guess we can this is America land of those that borrow and then go bankrupt.
I understand the argument that the war in Iraq costs this much already so we should quite the war there and use that money to pay for health care. I do think that the war needs to end quickly but here is my question when the war ends we stop spending money on it right? Well if we start up socialized medicine when do we stop spending money on that? And why can't we just not spend that money on anything and maybe start paying back our debts?
I am all about helping people but I would like to do it because I want to. I don't want people to take my money to help someone else. Does that make me a jerk? Why can't I be charitable instead of made charitable?
Regards,
Bass
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Hermit
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Re:Socialized Medicine?
« Reply #4 on: 2007-09-20 02:36:24 » |
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Fact, 20 years ago, every citizen of the USSR had free access to better healthcare than 99.5% of Americans have today. It seems likely that every citizen of Cuba has free access to better healthcare than 85% or more of Americans today.
As another fact, the US is not the capitalist haven you seem to imagine it is. It is a particularly nasty species of oligarchy, a socialist system run almost exclusively for the benefit of the top 0.5% who manage and benefit from it. The ever increasing income and ownership disparities make this obvious to all but mathematical morons.
Which means that maybe you are asking the wrong questions. Or perhaps I'm giving you the wrong answers.
While socialized medicine isn't socialism, the Swedish experience proves that sensible socialism can cost less, give most of the populace a much happier, healthier and longer life, ensure far greater equality, not destroy lives at nearly the same insane rate as America's "justice" system does, all on far less effort, on far fewer hours per week and on a lot less money per capita (after taking the insane inflation rate and public debt into account) than America wastes on its government.
When your neighbor gets cholera from the failing water supply, and his bacteria escaping from the failing sewer system contaminates your environment, from which you can't escape because the few dollars (Swedes have real savings too) you have are worth next to nothing, and the emergency room is closed (due to lack of funds) and you can't get treatment because your condition is chronic, and the government can't or won't supply antibiotics because they cost too much or are waiting to be returned from Iraq with the rest of the largely now non-existent emergency supplies, will your corpse then contaminate your neighbors environment because nobody wishes to pay for its disposal?
In practically any country in the world, bar the US, when somebody has a mentally defective child or parent, there is a suitable institution available to help or house such cases when needed. In the US, they go homeless and eventually die; or end up in the jail system. Which of these answers do you see as more attractive? Which do you imagine is more cost effective? What does your answer say about you? About your country?
The US is not becoming a failed state. Arguably, by any rational measurement, it already has failed, and failed dismally.
I have lived and worked in most of the world, in first and third world environments - and aside from Walmart products and cardboard dwellings (if you see these as benefits), bought on the never-never courtesy of the wonder of the credit card and permanent debt, the people of many 3rd world countries live better lives surrounded by better infrastructure than most Americans. While the Americans pay much more for their government than the even the citizens of Europe's most highly regulated and cradle to grave socialized environments.
As one example that doesn't need careful analysis, take a trip to Europe and look just at the quality of roads and railways. Why can't the US even begin to compete. In 1900 the USA had a railway system that was a wonder and the envy of the world. Where is it today? Visit South Africa and drive from Cape Point to Phalaborwa. A two to three day drive on superb roads. If a third world country can produce high quality, heavy traffic highways spanning their country, with signage, emergency call boxes, attractive toilets and service stations in the middle of nowhere, and where the surface doesn't break up every year, why can't the US achieve at least the same?
The only reason that Americans are not revolting at their incredible situation, where the Reagan administration's looting of the social security system went unnoticed until now, but where both parties are discussing how to deal with the collapsing social services by reducing the benefits that are all that the baby boomers will have to live on aside from their debt, is that the circus of television, and their abysmal education has left them imagining that this is how the world ought to be; while believing that they are doing well compared to others. Neither of these articles of faith are any more true than the most ridiculous religious claims accepted as true by their most baffled of believers.
Which leads me to wonder, which color pill do you want to suck on today?
Hermit
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Blunderov
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Re:Socialized Medicine?
« Reply #5 on: 2007-09-20 02:47:29 » |
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Quote from: Bass on 2007-09-19 20:08:28 | ...I am all about helping people but I would like to do it because I want to. I don't want people to take my money to help someone else... |
[Blunderov] Socialism means different things to different people. Most of these different meanings have some relationship to the notion of the collective.
In this sense the very idea of government is a 'socialist' idea; the people collectivise various resources in the interest of the greater good. Government also collectivises people under a single system of law in the interests of an unamibiguous social justice. Consider the military. Paid for by the taxes of the people to effect their collective defence, or offence, as the case may be. Consider roads and other vital infrastructure. In most countries these are paid for and maintained by the what amounts to a peoples collective. Is this socialism?I submit that it is.
It seems then that there is a continuum of 'socialist' behaviours. We see that it is not an either/or situation but the matter of degree to which various cultures embrace it. We also see that socialist ideas are very much tied up with notions of social justice.
Now in connection with medicine I think we need to ask the question : is it 'just' that the rich should live longer and healthier lives than the poor? Some people might answer yes to this question. They might argue that the rich deserve to enjoy the advantage of their industry. But there is, IMO, a problem with this view. First of all it makes the huge assumption that the only kind of 'deserving' behaviour that is worth a damn is wealth generating behaviour. How very demeaning to the human spirit! Second of all it makes the assumption that wealth is always deserved. This is by no means the case as should be obvious. Wealth entrenches itself, mostly quite undeservedly.
A parable. There was once a village. There was an old man who lived in this village who was too old to work in the fields. Instead he told the children stories from his long life and imparted much wisdom to them that would serve them well for the rest of their lives. Came the day when the old man fell ill. Nothing very serious but the chief refused to allow anyone to come in off the fields to nurse the old man back to health. "No" said the chief. "Leave him." "He does no work. Why should one of us go hungry for the sake of a useless old man?"
And so it was that the old man grew weaker and died and there were no more stories for the children after that and the tribe was much the poorer for the lack of a useless old man.
Kant asserted that it is morally imperative to treat people as ends in themselves and not means to an end. I agree. Sadly the pusuit of wealth and ambition often cause us to lose this empathy and in the end it is to our own human cost.
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Bass
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Re:Socialized Medicine?
« Reply #6 on: 2007-09-20 13:03:55 » |
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Thank-you both for your views and replies. But I'm not sure that answered any of the questions I had?
Hermit, I understand that you dislike the United States and feel like it is failing. However this seems to be an opinion. Sure you can say that "America sucks" look at the streets and we have poor people that die without the governments taking care of them. But I have lived outside of the United States also and have seen negative aspects of every country I have been too. I have also talked to many people in these "better off" countries that would like to migrate to the United States.
Also just saying fact doesn't make it a fact. And if it does then arguing seems a lot easier.
Not to mention that I am not sure how your argument about my neighbor getting cholera fits into this thread about socialized medicine? Our water supply will fail, my bank account will be empty, and emergency rooms will fail if we don't have socialized medicine?
Your argument seems more like it is trying to put America down and make anyone that stands up for it feel stupid for doing so. I for one know that America is not perfect. We spend like drunken pirates, no one saves, etc. But I am defiantly not going to try to say it is black and white that America is bad and other places are good. In fact that is not what this thread is even about. I am more interested in the positives and negatives of socialized medicine so that when it comes time to vote I can make an intelligent decision on how to vote to improve our imperfect country.
Regards,
Bass
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Hermit
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Re:Socialized Medicine?
« Reply #7 on: 2007-09-20 15:42:05 » |
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[Bass] I understand that you dislike the United States and feel like it is failing
[Hermit] You understand both my attitude and my feelings incorrectly. I like the United States but loathe its system of government and many of the consequences of its system of government. I do not "feel like it is failing", but have concluded not only from what it does to its citizens (e.g. jails 10x more of them than any other Industrialized nation!) and others (e.g. 3m - 5m surplus Iraqi deaths, using Ethiopia to destabilize Sudan, supporting Israel's murderous and illegal invasion of Lebanon), but for what it does not do for its citizens (e.g. New Orleans after Katrina, Florida after Rita, failing infrastructure everywhere, medical care for anybody who is not wealthy and becomes ill) that it has failed.
[Bass] Sure you can say that "America sucks" look at the streets and we have poor people that die without the governments taking care of them. But I have lived outside of the United States also and have seen negative aspects of every country I have been too. I have also talked to many people in these "better off" countries that would like to migrate to the United States.
[Hermit] "I came to the United States because I had heard that it is a land of great opportunity and freedom. I was wrong, but this is an error I can't correct correct in this lifetime." Einstein, FBI file, my translation. You are not responding with sustainable argument but with emotional assertion and tu quoque.
[Bass] Also just saying fact doesn't make it a fact. And if it does then arguing seems a lot easier.
[Hermit] The trouble I have is that I have replied to these questions before, with both statistics and anecdotes, and you don't appear to have been paying attention. Also substantiation is only a google away - and you don't seem to be bothering.
[Hermit] Lets see. According to my information, every citizen of the USSR had 6 monthly medical wellness examinations. If people didn't attend them, a nurse was sent to track them down. In the Chelney area, STD, pap, cholesterol, TB, colon, prostate and breast screening was automatically performed, meaning that early diagnosis and a reasonable prognosis. An annual dental examination was performed and corrective treatment provided as required. None of this cost anything, it was part of what the system provided. When series medication was provided, e.g. Tuberculosis treatment, chemotherapy, antibiotics, the medication was provided and ingestion supervised by a visiting nurse, or the patient hospitalized.
[Hermit] In America, 45% of the population has no health insurance, and as we have seen here, deaths of preventable causes and patient suicide rates are both at all time highs. People don't present to doctors unless they are too ill or in too much pain to carry on, and often not even then. The failure to complete antibiotic courses is a major contributing factor to the development of "superbugs" - immune to all current bacteria; and CDC has had at least one TB carrier arrested under security legislation and jailed without bail pending trial because no alternative protective methodologies are available.
[Hermit] Moore's current film, "SiCKO" provides a comparison of the US and Cuba's healthcare. While many people can and have said a lot of negative things about Michael Moore (much of it untrue), in this instance most of the underlying facts are readily ascertainable to any observer. Cuba made the provision of primary health care, and availability of medical staff a priority - and it has done wonders for the well being of the population (not to mention Cuba's balance of payments).
[Bass] Not to mention that I am not sure how your argument about my neighbor getting cholera fits into this thread about socialized medicine? Our water supply will fail, my bank account will be empty, and emergency rooms will fail if we don't have socialized medicine?
[Hermit] I was responding to:
Quote:| I am all about helping people but I would like to do it because I want to. I don't want people to take my money to help someone else |
[Hermit] I don't see your statement being about socialized medicine, but being about your (not uncommon) attitude.
[Hermit] It is because of such attitudes that in most of the USA, along with roads and bridges, the water, sewage, electrical and gas infrastructure is already in a catastrophic state (my in field opinion). If you are like most Americans you currently owe 1/3 of a year's income to your bank rather than having anything in it (the good news that inflation at 18%/annum is eating the value of that debt is mitigated by the punishing 30% plus interest rates that more than 20% are paying and cannot escape through bankruptcy due to the wonderful gift the Cheney-Bush administration made to the financial services industry). As we have seen reported here, the few emergency rooms left in operation are breaking under the strain of providing the only medical service many Americans will ever experience - and getting very little payment for it.
[Hermit] The trouble with this situation is that when your neighbor is suffering from curable communicable diseases there is a tendency for you to get them too. When your infrastructure fails because you don't want to help pay for a service that your neighbors will benefit from too, then you have to live (or die) from the consequences. The reason that civilized societies (including the once civilized USA) started to provide such services is that society can afford to do things on a large scale that individuals cannot afford on a personal basis. The reason you have a sewer is because society recognized that the small cost of building them is a much lower burden than dealing with the consequence of epidemics on a regular basis. Given that infrastructure is failing throughout the US, this lesson will likely have to be relearned.
[Hermit] Oh, and the other point my parable was intended to convey is that you don't control the value of your money. Your government does. And at an effective 18% inflation rate its value is declining so fast that it is equivalent to a massive additional tax. As this is a tax on prior taxed income, its effect is much greater than first appears. Do the math.
[Hermit] The opinion I was trying to convey is that your ill considered attitude is dangerous to yourself as well as to those around you, and that you can only afford this attitude while there are still people around you that will pay for your share of infrastructural costs whether you do or not.
[Hermit] Given that unsocialized medicine in America has clearly failed most Americans, while socialized medicine in all the industrialized and some developing countries is providing much higher levels of service to a vast majority, reason should compel you to accept that it is beyond time to stop clewing to inappropriate labels and adopt practices that have better results even if they were invented elsewhere and offend your selfish attitude.
[Bass] Your argument seems more like it is trying to put America down and make anyone that stands up for it feel stupid for doing so. I for one know that America is not perfect. We spend like drunken pirates, no one saves, etc. But I am defiantly not going to try to say it is black and white that America is bad and other places are good. In fact that is not what this thread is even about. I am more interested in the positives and negatives of socialized medicine so that when it comes time to vote I can make an intelligent decision on how to vote to improve our imperfect country.
[Hermit] Reasoned criticism only seems like "trying to put America down" because you are not used to the idea. And the fact that you feel stupid (appropriately) for "standing up for it" is not my fault, it is inherent when people attempt to defend stupidity against a competent opponent.
[Hermit] I am of the opinion that nobody is proposing "socialized medicine" in America, but would applaud anyone doing so. Instead I see the labels being applied to very modest proposals that are unlikely to remedy the current and pending catastrophes, in the hope that a knee jerk reaction to the labels will result in the maintainance of the status quo. Given your response they are probably right. But ask yourself, cui bono.
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Bass
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Re:Socialized Medicine?
« Reply #8 on: 2007-09-20 19:19:29 » |
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[Bass] I want to start by saying that I appreciate the discussion that is going on in this thread because I feel that I have learned a lot about socialized medicine. I also want to say that I appreciate people answering my questions, it has been very helpful. In fact I feel that I understand both sides of the argument far better than I did before.
[Hermit] The trouble I have is that I have replied to these questions before, with both statistics and anecdotes, and you don't appear to have been paying attention. Also substantiation is only a google away - and you don't seem to be bothering.
[Bass] Thats my problem I am googling and would like to find these facts? and why do I have to google your facts? If you are getting them from another website can't you provide them? And don't give me this I have given you statistics and anecdotes - I like to learn I read everything, I just don't think your facts here are accurate and partisan. Even though I know it is hard to get non-partisan facts these days.
[Hermit] Lets see. According to my information, every citizen of the USSR had 6 monthly medical wellness examinations. If people didn't attend them, a nurse was sent to track them down. In the Chelney area, STD, pap, cholesterol, TB, colon, prostate and breast screening was automatically performed, meaning that early diagnosis and a reasonable prognosis. An annual dental examination was performed and corrective treatment provided as required. None of this cost anything, it was part of what the system provided. When series medication was provided, e.g. Tuberculosis treatment, chemotherapy, antibiotics, the medication was provided and ingestion supervised by a visiting nurse, or the patient hospitalized.
[Hermit] In America, 45% of the population has no health insurance, and as we have seen here, deaths of preventable causes and patient suicide rates are both at all time highs. People don't present to doctors unless they are too ill or in too much pain to carry on, and often not even then. The failure to complete antibiotic courses is a major contributing factor to the development of "superbugs" - immune to all current bacteria; and CDC has had at least one TB carrier arrested under security legislation and jailed without bail pending trial because no alternative protective methodologies are available.
[Bass] First off I live in a free country do I want the government to hunt me down if I don't go to the doctors? Do we make people eat healthy? Do we make people exercise? Do we make people clean their houses? If so why do we do it? To help the community? If so can we make people become bus drivers because we have a shortage? If so where do we stop?
[Bass] As for google facts?
[Bass] Data released today by the Census Bureau show that the number of uninsured Americans stood at a record 46.6 million in 2005, with 15.9 percent of Americans lacking health coverage.
[Bass] Where did you get 45%?
[Hermit] Moore's current film, "SiCKO" provides a comparison of the US and Cuba's healthcare. While many people can and have said a lot of negative things about Michael Moore (much of it untrue), in this instance most of the underlying facts are readily ascertainable to any observer. Cuba made the provision of primary health care, and availability of medical staff a priority - and it has done wonders for the well being of the population (not to mention Cuba's balance of payments).
[Bass] I hope that all your facts are not from Moore because googling Michael Moore brings up way too many points to argue. Still if we are going to prop up Cuban medicine how about these?
[Bass] You may also like this:
SALLY PIPES - president and CEO of the Pacific Research Institute
Quote:"Moore ignores the fact that 85% of hospital beds in the U.S. are in nonprofit hospitals, and almost half of us with private plans get our insurance from nonprofit providers. Moreover, Kaiser Permanente, which Moore demonizes, is also a nonprofit.
"What's really amazing is that even the intended beneficiaries of Moore's propagandizing don't support his claims. The Supreme Court of Canada declared in June 2005 that the government health care monopoly in Quebec is a violation of basic human rights." |
[Bass] Want more? Try googling "socialized medicine and cuba"
[Hermit] It is because of such attitudes that in most of the USA, along with roads and bridges, the water, sewage, electrical and gas infrastructure is already in a catastrophic state (my in field opinion). If you are like most Americans you currently owe 1/3 of a year's income to your bank rather than having anything in it (the good news that inflation at 18%/annum is eating the value of that debt is mitigated by the punishing 30% plus interest rates that more than 20% are paying and cannot escape through bankruptcy due to the wonderful gift the Cheney-Bush administration made to the financial services industry). As we have seen reported here, the few emergency rooms left in operation are breaking under the strain of providing the only medical service many Americans will ever experience - and getting very little payment for it.
[Bass] I have already said I agree that America spends WAY too much and saves far to little. I think it is because as a nation we don't really create anything solid anymore. Mostly we have become a nation that lives off of ideas and consumption.
[Bass] However I was interested in your emergeny room argument so I googled it. This is what came up:
[Bass] I could go on but to me it would seem that helping "our neighbors" is causing many of our emergency room problems?
[Hermit] The trouble with this situation is that when your neighbor is suffering from curable communicable diseases there is a tendency for you to get them too. When your infrastructure fails because you don't want to help pay for a service that your neighbors will benefit from too, then you have to live (or die) from the consequences. The reason that civilized societies (including the once civilized USA) started to provide such services is that society can afford to do things on a large scale that individuals cannot afford on a personal basis. The reason you have a sewer is because society recognized that the small cost of building them is a much lower burden than dealing with the consequence of epidemics on a regular basis. Given that infrastructure is failing throughout the US, this lesson will likely have to be relearned.
[Bass] After you asked me to google emergency rooms I would have to say I am even more against helping my neighbors (who I don't even know) because it sounds like many of them are just taking from society without returning anything. I could see how paying for things as a society is beneficial to everyone as a whole until we get people that just take and don't give. Why do I have to provide for someone that just waits for me to provide?
[Bass] Also it seems like if our emergeny rooms are overcrowded now it will get worse with free health care. Currently I try not to go to the hospital for silly things. However if I feel like it costs the same if I go or not then I'm going. I want to get my moneys worth.
[Hermit] Oh, and the other point my parable was intended to convey is that you don't control the value of your money. Your government does. And at an effective 18% inflation rate its value is declining so fast that it is equivalent to a massive additional tax. As this is a tax on prior taxed income, its effect is much greater than first appears. Do the math.
[Bass] Okay I don't like raise property taxes and I wish they would stay at the same price but I use my property. In fact only my family and I use my property but if I had to start paying for everyone else's property tax then I might get more upset.
[Hermit] The opinion I was trying to convey is that your ill considered attitude is dangerous to yourself as well as to those around you, and that you can only afford this attitude while there are still people around you that will pay for your share of infrastructural costs whether you do or not.
[Bass] It is dangerous to ask questions before I throw my money at the government? I think it is more dangerous to just think that I should sit back and let things happen because it might be needed. Why not question health care? It seems very silly to think that because Hillary Clinton suggests that we need National Health Care that we need it. Why does she get to decide? Is she a doctor? I would like to hear all sides.
[Bass] In fact googling our national debt I get the idea that not questioning these ideas are what is bringing this country down.
[Bass] I can add more if you would like them.
[Hermit] Given that unsocialized medicine in America has clearly failed most Americans, while socialized medicine in all the industrialized and some developing countries is providing much higher levels of service to a vast majority, reason should compel you to accept that it is beyond time to stop clewing to inappropriate labels and adopt practices that have better results even if they were invented elsewhere and offend your selfish attitude.
[Bass] You keep saying that unsocialized medicines have failed but how has it failed? I would love to see some info on that.
[Bass] Also I thought I would like to look up who is uninsured and thought this web site was interesting.
[Bass] Also I know that there are health insurance systems in place for lower income American's. I know many people that have signed up for government programs to receive aid with health care costs and they seemed to work out all right?
[Hermit] Reasoned criticism only seems like "trying to put America down" because you are not used to the idea. And the fact that you feel stupid (appropriately) for "standing up for it" is not my fault; it is inherent when people attempt to defend stupidity against a competent opponent.
[Hermit] I am of the opinion that nobody is proposing "socialized medicine" in America, but would applaud anyone doing so. Instead I see the labels being applied to very modest proposals that are unlikely to remedy the current and pending catastrophes, in the hope that a knee jerk reaction to the labels will result in the maintenance of the status quo. Given your response they are probably right. But ask yourself, cui bono.
[Bass] What? I am not saying I feel stupid. In fact the more I read about socialized medicine the more I agree with the feelings I had at first. We seem to be shooting ourselves in the foot with these entitlement programs. Also I would like to ask have you googled socialized medicine? I have and most of what comes up is bad. In fact that is why I started this thread I wanted to like socialized medicine but everything that I read on google about it seemed to be bad. Try it.
[Bass] First hits if you google socialized medicine:
Wikipedia
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teh
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Re:Socialized Medicine?
« Reply #9 on: 2007-09-20 20:13:37 » |
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I personally value the NHS very highly. So too, do the vast majority of this country.
Wikipedia on Socialized Medicine (wihch you didn't post the link for)
"Socialized medicine or state medicine is a term used principally in the United States to describe health care systems which operate by means of government regulation and subsidies derived from taxation."
and
"In the United States, the term is often used pejoratively in political discourse and has been referred to as an epithet."
and
"Some have pointed out that the U.S. government already operates public health care. That approach to health care is provided by U.S. Veterans Administration clinics and hospitals to former members of U.S. military services. Thus, the usage of the term "socialized" is inconsistent, as it is rarely used to describe the Veterans Administration or the Army Medical Service, which meet the definition of socialized medicine and which are proven to provide good care at low cost, nor to Medicaid or Medicare."
and
"The term is widely used by the media and pressure groups. However, medical staff, most professionals in the field and international bodies such as the WHO tend to avoid its usage. Outside the U.S., the terms most commonly used are universal health care or public health care and have wide public support. People in the United Kingdom, for example, are overwhelmingly supportive of the National Health Service, leading a member of Margaret Thatcher's government, Nigel Lawson, to described the NHS as a "national religion" because everyone believes in it. The Thatcher administration made only minor changes to the system, and although many state industries were privatized, the state health sector was not one of them."
and
"International comparisons of quality of care and health outcomes generally rank the UK above the U.S."
etc etc..
one of the beautiful things about Wikipedia is the list of references at the bottom of each page as well as the "related links" section. When you have the time and inclination you may want to have a glance at them.
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Hermit
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Re:Socialized Medicine?
« Reply #10 on: 2007-09-20 21:25:39 » |
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The 45% was my error. I should have said 45 million as this was the number that came to mind. Thank-you for the correction. Nonetheless, the 45 million is likely a massive understatement and definitely speaks to personal tragedy far beyond the reach of smug platitudes. You might read this (it is only $ : http://www.ucpress.edu/books/sale/pages/10379.html. The medical community recommends that you do.
Perhaps you can find the time to examine this: http://www.kff.org/uninsured/1407-index.cfm (noting that the last available official data is for 1998. Since then the economy has collapsed (unless you are exclusively informed by talkradio spinmeisters and Fox TV in which case you might imagine that it is thriving), employers have dumped unaffordable contributory schemes, people have exchanged well paying industrial jobs with medical benefits for low paying service industry opportunities without, and the unemployed (but not reflected as such due to expiry of benefit eligibility) population has increased dramatically. All the people affected by these changes have surely lost their insurance if they had it to begin with. Balancing this to only a small extent are the increasing numbers of babyboomers just becoming eligible for public medical insurance - and whose access Democrats and Republicans are intending to limit.). And the politically motivated sources you cite assert that the total population of uninsured has remained constant. Perhaps you need to find some new sources.
And then consider this: http://www.kff.org/uninsured/7403.cfm which shows that "care-seeking patterns among those with private coverage but having problems paying their medical bills resembled those of the uninsured." Add to this the fact that prior to the recent changes in the bankruptcy law which moved medical bills out of the realm of the dischargeable, the vast majority of personal bankruptcies in America were caused by unpayable medical bills. Even with American private medical-aid, any serious condition is likely to result in huge uncovered medical bills and chronic conditions tend to be triply killing as the cost for coverage is then added to the cost of the uninsured portion of medication, while reduced capacity and possibly insufficient treatment levels tend to reduce household income.
Your response to Michael Moore was amusingly predictable. The reason he is so well hated is that he is a competent story teller, but the stories he tells are not ones that the anti-humanists wish to hear. It is only the fact that he does cite a discouraging number of revolting facts that makes him as effective as he has been. It is easy for him, because the more closely you look, the more scabrous this society appears. The only possible response for the anti-humanists is to bluster and lie at a sufficient volume to not hear what he is saying. Because if you listen, and then look, you will find that what he is saying is not very different from what the medical community, at least the ever dwindling portion of the medical community that is not dependent on the insurance industry, has been saying for years.
Finally, I know what kind of sites you have been reading from the content you raised, and suggest you look for some which are somewhat more balanced. Perhaps by including medical, nursing and paramed perspectives, along with economists, rather than relying on the insurers, anti-humanist bloggers and talkradio "personalities". For example, every economic analysis I have seen has demonstrated that "illegal immigrants" contribute far more to the tax systems (including social security) than they cost in benefits. Which seems reasonable as tax occurs at source; but collecting benefits requires collectors to prove eligibility. Which effectively bars the "illegal immigrants" (who definitely don't have the same rights as anyone else) from accessing assistance which they have helped to pay for. Another example is the fact that your perspective on emergency room conditions appears to ignore the wealth of material posted by Walter Watts and myself in recent months - articles which do not mention the issues you seem to think are the drivers, but emphasize other structural problems.
You are doing much better even if your source material selections are regrettable. It maybe the key terms you choose reflect too much prior selection (Excellent points by the way Teh. Thank-you for your valued contributions.)
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Blunderov
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Re:Socialized Medicine?
« Reply #11 on: 2007-09-21 01:34:59 » |
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[Blunderov] I suppose that if it wasn't for the hideous war the health care debate would be the main political issue. Here's another log for the fire.
http://www.opednews.com/articles/opedne_jim_free_070920_living_in_absurdista.htm
Living in Absurdistan--the State of American Health Care
by Jim Freeman Page 1 of 2 page(s)
http://www.opednews.com
President Bush not only denounced, but threatened to veto a congressional plan to insure kids who have no health insurance, calling it a step “down the path to government-run health care for every American.” I wonder if he realizes how stunningly oxymoronic that sounds, as costs among private insurers rose over 6% this year, following a rise of near 8% last year.
America has become the Absurdistan of health care;
Spending more, both as a proportion of gross domestic product (GDP) and on a per-capita basis, than any other nation in the world.
Currently Americans spend 15% of GDP (the world's highest) and rate 37th down the list of effective programs, according to the World Health Organization.
Costs are predicted to reach 20 percent of GDP in nine years.
48 million of us don’t have any health insurance at all (which puts an interesting slant on what ‘per capita costs’ actually mean—we are all included, insured or not).
Medical bills are overwhelmingly the largest cause of American bankruptcies.
Meanwhile, the state of our health for all this dough rates an embarrassing 72nd of 191 countries compared.
60% of us get our health care through an employer
Which means most of us who have a dependent with serious health issues cannot change jobs because of the pre-existing condition clause in most health insurance policies.
Government-run (paid and administered) health care for every American should be a goal rather than a scorned ‘down the path’ destination by an elitist president. This president (and his Republican party) smear single-payer health insurance as ‘socialized medicine,’ a derogatory term worthy of Joe McCarthy’s ‘fellow-traveler’ or ‘card-carrying member of the ACLU,’--terms that were equally meaningless and inflammatory.
The 36 nations that spend less and the 72 whose citizens enjoy a better standard of health are almost uniformly ‘socialized’ in that they provide single-payer systems.
Here is my proposition to you as a fellow citizen:
I’m going to sell you an insurance policy to cover the health of you and your family. Pay attention now, because if you think your employer is currently picking up that cost, you are sadly (and badly) mistaken. You are paying the premiums, either directly or as a deduction to what your salary would be were those costs not taken out.
Employers do not pay for health insurance. They administer the costs, just as government does not pay in a national program (where you pay the costs through taxes). Now that we have that squared away, let’s talk about coverage.
I’m proud to say that my company, the Freeman Health Care Scam (FHCS) is a leader in holding down premium costs. We do that by denying claims. In fact, we are currently denying 21% of policyholder claims, up from a healthy (no pun intended) 18% last year. It is our hope and expectation to deny even more claims as we bring new computer models online, keeping premiums low with the best claim-denial software in the industry.
Got a child with spina bifida of a wife fighting breast cancer? Sorry--pre-existing condition--just another small battle won on your behalf in the greater war against premium surge.
Why, you might ask, would a serious-minded and intelligent consumer want to
pay an insurer to deny him coverage,
argue over what is and is not covered,
pay higher and higher co-payments,
not be allowed to switch jobs without loss of coverage, all the while
paying increasing premiums at four times the cost of living index?
Good question. Which the real world fails to answer.
(NYTimes) The cost of employer-sponsored health insurance premiums has increased 6.1 percent this year, well ahead of wage trends and consumer price inflation, but below the 7.7 percent increase in 2006, the Kaiser Family Foundation reported today.
Somehow the Times makes 6.1% sound like a victory.
Because doctor and hospital costs continue to rise at an even faster rate, the modest slowdown in insurance inflation mainly reflects cutbacks in coverage by many health plans, which have found ways to make employees pay more for their care. Industry experts said that without those measures, premium costs would have risen by 9 percent or more.
We actually slowed inflation by cutting your benefits. Without that, you’d really have been in deep shit.
The total average annual cost for family coverage premiums rose to $12,106.
That’s 28% of median family income, friends. Damned near a third (and will be soon).
“For that kind of money, you could buy a compact car every year,” said Drew Altman, president of the Kaiser Foundation, a nonprofit group that produces the widely watched annual survey. He noted that health costs had increased 78 percent since 2001, more than four times as fast as prices and wages.
Interesting analogy about the compact car, because the overarching reason Ford, GM and Chrysler are on the brink of going under is their cumulative health-care obligation. Which they haven’t a prayer of paying off.
Same goes for the airlines, manufacturers in other industries, retailers and the service sector. Toss in the employees in the city where you live, all those teachers and garbage collectors, meter-readers and bus drivers.
On the way to trying to solve social security, health care costs are going to run us down like a rabbit on the highway. All because of a Republican bugaboo, all for a bogeyman called ‘socialized medicine.’
The government will not pay for socialized medicine. You pay for it through taxes, just like you pay for roads, bridges, Yellowstone Park, air traffic control and national defense.
What you do not pay for is the overhead and profit of an entire industry devoted to skinning you out of decent care. You will not continue to pay the highest pharmaceutical costs on the face of the earth, nor will you indirectly pay the tab for bribing your Senator or Representative to deny you health initiatives.
You will not pay the uninsured costs of emergency care for the 47 million of your neighbors who do not currently have access to health care, nor will you pay the long-term costs of their illnesses within American society.
You will not spend half again as much as Switzerland, Germany, Canada or France, getting crap health-care as part of the bargain. Your premiums will not rise 87% in six years (as they have). We will not, as a nation, spend over four times as much on health care as we do on national defense (remembering that we already spend more on our military than the combined military budgets of all the nations of the world combined).
For our president to blithely deny us the health benefits enjoyed by the Swiss, Germans, French or our neighbors to the north, Canada, is incomprehensible. To deny us those benefits, which would cover all 300 million of us at a third less cost for twice the effective care, is unconscionable. To deny us those benefits and break the national bank, while destroying our remaining business base, is treasonable. To deny us those benefits in favor of a small and narrowly focused business base, is criminal.
President Bush denigrates the expansion of health care to uninsured kids as “a step down the path to government-run health care for every American.”
Universal single-payer health care is a step up the path we should have taken years ago, a path big business interests in the United States are beginning to demand. George Bush, who never experienced a personal obligation of any kind that was not paid by someone else, is not fit (nor has he ever been) to comment on what health care path this nation deserves or should pursue.
_________________________________________________________________
Media comment;
CNN-Bush challenges Dems over kids' health care bill
Detroit Free Press-Dingell attacks Bush on child health care program
1 | 2
www.opinion-columns.com
Jim Freeman’s op-ed pieces and commentaries have appeared in The New York Times, Chicago Tribune, International Herald-Tribune, CNN, The New York Review, The Jon Stewart Daily Show and a number of magazines.
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Hermit
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Re:Socialized Medicine?
« Reply #12 on: 2007-09-21 13:31:21 » |
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Further refutation of Bass' rather limited perspective on the crisis in the medical system of the US after Teh and Blunderov's brilliant contributions, here is a link and some excerpts to a post made in May this year by our most esteemed "half-wit",whose "half wit" exceeds most other people's "full wit" - and then some, Walter Watts (whose primary extensive expertise is in this field).
[ "Church of Virus BBS, General, Science & Technology, Portrait of an ER at the Breaking Point", Walter Watts (Newsweek, Arian Campo-Flores, 2007-05-10), 2007-05-10 ]
(...)
The portrait that emerged was disconcerting. Like many ERs across the country, Grady's is perilously near collapse. The reasons are familiar: cutbacks in funding, a growing pool of uninsured people, and an older and sicker population that requires more costly treatment, among others. Grady has been sending distress signals for years, but those warnings are now direr than ever. The facility is losing $3 million per month. It's 120 days behind in paying some creditors. And it almost failed to meet payroll in March. To put it simply, the hospital cannot survive much longer in its current state. Were it to shut down, the impact on Atlanta and the surrounding area would be devastating. What follows is the account of one revealing, and utterly routine, night.
(...)
Grady is stretched to the breaking point. It lost more than $20 million last year, up from $13 million in 2005 and $10 million the year before. In 2006, it incurred around $170 million in costs to treat uninsured patients, including both outpatient care in the ER and inpatient care in the hospital. As a public institution, it receives about $105 million annually from Fulton and DeKalb counties, but that figure has remained flat for years and covers only 17 percent of its operating budget (the bulk of the remainder comes from Medicaid, Medicare and commercial insurance). It's hard enough for such a strained system to handle the routine flow of patients. How would Grady deal with a major disaster or terrorist strike? In the midst of the Saturday-night crunch, Kellerman evoked the 1996 Olympics bombing in Atlanta, which flooded Grady with scores of victims. Back then, he said, the ER was less burdened. “Imagine what we would do with an Olympic Park right now.”
Grady is the only Level I trauma center (the highest designation, with 24-hour trauma surgery coverage) in a 120-mile radius. Staffed by Emory and Morehouse School of Medicine faculty, it's also a teaching hospital that trains one quarter of Georgia's physicians. The vast ER, which is spread out over nearly 1.5 acres, is divided into a Red Zone that handles trauma cases (injuries) and a Blue Zone that deals with medical cases (such as diabetes and chest pain). Beyond the ER's 80 beds, there are now 30 “holding spots” for patients in the hallways, but all of these are routinely filled. In recent years, the overcrowding has worsened. While Atlanta's population has grown by double digits in the last 10 years, three area ERs have shut down during that period and another hospital is due to drop out of the trauma system this summer. The result: those facilities that remain are reaching their saturation point more quickly, and diverting ambulances to other facilities more frequently.
(...)
what if Grady were to collapse? Or what if, as hospital executives have contemplated, it were to downgrade to a Level II trauma center? “Can we continue to be all the things people want us to be?” asks Haley, the chief of emergency medicine. “No, we can't. … Society has to decide what it's willing to support.” And, he might have added, it will have to live with the consequences.
Postscript: since the time of this report, Grady's condition has worsened. The institution has had to slash costs to remain viable. Earlier this year, it offered buyouts to 560 older and more experienced personnel; 420 of them accepted. With the help of the consulting firm of Alvarez & Marsal, which specializes in rescuing companies, Grady is studying a host of other potential cuts, including its dialysis program and its neighborhood health centers. It has also reached out to the Metro Atlanta Chamber of Commerce for help in addressing its funding challenges. In response, the chamber convened a task force of top business leaders in April, co-chaired by A.D. “Pete” Correll, former chairman of Georgia-Pacific Corp., and Michael Russell, CEO of H.J. Russell & Company. The group expects to issue its recommendations in the next few months.
Not a word about "illegal immigrants." Much about a huge catchment area that is simply not paying a fraction of the cost needed to maintain a first class facility (ideally one sees three triage staff per patient: ABC + nursing + resuscitation + specialities. Worst case European staffing would be the inversion of that at 1 staff member per 3 patients (possible in a very large, well structured ER intake area). The situation documented here, at the time of writing, was 4 times worse at a 12 patient : staff member ratio and the loss of 560 staff raised in the last paragraph in all likelihood further impacted this ratio. The situation is exacerbated by the lack of beds to which to transfer intake patients (i.e. who have insurance), meaning that ER staff have to continue to provide basic care to patients awaiting intake.) Speaking from an actuarial perspective, where a major life valuation factor is the amount a society is prepared to pay to ensure the medical care required for people to be sustained through survivable medical events, the value of life in Georgia Atlanta is at most 1/4 of the value of a life in Europe. This in a culture which claims to value life, but their actions and willingness to pay give the lie to their words.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Walter Watts
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Re:Socialized Medicine?
« Reply #13 on: 2007-09-22 00:25:19 » |
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Quote from: Hermit on 2007-09-21 13:31:21
Quote:Further refutation of Bass' rather limited perspective on the crisis in the medical system of the US after Teh and Blunderov's brilliant contributions, here is a link and some excerpts to a post made in May this year by our most esteemed "half-wit",whose "half wit" exceeds most other people's "full wit" - and then some, Walter Watts (whose primary extensive expertise is in this field).
[ "Church of Virus BBS, General, Science & Technology, Portrait of an ER at the Breaking Point", Walter Watts (Newsweek, Arian Campo-Flores, 2007-05-10), 2007-05-10 ]
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Thank you for the kind words old friend.
(WW rolls on his back and jerks his leg back and forth in a frenetic, autonomic fit of neuromuscular feedback looking like a bird dog getting his stomach scratched with a stiff hair brush)
More stuff germaine to the thread:
PS--Honest! I didn't use the NYT as source on purpose.
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The New York Times
September 22, 2007
Rule Limits Emergency Care for Immigrants
By SARAH KERSHAW
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.
The change comes amid a fierce national debate on providing medical care to immigrants, with New York State officials and critics saying this latest move is one more indication of the Bush administration’s efforts to exclude the uninsured from public health services.
State officials in New York and other states have found themselves caught in the middle. The New York dispute, focusing on illegal immigrants with cancer — a marginal group of unknown size among the more than 500,000 people living in New York illegally — has become a flash point for health officials and advocates for immigrants in recent weeks.
Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said.
Last month, federal officials, concluding an audit that began in 2004 and was not challenged by the state until now, told New York State that they would no longer provide matching funds for chemotherapy under the emergency program. Yesterday, state officials sent a letter to the federal Medicaid agency protesting the change, saying that doctors, not the federal government, should determine when chemotherapy is needed.
Federal health officials declined to discuss chemotherapy or the New York claims. But Dennis Smith, director of the Center for Medicaid and State Operations at the federal Centers for Medicare and Medicaid Services, said in a statement, “Longstanding interpretations by the agency have been that emergency Medicaid benefits are to cover emergencies.”
The federal statute that defines an emergency under Medicaid makes it clear that routine care for illegal immigrants and nonresidents, including foreign students and visitors, is not covered. But the only procedures it specifically excludes from reimbursement are organ transplants, leaving to the states the task of further defining an emergency. States and courts have grappled with the question for years, yielding no clear definition.
Some states have maintained that any time a patient is able to schedule an appointment — as opposed to showing up at an emergency room — the condition would not be considered an emergency. Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death if untreated.
“There are clearly situations that we consider emergencies where we need to give people chemotherapy,” Richard F. Daines, the New York State health commissioner, said in an interview late yesterday. “To say they don’t qualify is self-defeating in that those situations will eventually become emergencies.”
Dr. Daines said that for every effort in the state to use Medicaid “creatively” to cover the uninsured, “the Bush administration, at every chance, is pushing it back.”
The state estimated that the federal government denied $60 million in matching funds for emergency Medicaid from 2001 to 2006, including $11.1 million for chemotherapy. Medicaid costs are typically split evenly between the state and the federal government.
It is unclear how many other states are providing chemotherapy to illegal immigrants, because all emergency services are generally lumped together in state Medicaid reports. But others have also been challenged on emergency Medicaid claims.
In Washington State, where illegal immigrants are entitled to Medicaid coverage for a month or more after treatment in an emergency, officials said a federal audit of their emergency Medicaid claims was under way, and the state has asked the federal government to provide a definition of emergency services.
“The awkward position state Medicaid programs are in is trying to figure out what kinds of medical care should be available for emergency conditions,” said Douglas Porter, assistant secretary for the Washington Health and Recovery Services Administration.
Washington and other states have also fought the federal government over Medicaid for infants born to illegal immigrants, an issue reflected in the ferocious debate over the national children’s health insurance program.
In the wake of stricter federal rules, New York, New Jersey, Connecticut and 20 other states have extended full Medicaid coverage, using only state money, to some immigrants who do not qualify for federal aid. Under federal law, proof of citizenship is required for full Medicaid coverage, but not for emergency coverage.
But some states with growing immigrant populations, like Georgia and Arizona, have themselves moved to limit coverage under emergency Medicaid, leading to intense opposition from immigrant health advocates.
Advocates for breast cancer patients said they were particularly concerned about the denial of coverage after lobbying the federal government for years to provide breast cancer screening to uninsured women. Under a program offered to underinsured and uninsured women, the Centers for Disease Control and Prevention provides free or low-cost screening.
“To allow women to be diagnosed with breast cancer and then create an obstacle for them to get treatment is a horrendous policy,” said Donna Lawrence, executive director of Susan G. Komen for the Cure in New York.
In New York City, cancer kills 15,000 residents a year. It is the second leading cause of death among both the native- and the foreign-born, according to a 2006 survey by the city’s health department, with lung, breast and colon cancer the top killers.
The state had initially accepted the federal finding that New York was not entitled to federal reimbursement for chemotherapy under the emergency Medicaid program. But until last month, state health officials had not informed medical providers that the treatment would no longer be covered by either state or federal funds.
That provoked a pitched outcry from immigrant health advocates over the last few weeks, and state health officials reversed their position this week, saying Medicaid should cover the treatment.
State officials said they were challenging the federal decision on the grounds that chemotherapy treatment qualifies as an emergency under the federal government’s own rules. Certain conditions, including diseases of the brain, spinal cord and bone marrow, could require immediate chemotherapy.
The state’s letter also said that chemotherapy could be used to “cure cancer, control cancer and/or ease cancer symptoms,” and that if the measures typically used to treat cancer were not available to patients, their health could be in serious jeopardy — one of the federal criteria in determining an emergency.
The cost of emergency Medicaid is still a relatively small portion of state Medicaid budgets, experts said, and a majority of the money is spent on care for pregnant women, labor and delivery. But the demand for it is rising quickly as the immigrant population balloons.
Health advocates say that many illegal immigrants who need and qualify for emergency care are afraid to seek help, and that emergency Medicaid is underused.
A recent study of emergency Medicaid services in North Carolina found that spending, largely devoted to pregnant women, increased by 28 percent from 2001 to 2004; still, the emergency costs accounted for less than 1 percent of total Medicaid expenditures.
New York City public hospitals, which serve 400,000 uninsured patients a year, among them illegal immigrants, would continue to provide the cancer treatment no matter what, said officials from the Health and Hospitals Corporation. But if there is no reimbursement from Medicaid, they said, they will have to look elsewhere for financial support.
Copyright 2007 The New York Times Company
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Walter Watts
Tulsa Network Solutions, Inc.
No one gets to see the Wizard! Not nobody! Not no how!
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MoEnzyme
Acolyte
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infidel lab animal
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Re:Socialized Medicine?
« Reply #14 on: 2007-11-16 09:30:19 » |
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Final Fantasy faux discussion plagiarizing and mirroring this one.
http://www.thefinalfantasy.com/forums/showthread.php?t=56917
We already know about Sasquatch, now what about Bass? He's in common with "Maxpower" on this thread, and "Agantyr" on on the Final Fantasy thread "Religion: Perhaps not so false after all, just interpreted wrong." I'm thinking he's either Sasquatch, or someone doing the same thing as Sasquatch.
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I will fight your gods for food,
Mo Enzyme
(consolidation of handles: Jake Sapiens; memelab; logicnazi; Loki; Every1Hz; and Shadow)
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