Hello everyone!
I'm new to the site and would appreciate any comments on this important issue.
I've been in my first teaching job (University of Applied Sciences, Steyr, Austria) as an English teacher for about five years. In these few years I feel that I have learned just as much from my students as I have taught them. One of the courses I teach is Health Mgt. (English focus), and as we discuss many health care systems throughout the world I am at a loss for words when it comes to the current reform debate in America.
I would like to be able to explain how we have reached this point in America and what is keeping us from passing a comprehensive, universal health bill, but I can't. It seems to me that a private insurance system stems from the fear of socialized medicine where German doctors were controlled by the National Socialism (NAZI) regime, but is this really the case?
As a Kansas native I grew up in the Bible belt, and many of these values I've learned (such as love thy neighbor) I still hold dear. But it seems to me that much of the opposition to universal health care comes from the Christian right who doesn’t want to pay for the health of others. Looking at the facts, I see that the US already spends more per capita than any other nation in the world, yet is still ranked about 30th in the world when it comes to quality and coverage.
In teaching this subject I’m often asked “How can the most powerful nation in the world not care for its citizens?” And this is the answer I’m looking for. I’ve discussed the role of lobbies contributing to election campaigns, but still I have no answer. For most of my studies I was without health care, my mom worked for the gov and my dad had been laid off from the railroad, and I was lucky that I never had any emergencies that would push me into bankruptcy. But what’s the answer for the many who have experienced life’s indiscretion, pain, suffering… and financial despair?
I don’t know the answers, and that’s why I’m posting this. I’d appreciate any comments to help me understand so that I can better communicate the issue with my students.
Many Thanks!

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How was fishing? Any big fish?

Here is my prediction David!

We will wind up with a two tiered system. One for private payers and one for Government payers. The market will divide. Private patients will have private insurance, they will be treated by private hospitals and private MDs. The Universal Health Care patients will visit universal MDs and Umoversal Hospitals.

Unless there are laws against providing non-government services, a split will be inevitable.
My vote is with you. I hope my taxes will not go up too much!
Hi, David! Is Switzerland a socialist country?
Do you have problems with the waiting list? Do you know if Germans have a waiting list for certain procedures?
Do you have several levels of care? Do you have systems within a system ?
And, what applied systems do you study and does anybody uses some systems analysis to your knowledge in Switzerland?

Dear John,

I remember that English were setting the limits on prices, when companies went too far. It is a capitalism Ltd.so to say. What you are describing in the field of pharmacology should have been corrected by a market system. Was it ?
Was your neighbor collecting an expert knowledge? Just kidding!

Dear David,

I would like to comment on two of the facts about US Healthcare.

FACT: The US spends more on healthcare per capita than any other Country. TRUE! We spend more money per capita on HealthCare, Welfare, Food Stamps, Public Housing and The WIC prgram than any other country on a per capita basis. Now these are public/government supported programs. I am not arguing against these programs. I am making the point that the US spends more money per capita on many programs and services.

FACT: The US is ranked 30th by the WHO in regards to healthcare quality and coverage: TRUE. However, the WHO's last ranking was over 10 years ago and it will not perform this study again. (From WHO website).
The study is a subjective weighted assessment. The presence of public healthcare programs were more heavily weighted than health care outcomes.The cost of healthcare lowers the ranking as well.

In the US, a patient, with health care insurance, can choose which facility they wish to be treated at. Scenario: I develop a serious disease, cancer. My local physcian recommends a local hospital for treatment. I DECIDE to say NO! I am going to NYU Hospital or Mother Cabrini. It may be far from my home, but what is more important? Conveinence or my Choice, based on my perception of care and positive outcomes?

The questiion,“How can the most powerful nation in the world not care for its citizens?” is a biased question. It assumes that its citizens are not receiving health care.

The question should be " How can the most powerful nation in the world provide better health care for its citizens?"

Well now, we have a question that has many positive responses. We can provide better health care at a lower overall cost and make that healthcare available to all its peoples and citizens.
We can do that without adding 2 trillion dollars to our national debt and WITHOUT adding 200+ new government agencies to oversee and issue regulations (laws) controlling our personal behaviour and the delivery of health care.

Good morning, John.
Here we are, you made a statement that "We can provide better health care at a lower overall cost and make that healthcare available to all its peoples and citizens." I wish you would be right. Where did you get that from?
If we could get a Health Insurance or to transfer ours from one state to another, we could do research on the patient outcome and pich up a Hospital , which does the best job.
You may be forgetting that 2 trillion will come out of our pockets on top of everything, unless something will be sacrificed or more dollars will be printed out as it is now. Am I right?

Hi John,

Assuming that over 47 American citizens are uninsured is it still a biased question to imply that citizens are indeed not getting healthcare? When the govt gives the health care industry free reign to do what they want, many unfortuante citizens are denied coverage because of pre-existing conditions. Insurance companies are allowed to choose their cutomers, and still when one gets sick they often try to avoid paying. This results in medical bankruptcy for tens of thousands each year and the deaths of many others denied potentially life saving treatment. A 2007 study by the American Journal of Medicine found that 46% of all bankruptcies (among the 5 states taking part in the study) were medical bankruptcies.
If something like this happened in other rich countries it would be seen as criminal, and yet it's a daily occurance in America.

After looking a bit more at those medical bankruptcy numbers, it is now up to 60% and over 70% of those that went bankrupt because of medical bills had insurance. So if we have a look again at the WHO numbers from 2001, it seems safe to say that things are getting worse, not better.
Hi, David, the problem is identified , but solution isn't. Bankruptcy does not equal a very bad thing, it is a good solution to a very bad situation. The bankruptcy does not equal the denial of health care
If people could use an insurance across the state board, I bet, there are good coverages there. In our
state everyone is covered if he wants to and we have the highest taxes and the highest unemployment rate at this time.
Hi David nad Nellie,

Well, that 47 million number that is frequently touted, is not that accurate. It is an estimate based on the last census. The test sample question was analyized and extrapolated to the entire population. Hence 47 million out of 300 million were deemed to have no health insurance.
There is another way to calculate this figure: First we will assume that there are now 330 million people in the US, Figure about 110 million adults. Then we add up all the following groups: US veterans, Federal employees, State and City employees, members of the armed forces, everyone over the age of 65, all MediCaid recipients, people covered by employee insurance and finally people who have private insurance.
The last time that I gathered this information, came up with a number that was about 12 million.
Now, since this recession, many people have lost their employee health care plans.

Well, I agree with you 100% about medical bankruptcy's. There are many cases when a family's personal wealth is destroyed by medical bills. This needs to be addressed.
Also, Pre-existing conditions should not exclude a person from present or future health care. Once again, this needs to be addressed.
I would like to believe that life saving treatments are not denied to anyone in the United States for any reason. I cannot verify nor disavow your statement.

A solution? What is possible and what is probable are two very conflicting positions.
Let us calculate the cost of critical treatments, hospitalizations and rehab for everyone.
Let us provide for "wellness" visits, annual, semi-annual or monthly depending upon the health condition of the patiient. Let us provide for "illness" visits for a diagnosis. That should cover 90% of all necessary health care for 330 million people. OK...now what would I exclude. That's easy!

Non life sustaining medicines. Generic medicines only! Except Cancer Drugs. Power wheelchairs for geriatrics. Elective surgery. Chiropractry, Homeopathics, Dermatology, Podiatry. There are exceptions for certain conditions. Now, open market purchases of medical devices and pharmaceuticals.

Lets add up all the care and divide that by the number of adults in the US (110 million)
So lets pull a number out of my hat. Lets say 2 Trillion, divided by 110 million. Thats 18,000 per adult.
Gee, that is what I am paying! Well, we have to get that price a little lower. Hey! I've got an idea! Lets cut back on other spending programs! Foreign Aid, Foreign Military bases,
Lets not create 200 more government agencies (that encompasses a great deal of the cost in this new Health Care Plan) I am sure there are a few more "Dept Ofs" that can have lower budgets and actually function.
The two trillion figure that I came up with us actually very high. It is based on GDP which covers all transactions in a given industry.
One last thing. DO NOT OUTLAW Personal Insurance or personal expense. Let us allow the purchase of additional insurance by those who choose to.
That'll do it, a little tweak here or there.BUT No inside deals. no buy offs or silly business.
So. What do you think? Rational......?????

One last point for David. Medical Care can be denied outright or it can be denied by elongating the period of diagnosis, and treatment. A bureaucratic delay can be just a lethal as an out right denial of service.

OOPS! Sorry about that! Just had an Eureka moment....it happens.

We already pay for all Federal and Local employess and Medicare and MediCaid....
We would only have to cover the other people and their families.
So why is this "Health Care Reform Law" going to cost a Trillion or so dollars????
Maybe I'm missing something!
Dear Nellie and John

Thanks again for keeping this discussion going! Everytime I read your replies it gets me thinking, often times about something I hadn't considered before. And no doubt you both have other work to do but still take time to discuss this vital issue.

The systems in Europe differ a bit and so too do the systems in Asia, they have their problems as well, but they work. In America it is broken. During his election campaign, Obama called for drastic health care reform at a time when the nation knew it was only feeling the first effects of a crashing economy. This is what the people voted for. What I don't understand is the constant back and forth among the parties jockeying for position in the next election. I am greatly dissapointed with both sides! Is it no longer possible to call on our brightest intellectuals, most brillant doctors/scientists and other experts in economics and operations/processes to find the best solution for Americans?

I don't know exactly how this new plan should look. John, you mentioned that there should be a private option for everyone and I agree, partly. Just like with social security, everyone should pay into the system and if you want the extra niceties (private room etc.) you can purchase additional coverage; however, if people are allowed to opt out it will create a two tiered system where the "haves" continue to pay outrageous costs to private insurance companies, and the "have nots" are supported only by a system with little funds.

Many countries thoughout the world have systems with a few common threads:
- No one is denied coverage
- Pre-existing conditions don't exist when it comes to the care offered
- Private insurance companies/ hospitals are not allowed to profit from basic care, they must compete to offer something better for their customers
- Costs are fixed by the govt (state or fed? I'm not sure on this one since it's a huge country)
- And lastly, there is no such thing as medical bankruptcy

Models built around these basics have been shown to work well. And GP's even get a financial bonus if they, for example, can get their patients off medication by losing weight, stopping smoking, etc. What we have now is doctors (and their families) who are flown to Hawaii by drug companies to attend "conferences" if they continue to support the biz by prescribing medication that in many cases was not made for certain diseases/disorders and often causes serious side effects that warrent another med to keep those in check!

There are reasons why neccessities should not be deregulated. Look what happened with California when Enron was allowed to create energy shortages! The price of electricity shot up 800% (mostly in the winter) California lost billions and Grey Davis lost his job. In America we have more rights than in many many countries throughout the world, yet the right to health at a resonable price isn't one of them. Currently (well at least recently) the pharma industry almost dictates legislation ensuring an unhealthy population that needs them.

In addition to exceedingly high drug costs, Americans also have to foot the bill for for adminstration costs of 22% (compared to 5-9% in Europe and as low as 3% in Taiwan) because of intransparency, claim denials and a system with too many erroneous, superfluous, rusty parts. The sad part of all of this is that the US is becoming ever more unhealthy: the percenatge of maternal deaths has risen drastically in the last 20 years, infant mortality too is on the rise (ranked somewhere around 25-32nd depending on your source). How can this be?

Well, sorry about the rant, but I've got to sign off for now, that stack of essays won't grade itself :)



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