House Democrat Health Plan

[Jackytar]

Why are they blamed? lol. Hmmmm... let me think. Maybe because longer wait times for non-critical procedures is the only area where public health insurance systems in some countries perform worse than the US, so it's like crack to health industry propagandists.

Yes, Alceste, but how is it that the provincial government is responsible for the waiting times if all they do is pay private providers? How is it that the policy-makers in government determine capacity under this system of so-called "private" providers?

If there is a long waiting list for, say, hearing tests, why is it that private providers don't buy more equipment and hire more staff to meet that need? Or that more facilities open up to meet that need? What, exactly, is stopping them?

Jackytar

 

[Alceste]

Yes, Alceste, but how is it that the provincial government is responsible for the waiting times if all they do is pay private providers? How is it that the policy-makers in government determine capacity under this system of so-called "private" providers?

If there is a long waiting list for, say, hearing tests, why is it that private providers don't buy more equipment and hire more staff to meet that need? Or that more facilities open up to meet that need? What, exactly, is stopping them?

Jackytar

Inadequate block transfers to hospitals, inadequate financial incentives, lack of qualified staff, spikes in demand for certain procedures, prioritization of services, low enrollment in relevant degree programs... there are dozens of factors. If you're genuinely interested in the issue, I found this paper very informative:

http://www.oecd.org/dataoecd/24/32/5162353.pdf

Or are you simply contesting the factual claim that three quarters of Canadian health services are privately delivered and publicly funded? I can look for more detailed information on that subject if that's your point.

 

[Jackytar]

Since a single payer system is all about who does the paying, this issue is not about whether private clinics can provide services covered by medicare - of course they can, and do, and send medicare the bill (which is prepared in accordance with the provincial fees schedule).

This is what I'm debating, Alceste.

First of all, the only provincial fee schedules you will find are for those limited overlapping private services that a provincial government ALLOWS to exist. I asked you to provide me with the fee for an MRI in your province. Do you live in Alberta whose fee schedule you referenced and where they are experimenting with actual publicly funded/privately operated clinics? I thought you lived in Ontario. Forgive me if I'm wrong about this. Anyhow, here's the fee schedule for Ontario - link

If you click on the diagnostic radiology link you will not find MRIs anywhere in the document.

The reason you or I can't start doing hearing tests in Canada and relieve the backlog is because we are not permitted to do so by the provincial governments. The waiting lists are a way of rationing care and saving money.

In your "75% private" statement you are obviously including hospitals in this right? So while it's true that hospitals are not administered by civil servants and are therefore "private" this is miles away from saying "this issue is not about whether private clinics can provide services covered by medicare - of course they can, and do, and send medicare the bill." Hospitals and clinics don't "bill" the government based on patient activity. They rely on global or block funding and have to operate within that set amount. Ergo the limited capacity and waiting times. Nobody actually knows how much the reimbursement rate is for an MRI scan in Ontario or for most of the other core services provided in the other provinces because it is not a "provide the care and bill medicare" system (which would describe an actual privately owned, single payer system).

Here's what the outgoing president of the Canadian Medical Association, Dr Robert Ouellet, had to say about this:

One thing we believe we need to change is the way we are funding hospitals. Here we have global funding, block funding. We are probably the last one to have that, the last developed country. What we need to do is to change that, at least partially, to what we call activity-based funding. Then the patient becomes the revenue instead of an expense, and it changes the attitude.

source

Here's another quote from this interview for my American friends:

People were very surprised when I told them our target for hip replacement was six months. They said, “This is your target?” and they couldn't believe that.

Propaganda! Rhetoric!

Sounds private to me.

Not to me.

Jackytar

 

[Alceste]

This is what I'm debating, Alceste.

First of all, the only provincial fee schedules you will find are for those limited overlapping private services that a provincial government ALLOWS to exist. I asked you to provide me with the fee for an MRI in your province. Do you live in Alberta whose fee schedule you referenced and where they are experimenting with actual publicly funded/privately operated clinics? I thought you lived in Ontario. Forgive me if I'm wrong about this. Anyhow, here's the fee schedule for Ontario - link

Yes, I'm living in Alberta. I don't know anything about Ontario. Lived in Toronto for a year but didn't use any health services. Lived in Montreal for a few years, and had some dealings there, including an MRI. I don't know what it cost. (That's kind of the whole point, isn't it? Worry about getting better, not the bill?) Is there something special about Ontario, or are you happy to use Alberta, which is where I am?

Why don't you just tell me what point you would make if I dug up the cost of an MRI for you? Let's say, hypothetically speaking, I looked it up and they pay $900 for it. That way I don't need a medical secretary course just to have a debate with you. (The fee schedule is full of codes).

The reason you or I can't start doing hearing tests in Canada and relieve the backlog is because we are not permitted to do so by the provincial governments. The waiting lists are a way of rationing care and saving money.

I'm going to need some evidence for that claim, please.

In your "75% private" statement you are obviously including hospitals in this right?

I'm including whatever the former director of the Canadian Medical Association was including when he made that estimate.

Here's what the outgoing president of the Canadian Medical Association, Dr Robert Ouellet, had to say about this:

If it's all the same to you, I'm not going to argue about factual claims I never made, such as that hospitals operate on a fees-for-services model. Did I say this? No. My comment was not intended to be anything other than a general summary of how the Canadian health system works, for the uninitiated, and for people who believe the entire health industry is comprised of civil servants.

You've acknowledged the government does not directly administer the hospitals, that's good enough for me.

Propaganda! Rhetoric!

It certainly is, the way you put it. Here's the whole quote with some additional context for the benefit of your American friends. It includes the bits you snipped out to make it appear as though Mr Ouellet believes our wait times issue is caused by a lack of participation by the private sector.

we took a look at what is going on in some European countries... we have seen it's possible to have a universal system that doesn’t cost more than our system – or even less – and where there's no significant wait times. And this should be our goal, to try to transform our healthcare system so this becomes possible here.

And if we compare ourselves to those European contries[sic], what we give an A grade here could be an F grade in those countries. People were very surprised when I told them our target for hip replacement was six months. They said, “This is your target?” and they couldn't believe that.


And one more for the road:

I wanted to get your thoughts on the health reform debate that's currently going on in the US.

I don’t want to tell them what to do, of course, but I think the most important thing they have to do is to have universal coverage. That is the big drawback of their system now, universal coverage. Of course they have to work on the costs because their system costs about one-third more than our system and more than any system in the world.

 

[Jackytar]

You've acknowledged the government does not directly administer the hospitals, that's good enough for me.

You mean they indirectly administer the hospitals? Hmmmm....

It includes the bits you snipped out to make it appear as though Mr Ouellet believes our wait times issue is caused by a lack of participation by the private sector.

What? You have disputed wait times in Canada. I 'm pointing out that they actually exist. Why do feel compelled to erect straw men?

I'm going to need some evidence for that claim, please.

When the governments slash the health care budget, wait times increase.

Jackytar

 

[Alceste]

You mean they indirectly administer the hospitals? Hmmmm....

The government administers the funding. The hospital boards administer the services. Please, just come out and tell me how you think it works. This is going nowhere.

What? You have disputed wait times in Canada. I 'm pointing out that they actually exist.

When did I dispute wait times in Canada exist? My position is that the solution to wait times is an administrative problem rather than a feature of universal health care models, and that the severity of the problem is overstated in the press. As far as I can recall, I haven't wavered from it. Who's building strawmen now?

When the governments slash the health care budget, wait times increase.

Jackytar

Finally, something we can agree on. This is why I vote NDP.

 

[Jackytar]

The government administers the funding. The hospital boards administer the services. Please, just come out and tell me how you think it works. This is going nowhere.

You think that private providers in Canada set up shop, deliver the service, and bill medicare for set fees. If this were the case there would be no substantial backlog. It would be a monopsony but it would still be a market system and the market would fill the chronic unmet demands. I'm saying that this is a mischaracterization of the Canadian system. It fails to recognize that hospital boards and other "private" providers who are not civil servants are so tightly under the thumb of policy makers that there is no wiggle room - no discernible difference, from a business standpoint, between the Canadian system and socialised health care. Civil servants determine the system's capacity - how many operating rooms, how many scanners, how many specialists etc - not the market based on demand. And they limit these services and create waiting lists as a way to save money.

I'm not saying this is right or wrong. The Canadian system is vastly superior to the American system, but there are better countries to model our reform after keeping in mind that this will be an evolution, not a revolution. As it stands it looks like we are hopefully headed towards what some health care policy analysts call the Bismarck or German model - multiple competing non-profit insurance companies with guaranteed issue (no pre-existing conditions), community rating (everybody pays the same), and individual mandates (everybody must participate). They make their money by enrolling as many persons as they can attract - the CEO's pay, for example, is tied to enrollment (although nothing like American for-profit insurance company executives) - and by selling other types of insurance policies to their customers. Canada has some aspects of the Bismarck model but are much closer to the so-called Beveridge or British model which is what we would typically refer to as socialized medicine where health care is a government service like garbage collection.

Jackytar

 

[Alceste]

You think that private providers in Canada set up shop, deliver the service, and bill medicare for set fees.

No, I would still summarize the system as I have: the private sector delivers services, and the government pays the bill. I wouldn't go down the road of getting into great detail because every province is completely different.

With respect to block funding transfers to hospitals, I think that is a terrible idea and agree it gives the government too much influence. Probably my reasons for this are different from yours, though. Both Conservative and Liberal governments, being pro-privatisation, use this power to squeeze services and create a perception of crisis. Then when people start to complain, they step in with the "private sector solution" to save the day. It drives me nuts. People never stop to think "wait a second, what does the private sector have to do with anything? The government has been cutting health care funding, so the services are getting worse." They just think (as instructed) "Oooh, health care is broken, we need the private sector to fix it for us!" Alberta was cutting funding for hundreds of hospital beds in a time of massive economic and population growth and huge budget surpluses. It's pretty obvious to anyone paying attention that they did this on purpose to open the door for greater private sector participation - and it worked. The private sector is well in, but hospital service here is still terrible compared to everywhere else I've been - waiting rooms in emergency are packed.

[/rant]

If this were the case there would be no substantial backlog. It would be a monopsony but it would still be a market system and the market would fill the chronic unmet demands. I'm saying that this is a mischaracterization of the Canadian system. It fails to recognize that hospital boards and other "private" providers who are not civil servants are so tightly under the thumb of policy makers that there is no wiggle room - no discernible difference, from a business standpoint, between the Canadian system and socialised health care. Civil servants determine the system's capacity - how many operating rooms, how many scanners, how many specialists etc - not the market based on demand. And they limit these services and create waiting lists as a way to save money.

IMO, it's not to save money. It's a strategy to transfer control of Canadian health care services to the for-profit health industry. I think moving to a fee-for-service model for hospitals would give politicians a lot less power to manipulate Canadians' access to care for their own ideological agendas, whether they are cost-cutting or privatisation, and that would be a good thing.

So, how would you sum it up in a sentence then? I don't accept "socialized health care" because IMO it's inaccurate (that would be Cuba, which is vastly different to any other western model). IMO, "single payer health insurance system" is more accurate, or "universal health insurance coverage".

I'm not saying this is right or wrong. The Canadian system is vastly superior to the American system, but there are better countries to model our reform after keeping in mind that this will be an evolution, not a revolution. As it stands it looks like we are hopefully headed towards what some health care policy analysts call the Bismarck or German model - multiple competing non-profit insurance companies with guaranteed issue (no pre-existing conditions), community rating (everybody pays the same), and individual mandates (everybody must participate). They make their money by enrolling as many persons as they can attract - the CEO's pay, for example, is tied to enrollment (although nothing like American for-profit insurance company executives) - and by selling other types of insurance policies to their customers. Canada has some aspects of the Bismarck model but are much closer to the so-called Beveridge or British model which is what we would typically refer to as socialized medicine where health care is a government service like garbage collection.

Actually, where I was living in the UK garbage collection has been privatized. That's why I had to sneak my trash into the wheelie bins of neighbouring businesses. The Labour gov't is mad about privatizing everything.

The bottom line, I think, is that there are a lot of ways to do universal health care. What I have been objecting to is the efforts of American lobbyists and ad-men to create the impression the government directly interferes with or participates in each individual's health care. (The phrase "Puts the government between you and your doctor" leaps to mind). Maybe to say that the only time the government has anything to do with it is when it's time to pay the bill is an oversimplification, but it's not uncalled for in the context of all the misinformation stinking up the American airwaves these days.

 

[Jackytar]

The bottom line, I think, is that there are a lot of ways to do universal health care. What I have been objecting to is the efforts of American lobbyists and ad-men to create the impression the government directly interferes with or participates in each individual's health care. (The phrase "Puts the government between you and your doctor" leaps to mind). Maybe to say that the only time the government has anything to do with it is when it's time to pay the bill is an oversimplification, but it's not uncalled for in the context of all the misinformation stinking up the American airwaves these days.

So, what you're saying here is that we should counter propaganda with propaganda?
That Canada has de facto socialised health care but we should use language to hide this reality? To repeatedly brag about how cheap it is, never mentioning that it is underfunded? That real evidence of rationing and waiting times - of people suffering under your system, of "government getting between you and your doctor" - even by your own supreme court, should be "taken with a grain of salt" and dismissed as anecdotal. And now to throw out an unsubstantiated conspiracy theory that any problems that do exist in the system are created by free market right wingers to further their evil cause?

And you have the temerity to accuse Rev Rick and others of arguing from a position of misinformation and propaganda whereas you and those who agree with you adhere to the cold hard facts. Going so far as to publicly accuse him of not caring about the plight of a suffering forum member when he clearly and genuinely does just so you and Auto can share a high-five.

Shame on you, Alceste.

Jackytar

 

[Alceste]

So, what you're saying here is that we should counter propaganda with propaganda?
That Canada has de facto socialised health care but we should use language to hide this reality? To repeatedly brag about how cheap it is, never mentioning that it is underfunded? That real evidence of rationing and waiting times - of people suffering under your system, of "government getting between you and your doctor" - even by your own supreme court, should be "taken with a grain of salt" and dismissed as anecdotal. And now to throw out an unsubstantiated conspiracy theory that any problems that do exist in the system are created by free market right wingers to further their evil cause?

And you have the temerity to accuse Rev Rick and others of arguing from a position of misinformation and propaganda whereas you and those who agree with you adhere to the cold hard facts. Going so far as to publicly accuse him of not caring about the plight of a suffering forum member when he clearly and genuinely does just so you and Auto can share a high-five.

Shame on you, Alceste.

Jackytar

Cuba has socialized health care. Canada has universal health insurance coverage. Since when is accuracy "propaganda"? I asked how you would sum it up, and all you can do is regurgitate the American health lobby's misinformation about the Canadian health care system, despite having demonstrated quite a decent grasp of the administrative details as recently as a single post ago? BTW, here's a tip: When every single republican and lobbyist starts simultaneously using the same phrase at exactly the same time ("government between you and your doctor"), it's propaganda. How you can not see that is beyond me. You do your own credibility no favors by repeating such nonsense.

The Supreme Court did not rule that there is rampant "rationing" and government interference throughout the entire health care system, or that "the government gets between you and your doctor". It ruled that Quebec's prohibition on the private sector duplication of coverage for insured services must be alleviated OR that Quebec must address the problem of lengthy wait times for certain elective, non-critical surgeries. That's just accuracy. I never said this is "anecdotal" once. I said the significance of it is overstated by advocates of privatization, and that the solution is administrative and manageable within the existing system. Maybe you disagree with my opinion that it's "overstated". So what? There's no "right" or "wrong" in such things. What's the exact right amount of significance to ascribe to any event? Do you disagree that it is being managed within the context of the existing system, and not always by increased privatization?

You've introduced no evidence but your own personal opinion that the reasoning behind waiting lists is "rationing" (another meaningless health industry lobbyist catch phrase), and yet my own similarly unsubstantiated opinion that the reasoning is "the creation of a perception of crisis to rally public support for privatization" is a "conspiracy theory"? Because the public are NEVER intentionally manipulated for political reasons in your little world?

Shame on me? Poppycock. Rick does not even believe Jamaesi exists, he's been so addled by propaganda. How can he care about her?

 

[jamaesi]

Jackytar[/B]]
And you have the temerity to accuse Rev Rick and others of arguing from a position of misinformation and propaganda whereas you and those who agree with you adhere to the cold hard facts. Going so far as to publicly accuse him of not caring about the plight of a suffering forum member when he clearly and genuinely does just so you and Auto can share a high-five.

Would you like to prove Rev Rick cares? I mean, if he really cared, I think he would be all for a system where I could get medical treatment, yanno, instead of treating me like an idiot like he is now by not listening to me and basically saying I'm just not ~*~trying~*~ hard enough.

 

[Copernicus]

That Canada has de facto socialised health care but we should use language to hide this reality? To repeatedly brag about how cheap it is, never mentioning that it is underfunded? That real evidence of rationing and waiting times - of people suffering under your system, of "government getting between you and your doctor" - even by your own supreme court, should be "taken with a grain of salt" and dismissed as anecdotal. And now to throw out an unsubstantiated conspiracy theory that any problems that do exist in the system are created by free market right wingers to further their evil cause?

Jackytar, I have followed this debate with some interest, because both you and Alceste have clearly thought about the Canadian system a lot. I have to say that she seems to have made most of her points, and I struggle to see some of yours. On balance, the Canadian system is preferable to our private insurance approach. Some groups of citizens in the US enjoy something like the Canadian system, but most do not. The Canadian health care system is not pure socialism in the sense that the government owns the means of production. It could be better managed--like health care is in some European countries with single-payer solutions. However, the bottom line is that the US fee-for-service approach has led to a broken system in which US citizens end up paying roughly twice as much as Europeans for worse results. Canadians do not get quite as good a return as some European nations.

Alceste has nothing to be ashamed of. She has held up very well in the debate.

 

[Jackytar]

Jackytar, I have followed this debate with some interest, because both you and Alceste have clearly thought about the Canadian system a lot. I have to say that she seems to have made most of her points, and I struggle to see some of yours. On balance, the Canadian system is preferable to our private insurance approach. Some groups of citizens in the US enjoy something like the Canadian system, but most do not. The Canadian health care system is not pure socialism in the sense that the government owns the means of production. It could be better managed--like health care is in some European countries with single-payer solutions. However, the bottom line is that the US fee-for-service approach has led to a broken system in which US citizens end up paying roughly twice as much as Europeans for worse results. Canadians do not get quite as good a return as some European nations.

Alceste has nothing to be ashamed of. She has held up very well in the debate.

I invite you to refute a single statement I have made.

The larger issue here is that progressives in America are starting to turn against Obama and the bill currently in committee because it doesn't include the public option. That there is misinformation and acrimony on both sides of this debate, not just by conservatives, that is destroying the process. And that we will not be successful in retaining the votes that we had before the break if we fail to recognize that the bill, as currently written, represents historic transformational change to health care in America. We had the votes for guaranteed issue, community rating, the individual mandate and maybe even limits on health insurance industry profits - a giant leap forward towards the Bismarck model. Now we have moderates losing enthusiasm because of the far left screed that the public option is not negotiable. That single payer is the ultimate goal (as you yourself seem to believe) whereas the reality is that many countries enjoy universal health care while still retaining multiple non-profit insurance companies that compete for our business by improving service. Germany has over two hundred.

Rev Rick is a compassionate man who may or may not understand the reality of health care in America and the solutions being proposed to address the problems. But very few conservatives advocate that we deny care to those who are suffering based on ability to pay. We have a lack of understanding of the complexity of the issues, not of a gut felt notion that health care is indeed a right, as is recognised in the rest of the developed world. As 94% of the people who voted in the last election have health insurance, we will not sell health care reform with mockery and counter propaganda towards those who have legitimate concerns about how they will be affected by this legislation. It is simply a political reality that single payer will not fly in this country at this time. And that is not a bad thing. While the Canadian system is indeed superior to ours, it is not the best model for America. Alceste will not tolerate any legitimate criticism of the Canadian model. I guess if we beat them on this too they will only have hockey to brag about.

Jackytar

 

[Alceste]

I invite you to refute a single statement I have made.

The problem, Jacky, is that you're parroting inaccurate and inflammatory (for Americans) right-wing rhetoric such as "socialized medicine" and then just redefining the actual meaning of the words you're using whenever this inaccuracy is pointed out to you. You can't "refute" such things, because the whole point of propaganda is that it is carefully designed to be emotionally evocative but rationally meaningless. All I can do, and have tried to do, is try to point this out to you and encourage you to be more accurate, and think about what the words you're using actually mean.

Alceste will not tolerate any legitimate criticism of the Canadian model. I guess if we beat them on this too they will only have hockey to brag about.

Jackytar

Horse ****. I've been criticizing it myself. It's not like it's a contest, Jacky. I'm genuinely concerned about the plight of my fellow human beings in America, such as Jamaesi who do not have access to any kind of health care, a problem which can not be eliminated by anything short of universal health insurance coverage.

 

[Copernicus]

I invite you to refute a single statement I have made.

I think that Alceste has already done that up to a point, but she is right that you do engage in a fair amount of shifting the goal posts. This is not a debate over socialized medicine, but over the best way for government to regulate the distribution of health care and whether or not citizens ought to have a right to a reasonable level of health care.

The larger issue here is that progressives in America are starting to turn against Obama and the bill currently in committee because it doesn't include the public option...

We are actually talking about several bills here. You are only talking about the bill coming out of the Finance Committee. The others, as I understand it, all contain versions of a public option. All of the House bills do.

That there is misinformation and acrimony on both sides of this debate, not just by conservatives, that is destroying the process. And that we will not be successful in retaining the votes that we had before the break if we fail to recognize that the bill, as currently written, represents historic transformational change to health care in America. We had the votes for guaranteed issue, community rating, the individual mandate and maybe even limits on health insurance industry profits - a giant leap forward towards the Bismarck model...

Insurance reform without a public option strikes me as essentially a gift to the insurance industry. What they want is mandatory insurance purchased by all citizens that is partially subsidized by tax dollars, where they maintain control over the cost of premiums and level of services offered. The Finance Committee bill has some reforms in it, but it could also lock in industry control over health care costs, a total disaster for everyone except some very rich moguls in the industry. Liberals and progressives are right to fight for a public option as a means of reining in the industry. (But rich campaign donations--leglized bribery, US-style--will probably keep the "public option" watered down, in any case.)

...Now we have moderates losing enthusiasm because of the far left screed that the public option is not negotiable. That single payer is the ultimate goal (as you yourself seem to believe) whereas the reality is that many countries enjoy universal health care while still retaining multiple non-profit insurance companies that compete for our business by improving service. Germany has over two hundred.

Germany has no "public option". You are just muddying the waters again with these distractions. The ultimate goal is single-payer. Obama campaigned on that argument. In his book The Audacity of Hope, he claimed that the only way to single-payer was through graduated change of the current sort under consideration. His argument was that radical change might bring down the whole system, since so many jobs are already invested in the insurance bureaucracy. Liberals are mad at Obama because he seems to have been a phenomenally lousy negotiator by bending over backwards in a hopeless quest for Republican votes.

...But very few conservatives advocate that we deny care to those who are suffering based on ability to pay...

They make no alternative proposals that are not laughable. Essentially, they have opted out of the debate, playing only a negative role. That is a recipe for the status quo--denial of care based on ability to pay.

...We have a lack of understanding of the complexity of the issues, not of a gut felt notion that health care is indeed a right, as is recognised in the rest of the developed world.,,

Do you believe that health care ought to be a right that is guaranteed by government? I certainly do. How we implement it is another matter. Conservatives and many moderates oppose making it a right. That is the fundamental issue here. If they believed it a right, they would offer alternative proposals instead of astroturfing tactics.

As 94% of the people who voted in the last election have health insurance, we will not sell health care reform with mockery and counter propaganda towards those who have legitimate concerns about how they will be affected by this legislation...

I do not know where that statistic came from, but it is a red herring. The majority voted for Obama, who vociferously supported a public option (then, anyway). I have very good health insurance by most standards, and I voted for Obama and support a single-payer system.

It is simply a political reality that single payer will not fly in this country at this time. And that is not a bad thing. While the Canadian system is indeed superior to ours, it is not the best model for America. Alceste will not tolerate any legitimate criticism of the Canadian model. I guess if we beat them on this too they will only have hockey to brag about.

Alceste has leveled her own criticism at the Canadian system, so you have misrepresented her. She won't tolerate your criticism of it. I believe that single payer would become a reality if Obama would lead the charge for it, but he hasn't. He led the charge to let Congress lead the charge for the public option. That is why we cannot even get that milquetoast solution through Congress, and that is why the left is so angry with him.

 

[Jackytar]

The problem, Jacky, is that you're parroting inaccurate and inflammatory (for Americans) right-wing rhetoric such as "socialized medicine" and then just redefining the actual meaning of the words you're using whenever this inaccuracy is pointed out to you.

You admitted to counter - propagandizing when you wrote:

Maybe to say that the only time the government has anything to do with it is when it's time to pay the bill is an oversimplification, but it's not uncalled for in the context of all the misinformation stinking up the American airwaves these days.

Canadian health care is socialized medicine. So what? It is vastly superior to health care in America by almost any measure. Rather than trying to fudge this reality you should take back the term and use it proudly. You are not going to have civil and healthy debate by countering rhetoric and propaganda with more of the same. And rationing occurs. I would say, sure it occurs - based on need and effectiveness and not ability to pay. That rationing based on need and especially effectiveness is a necessary part of the discussion if we are going to keep costs contained.

And, worst of all, what do you think you are going to gain by demonizing Rick and Kathryn as self centered malcontents who have no compassion? To behave in exactly the same manner as those town hall lunatics with whom you seem to want to lump anybody who doesn't agree with every word and tactic you use.

If you are really concerned about Jamaesi and others in her position you should be throwing your support behind this bill and working in a civil and forthright manner to get it passed. Otherwise this opportunity to affect actual, meaningful change may elude us for another decade or more.

Jackytar

 

[Jackytar]

Germany has no "public option". You are just muddying the waters again with these distractions. The ultimate goal is single-payer.

Of course not. That is my point. That it's not necessary to have a public option to obtain universal health care. Are you willing to see those reforms that we can achieve go down in flames over a dogmatic adherence to a reform that we cannot? And yes, it will be incremental. Cost-effectiveness will have to wait. But for now, gauranteed issue, community rating and the individual mandate is nothing to turn your nose up over. We had the votes for all of these things before the break. I worry that we will lose it all.

Jackytar

 

[Copernicus]

Of course not. That is my point. That it's not necessary to have a public option to obtain universal health care. Are you willing to see those reforms that we can achieve go down in flames over a dogmatic adherence to a reform that we cannot? And yes, it will be incremental. Cost-effectiveness will have to wait. But for now, gauranteed issue, community rating and the individual mandate is nothing to turn your nose up over. We had the votes for all of these things before the break. I worry that we will lose it all.

I am not as worried as you that we will "lose it all". We will have lost it all if the health insurance industry remains in control of insurance premiums and other medical costs. An individual mandate even with "community rating" could become a poison pill for US taxpayers. That is, we would have another government-subsidized insurance bonanza for the health care industry. They will have given up "experience rating", which allows them to penalize individuals based on their health history, in exchange for a guaranteed government subsidy. There is very little competition in the insurance industry, and that is why they have been able to jack up prices to the point where we are paying twice what other industrialized nations pay. The current Finance Committee bill does little to address premium costs, which will continue to go up.

Let me explain to you what has happened with "good" health insurance over just the past year. My employer gives me a choice of several insurance plans, the details of which I have no say in. My employer, like any sane corporation with soaring health care costs, has negotiated a reduction in the amount it pays by negotiating to shift the payment burden onto me. So my fees and deductibles have way more than doubled in just the past year. My wife has just recently refused to get a doctor-ordered test, because she could not get the insurance company to say whether it was covered under our plan. (The test was covered by the same plan last year.) It turns out that even the insurer is incapable of understanding its own complicated jargon, fee schedules, and exclusions. Meanwhile, we are now seeing all kinds of fees for tests after every visit--fees for tests that were covered last year.

Why is there so little competition in the health insurance industry? I get several plans to choose from, and I can change my plan in November of every year. Theoretically, that should make the plans compete. But they do not. When you try to compare the plans, they all have different exclusions and complicated conditions on different procedures and services. You do not necessarily know which of these you will need in the coming year. They do not publish which drugs they will cover. (You find that out when you get a prescription and discover that the insurance company has not approved it.) They have intentionally created such a maze of complexity that it is utterly impossible to decide between plans, except on the basis of up-front premium costs that do not necessarily reflect the ultimate cost to consumers. As far as I can tell, the current Finance Committee bill, which was essentially written by the insurance industry lobbyists, does little or nothing to address out-of-control health care costs. I would rather not pass a trojan horse in place of real health care reform.

 

[Jackytar]

I would rather not pass a trojan horse in place of real health care reform.

The main reason, not the only reason, but the main reason your premiums are going up is that every year the insurance company has to pay out more to providers. Don't confuse this with me being an apologist for the insurance industry. I'm not. But we should temper our liberal demonization of the industry with what is real, not imagined. Where does this leave Jamaesi if we follow your lead?

Jackytar

 

[Alceste]

You admitted to counter - propagandizing when you wrote:

No, I "admitted" to simplification. You should probably learn what propaganda is.

Canadian health care is socialized medicine. So what? It is vastly superior to health care in America by almost any measure. Rather than trying to fudge this reality you should take back the term and use it proudly.

I would, except that Cuba is already using it correctly to accurately describe a completely different health care system.

And, worst of all, what do you think you are going to gain by demonizing Rick and Kathryn as self centered malcontents who have no compassion?

What? Where does Kathryn come into it?

Rick is a self centered malcontent on the topic of health care. He's repeatedly stated that his biggest problem with allowing EVERYBODY to have health care is that HIS health care might be diminished. How you've missed that, I don't know. I haven't seen a lick of compassion for others from Rick in any thread related to health care reform, and I'm not going to pretend I have just to be polite.

If you are really concerned about Jamaesi and others in her position you should be throwing your support behind this bill and working in a civil and forthright manner to get it passed.

lol - from Canada? How do you suppose I should do that, apart from - as I have been doing - helping to dispel the American myth that universal health insurance coverage in Canada involves "rationing", "socialized medicine", and "the government getting between you and your doctor"? Not to mention "death panels", which you haven't yet gotten around to justifying, although I don't doubt that you would if pressed on the subject.

I hope a bill of some kind passes, I really do. Doing just about anything would be better than doing nothing. But I'm not going to be an enthusiastic cheerleader for a bill that's only slightly better than nothing.