National healthcare for all

[kristo]

Yes, we fund our universal health care system with taxes. Shouldn't be a big surprise. That's also the way we fund our roads, education systems, etc.

Did you know that I can go anywhere in Europe with my little blue card and get access to their universal health care? My fiancée was on a vacation with her parents in London two years ago and got acute appendicitis. She was immediately rushed to surgery in the same hospital the royal births are. She had a private phone by her bed and got top-notch service. When they discharged her, they gave her a bunch of medicine to take for the first few days afterwards.

How much, you may ask. Well, we'll never know. Due to co-operation of countries in the European Union / European Economic Area, the bill was sent directly to the Icelandic Insurance Agency (Tryggingstofnun Ríkisins - TR), where it was dealt with.

The way we have it is that we have the above mentioned Insurance Agency (TR), which insures all Icelandic citizens and foreigners that have a work permit or a permanent residence permit in Iceland. When we go to a doctor, he charges TR for the majority, and we pay the rest ourselves (eg. $10 for seeing a family physician). When we go to a specialist (any other doctor than a family physician), we go to their own privately owned clinic. That clinic simply charges TR as any American clinic would charge your insurance company. Of course, this influences how much the doctors can get for each procedure, but no more than the insurance companies in the US do. We only have state-run hospitals, but they also charge TR for any services rendered, and I would actually like to see a private hospital here, it would give patients more options. I am considered very liberal in advocating a private hospitals, as most people are too conservative for that...

According to the US Census Bureau, 47 million Americans were without health insurance in 2006 (http://www.census.gov/hhes/www/hlthins/hlthin06/hlth06asc.html). According to the NCHC, the average premium paid for health insurance for a four-person family in 2006 was $11,500 (http://www.nchc.org/facts/cost.shtml).

Now, divide that by four, and we have on average $2,875 per person per year. According to the CIA World Factbook (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html), you have a working force of 151,8 million people, of which 95.2% are working. That makes just over 144 million working Americans. If those people would buy health insurance for the 47 million uninsured people, that would mean them paying extra $2.6 per day per every working person.

Now, what would you, normal, hard-working Americans get for your $2.6? Well, first of all, you would know that everyone could get basic healthcare (and maybe even more than basic, I don't know what "average" American health insurance gives you). Second of all, our industry, the health care industry, would get just over 135 billion dollars more annually. Of course, you'd have to split that with the insurance companies, but still, you could use the money, couldn't you? No more unpaid transfers, no more ER frequent flyers that just come there because they can't afford to go see the "correct" doctor for their problem.

Would you get more bullshit calls? I don't know. I don't think they are a problem anywhere in the world, except the US. Maybe you would get fewer, as people could now go see their family physician with their problems. Maybe some chronic problems would go away.

This may sound communist, "un-American" (whatever that means) or anti-capitalist to you, but let me tell you this: Capitalism is what keeps the first world going. It gives us initiative to do great things that benefit our society, it keeps us on our toes, and it makes us want to do better, work harder. It's a system where you can get to incredible heights if you're smart, lucky, or just plain hard working. But there's a flaw. It only works perfectly for one generation. The children of the hard workers now have more possibilities. They can get better education, better jobs, better healthcare. Now, that's all fine. Really. But how about the potential achievers that die because they don't get proper healthcare? What about the geniuses that never do great things because they can't get any education? In my opinion, our society loses by not utilizing those people. That's one of the biggest reasons for universal health care. Let's give everybody at least a chance to achieve - for our own benefit.

[Scaramedic]

"She had a private phone by her bed and got top-notch service."

You found that impressive? A private phone, hell even the crappiest hospital in the U.S. has a private phone and a TV with cable. Many hospitals even have room service for your meals, valet parking & bellhop service for patients, pay-per-view movies and wireless internet. Birthing suites in the U.S. have hardwood floors, couches and chairs for loved ones, the baby is born and kept in the room with the mother and family. Here, a picture is worth a thousand words...

This is what my wife will get for that $3 a day when we have children.

Our pediatric hospitals are beyond description, but I guess wonderful would be a good word...

Also I think you might be under a misconception. The U.S. does have healthcare for the elderly, the poor and for those who can't fend for themselves. Medicare and Medicaid cover millions of Americans. The numbers of those who are not covered forget to account for those that do not sign up for healthcare, either from the government or from their employer. When I was younger I turned downed coverage with my employer cause I did not want it, I wanted the money instead of throwing it away for coverage I didn't need. Also, no hospital in the U.S. can turn away an emergency patient, they have to treat them. We take care of our own believe it or not we just do it in a different way.

Peace,

Marty

[kristo]

"She had a private phone by her bed and got top-notch service."

You found that impressive? A private phone, hell even the crappiest hospital in the U.S. has a private phone and a TV with cable. Many hospitals even have room service for your meals, valet parking & bellhop service for patients, pay-per-view movies and wireless internet.

Great. I wish we had those - in fact, that's exactly why I think we should build private hospitals for patients prepared to pay for those kind of services. Somehow, I doubt this is the case in every hospital in the US, though.

Birthing suites in the U.S. have hardwood floors, couches and chairs for loved ones, the baby is born and kept in the room with the mother and family. Here, a picture is worth a thousand words...

(picture)

This is what my wife will get for that $3 a day when we have children.

Yeah, we actually have those, too...except we've already paid for it with our taxes.

Our pediatric hospitals are beyond description, but I guess wonderful would be a good word...

(picture)

I understand ours are pretty good, too, but I haven't been there, so I wouldn't know. That's not really the point, though. The point is that we *can* provide at least basic health care (or not that bad health care) for those who don't have it today for a minimal cost - and the health care industry, especially EMS, would even benefit financially.

Also I think you might be under a misconception. The U.S. does have healthcare for the elderly, the poor and for those who can't fend for themselves. Medicare and Medicaid cover millions of Americans.

You're probably right about many Europeans - the strongest argument over here against private hospitals and private anything related to health care is "Do you want things to be like they are in the US?", to which the private-advocates reply "No, of course not, but...". I realise, however, that medicaid and medicare cover millions. How about extending those programs to those who don't have anything else? It might be crappy, and people might want more (and most will be prepared to pay for more), but at least it's something for those who can't pay for more.

The numbers of those who are not covered forget to account for those that do not sign up for healthcare, either from the government or from their employer. When I was younger I turned downed coverage with my employer cause I did not want it, I wanted the money instead of throwing it away for coverage I didn't need. Also, no hospital in the U.S. can turn away an emergency patient, they have to treat them. We take care of our own believe it or not we just do it in a different way.

Are you saying that every American who is not insured is that way by his/her own choice? I find that very hard to believe. I know hospitals can't turn away emergency patients. That, combined with the fact that so many have no insurance, is one of the reasons EMS can't afford to pay it's staff a decent wage, and thus contributing to the lack of professionalism we have discussed so in-depth on this website.

You keep saying you take care of your own, but yet, I keep seeing people complaining on this very website that EMS doesn't get paid for its transfers, and hence can't have paid staff, can't afford properly educated people, etc. I've seen lots of people advocate having municipalities pay for local EMS, presumably with tax dollars, but yet, when the idea of actually implementing such a system is discussed, everyone is convinced it's going to doom you all.

[aussiephil]

Would you get more bullshit calls? I don't know

We have a system for ambulatory services in my state where any person who is entitled to claim an aged pension, Vetrans pension & a number of other pensions & benefits (including low income families) recieve FREE, yes 100% completley & utterly free, ambulatory cover, whether that be BLS or, shock horror, Intensive Care!!!!!!!!!!!!!!!!

Yes we get some BS calls, but on the whole most people dont abuse the system.

A question to consider is; How much money is billed by your companies to people who simply cannot afford to pay & then how much more is spent chasing that bad debt & how much more still is spent writing off that bad debt?

Would it not be better to transport them for free & put up with a bit more BS than we already do?

[WelshMedic]

Hi,

I'm with Kristo on this one, guys. I would consider myself right of center when it comes to political ideologies. I do think it's everyone's responsibility to look after themselves, I believe that a Welfare State is detrimental to a country's economical development. However, health care is a completely different matter. Why should a bank director be given better health than his janitor? They both work just as hard, don't they?

And yes, taxation would go up. I have a moderate income ($78,000 a year) over which I pay 42% taxation. I see some eyes opening wider and wider................but here's the thing: I live in a country that can afford to look after it's poor and elderly properly. A child with leukemia will get the best possible treatment, not just what their HMO paysfor.New mothers get thirown personal maternity nurse at home for the first 10 -days. The elderly are cared for in state-run homes that are bright, airy and a joy to visit. But best of all (from my perspective): we have decent primary care options for everyone. If I get called to someone then it's because they are genuinely ill, and need hospital admission. The rest is taken care of by the primary healthcare team.

I also tend to agree with Kristo that the current situation is a to the detriment of EMS. Billing and debt collection is, to a greater or lesser extent, a headache for every EMS organization in the US. We don't even need to think about it, it's covered, period. Maybe that's also why we are all full-time RN's with specialist qualifications in critical care and EMS.

And that's also the reason why we earn a decent living wage and don't all have 3 jobs to support our families.

Just my 2cents worth....

WM

[ERDoc]

There have been a lot of issues brought up and it is good that we have opinions from people outside the US to give their feelings on their current systems. Universal health care does not equal communism. In a first world country we should be able to provide all citizens with basics such as food, education and healthcare. Yes, here in the US we have Medicare which covers the elderly and Medicaid which covers the poor. However, there is a large portion of the population that is not insured because they make too much money to be able to afford medicare, but don't make enough to be able to pay for their coverage. It is the people in this group that are at the center of the current SCHIP debate. I usually agree with Dust on most points, but Darwin will not work this one out. One of the greatest forves fighting survival of the fittest is Emergency Medicine. Without insurance people have no primary care provider, so what do they do? They go to the ER for their primary care. The last person you want providing primary care is an ER doctor (Doczilla can back me up here). I am not trained in primary care and I do not have the time to get deep into your history (like a good PCP should). I have about 10 minutes tops to figure out which one of your many complaints I need to work up to make sure it won't kill you and then move on to the next person. It is these people who use the ER for primary care that are putting such a burden on the system. These people also affect you in the field. You are the ones that they are calling to get to the ER. They are the ones that are taking up the bed that you are waiting 60 mintues for to unload your chest pain patient. Give these people insurance and they will have someone that they can see instead of jamming up the ERs and EMS crews.

I support a universal health plan, but not one run by the government. I think it will take a program that is developed by collaboration between the government and the private sector to be effective. I also support a system where people are penalized for inappropriate use of services. There should be significant copays for using the ER/EMS for a cold. I think this would help control the increasing health care costs because people would not be so quick to run to the ER for every little thing.

The population that is being hit the most by the rising costs are the blue collar, working people. They generally tend to be the ones who cannot afford insurance but feel the right thing to do is to pay the bills anyway. Hospitals (and EMS for that matter) will never collect what they bill from insurance companies/medicare/medicaid. I beleive medicaid pays about 30% of what is billed. You also have the population that gives a fake name and address who get their care and can never be collected from. The losses that the health care system takes from the insured and the scammers are passed along to those who are willing to pay for their own care. These people are unable to negotiate fees like the insurance companies can so the burden of the costs get passed on to them and they get shafted.

Scaramedic, you said, "Also, no hospital in the U.S. can turn away an emergency patient, they have to treat them. We take care of our own believe it or not we just do it in a different way." This sounds all good and dandy, but let me put it in a different light for you. As I said previously, going to the ER is not a good form of primary care. Also consider this. As you said, we in the ER cannot turn away any patient. The ER doc is the only physician in the country that is forced to see any patient. All others (surgeons, pediatricians, internists) can select who they see. We are forced to see these people whether they can pay or not. This is going to sound greedy, but stay with me for a second. I am being forced by the government to see any and all patients reguardless of their ability to pay. While I am doing this I am also taking on the liability of seeing these patients (there is no Good Sam laws or anything to protect me). So I am now being forced by the government to put my career, license and family on the line and will get nothing in return. Would you be interested in a job where they told you that you will not be paid for the time you spend doing transports that do not pay their bills, but should you end up in court you are responsible for the outcome? I can't see too many people taking this position. Outside of academia there are many ER doc who are paid based on what they are able to collect. If 50% of your pts don't pay (a very real figure in some areas) you are volunteering your time for half the time you work. Again, would you be willing to take a job like this?

I'm sorry for any rambling but I am working on a few hours of sleep over the last few days and it makes sense in my foggy state. If it doesn't make sense, let me know and I will clarify.

PS- most politicians aren't saying that the government should control the healthcare system like a classic medicare/caid system, but are promoting a combined govt/private sector run program that gives people choice while keeping premiums low and guaranteeing coverage even to those with preexisting conditions. Some on the other hand have talked about giving tax credits to those that pay for thier own coverage (this is good only for those that can afford it and does absolutely nothing for those most in need). I actually took a look through several of the candidates websites and checked out their plans. Some interesting stuff that I still haven't had enough time to form an opinion over. Here is a link to the ED forum on SDN with a similar discussion.

[Dustdevil]

1. Show me where in the constitution that the federal government has the right to legislate mandatory health care? That honestly is stretching the interstate commerce clause a little too far.

2. Universal health care should only be an option when we decide that the government has a right to tell us what to do if it involves our health. Why should I pay for the health problems that someone else has due to their own fault [obesity, drinking, smoking, etc].

3. Why would anyone trust the government with more money? Earlier this week, a report came out reporting that employees in numerous government agencies were flouting both the governments guidelines, as well as in many cases their own agency's rules, regarding first class vs coach airline seats [guess which one they were using]. Over the past year, they had wasted over 146 million dollars for first class or business class travel. Yea, these are the same people that I want to trust with more of my money.

Most intelligent post so far. ^

Bottom line: Universal Healthcare is unconstitutional. The United States Constitution specifically reserves this issue as domain of the individual states. You want it in New York, New Jersey, Michigan, and Kalifornia? Go for it! No argument from me. Hopefully that will attract all the losers in Texas to move back to where they came from, and we can lower our taxes.

Ooops, that's right. We don't have taxes in Texas!

[kristo]

Bottom line: Universal Healthcare is unconstitutional. The United States Constitution specifically reserves this issue as domain of the individual states. You want it in New York, New Jersey, Michigan, and Kalifornia? Go for it! No argument from me. Hopefully that will attract all the losers in Texas to move back to where they came from, and we can lower our taxes.

Ooops, that's right. We don't have taxes in Texas!

Maybe it's time to decide if you want to be a country or if you want to be a bunch of loosely connected, kind-of-friendly, independent countries. If you can all join together in wars all around the world, one would think you could all join together on a minor issue like the implementation of universal healthcare (again, I must emphasize that the US is the only country I know of that is considered to be in the first world despite not having universal health care).

Another idea would be for the federal government to make a plan and for the states to join it on a voluntary bases.

I actually think it wouldn't even have to mean more taxes if you implemented this. How about just skipping the invasion of Iran this time and implement universal healthcare instead? Surely, there is nothing "unconstitutional" about the federal government spending money it already has to buy health insurance for its citizens?

Anyway, if your constitution is such a problem, just amend it. That's how the best parts got in. 8)

[Dustdevil]

We could easily pay for it by forgoing all the economic aid we send to Europaean countries every year. Or Africa. Or every other third and fourth world shytehole we dump money into.

Or we could just use the money we spend on welfare, social security, education, and medical care for ILLEGAL aliens every year and give every citizen top notch healthcare.

But personally, I'd rather them just stop all that, keep their healthcare, and let me keep my own farking wages in the first place.

You don't seem to understand, Kristo. We don't want this. It is why we kicked Britain's arse in the first place. And the lack of it certainly doesn't seem to stop half the world from wanting to come here anyhow. I suppose if your people are too stupid and lazy to manage their own affairs there, then they need big daddy to take care of them. To each his own. We don't.

[reaper]

Kristo,

You don't seem to get it. We Americans don't want the government ruling our lives. In this country we work for what we want!

We do not amend our constitution on a whim. This is why our country has made it work, when others have failed. There is a reason why every other countries population wants to come here. If we didn't have to please the rest of the world with being PC, we could solve our problems alot faster.