Universal Health Care

[Douglas]

I was going to put this under politics but since this is the month of starting new threads i started one. Beside i think it is a big enough topic to be on its own.

I have been thinking a lot about the health care crisis in the states and i am very interested to see how all the candidates approach it. It is no longer an issue that can be ignored, i have heard it stated by several of the candidates that there are now 47 million people without health care. I think that is about 1 in 6 given a population of 300 million. That is a lot of voters.

Costa Rica has a universal health care system and it has been interesting to see how it works. In some things like preventive care is does really well. People can go in to the doctor when they get a cold and this really helps to identify and treat problems before they become serious. The system though is not all good, there are some serious drawbacks. It is not all the health care you want for free. All the more complex medical procedures are rationed. Everyone has to get paid and this means that to stay in budget the government has to put caps on the number of certain procedures.

Just this morning in Church we heard about a lady who has degenerative disease in her eyes, she was told that if untreated she would loose her eyesight in 6 months. Unfortunately this procedure is very expensive and she was told that the next available operation was 2 to 3 years down the road. By that time there would be no point as she would have irreversibly lost here sight. Fortunately her friends and family were able to collectively raise the money that she needed to get it done privately.

This however is the way that it is with all the universal health care systems that i know. You have to stay in budget which necessitates rationing of expensive procedures to maximize the money so that it can help the most people. Oregon has a almost universal health care system and they have had to do the same things. Moms and young children can easily get into the program but men between 18-55 have a terrible time getting coverage. This come down to the all mighty dollar. Investing money in young mothers and children pays off in the long run eliminated many health problems for years to come.

I have not heard about a program put out by any of the candidates that really addresses this issue. I looked at Obama's system but it is quite complicate and never touches on part. I will be looking in to others as well but it would be interesting to hear some other people thoughts.

Any thoughts?

[meghan]

I'm also very interested in the health care issue. I don't have health care, and I know a lot of people who are against the idea of universal health care. I tried to sign up for health care through the state, but since I wasn't pregnant I couldn't get covered

[robin]

Given the way that the government runs all of it current bureaucracies, I think it would be a very bad idea to turn over our health care to uncle Sam. Just ask your doctor what he thinks of Medicare, if he takes it at all.

By the way I'm a little biased. I sell broker sponsored health plans for a living.

Robin

[Douglas]

My own personal ties to the health care industry are that both my parents are nurses and i have had a first had experience of the underbelly so to speak of the industry. There are so many people that know so little about health care that have very grand and idealistic ideas of how it ought to work yet dont really know any thing about it at all.

I totally agree about the inefficiency of government managing anything. yet the problem is not being solved by the free market alone. I personally think that the best option may be some sort of combination between government and independent companies. There are so many people that are falling through the cracks right now that some things has to change.

2 big issues that no one has had the guts to address so far are the extreme high cost of end of life care and care for those that are extremely obese and/or smokers. My dad worked in an intensive care unit for 15 years. 9 out of 10 patients fell into these categorize. The problems is that the cost of care for these patients often runs into the millions and the end result are often little more than a few more months of life. The cost is then differed into the insurance companies who raise their rates to cover it or it is charged to Medicare / Medicaid. The result is then higher rates and less money available for preventative care for the relatively healthy. A million dollars spent to give one 90 year old man 2 more weeks of life could cover the basic health care costs for 1000 children for an entire year. (That just an estimate but a fair one i believe.)

No one wants to take money (or life) away from anyone but the fact is that the money is limited and so we must choose how it will be spent. This is a very hard choice to make but if we do not change something the problem will only get worse.

[sarah]

Having recently joined the ranks of the uninsured, I have a rather strong interest in this topic at the moment. What I will say is that if you lack employer provided plans there are a lot of obstacles to getting insurance. Here are a few of our "hurdles"

+ When we had employer provided insurance the premium was almost $500.00 per month for our family of 3

+ COBRA came in at almost $1100.00 per month. Almost the same amount as our Unemployment Insurance!

+ Oregon Health plan is very challenging to get into. You have to meet the income requirements for 3 months before you are even eligible for coverage. Also until recently the only people who could enroll were children and pregnant women. Enrollment was closed to all others. Our family will not be eligible for OHP until April!

+ We applied for private pay insurance but only Lindsay was accepted.

+ because we were rejected, we may be eligible for two other programs that I have to look into. The Oregon Medical Insurance Pool and the Portability plan

Let the cutting of the red tape commence!

[Douglas]

That is a pretty good summary of the problem at hand. In contrast Costa Rica's national health care is dirt cheap. We can buy into it and get full coverage, all medical, dental, emergency visits, check ups, medication ect. ect. for $60 a month. If you are employed the employer is required to pay this and you dont pay a dime. There are no out of pocket fees whatsoever. Crazy.

As i mentioned above this system is not without it problems. But it is still something to consider. Costa Rica pays a fraction of what the States does and their health care system is rated in the top ten in the world if i remember correctly.

[michelle]

Prepare yourselves for overshare...

I was talking to my sister this afternoon about health care and I was telling her that a couple of the candidates are proposing that no person be turned down for health care regardless of any pre-existing conditions. I wasn't sure how I felt about it at first, but my sister told me something that was a little disturbing. She has a friend who has been denied private insurance 5 times due to an "abnormal" pap smear. A pap smear will be abnormal if there are cancer cells present, but it can also be something as simple as the test being done at the wrong time of month or the doctor messing the test up by scraping too hard. When results come back as abnormal, they run further tests to see if they found any cancer cells. If they didn't, they ask you to come back for another test in 6 months. Then they have you tested every year until you have 3 normal paps in a row. It is only after a woman has had 3 normal paps that she no longer has a pre-existing condition.

This is really disturbing for me, because I've had 2 abnormal paps (not in a row), but when I've been retested it's come out normal. The thought that if I change jobs or get laid off, I could be denied insurance, even though nothing further has been found.

[robin]

The idea behind insurance, is that one party (Individual or business) contracts with or pays another party (insurance company) to protect themselves from unknown risks. Underwriting is essential to assessing risk, and this process should not be hindered by the government. The government could monitor it in order to see that there is no discrimination (race, sex, religion) but the process itself must include discriminating along the lines of risk.

Most states including Oregon have public funded programs for individuals that are denied health insurance on the bases of pre-existing health conditions. In Oregon its OMIP. I would be willing to bet that all states have something similar.

Personally I don't think that many of our politicians have any real interest in solving the current health care crisis, especially those on the left. Most of them would like nothing more than to see rates continue to rise, and for public opinion to turn against the current system, in order that the government could take over all together, giveing more power to an already intrusive government. But they sure talk like they are only worried about the children. They use cheap political tactics and slogans like "Health care for all children" or "The Children's Heath Insurance Program" or "insurance for all Americans".

It seems obvious to me that Insurance itself is not the problem. Health insurance rates for the most part reflect the level of risk. Much like auto insurance. If you want to see rates start to fall, remove government intrusion. We should work toward proper tort reform, and start easing up and state and federal mandates. Perhaps we should lighten up the load that HIPAA place and insurance companies in additional administrative costs.

As far as comparing our system to Costa Rica, Costa Rica's system has little to be desired when you look at the problems that face the American health care system. Costa Rica is just another third world country that is piggy backing on the innovation and success of the American system. how many of the drugs that are prescribed and dispensed in Costa Rica were actually researched and developed there? None! How many life saving procedures and surgeries has Costa Rica developed? None! If you want $60 health insurance you will get $60 care, and I'm sure you will not be satisfied.

Just ask any Canadian who has come to America to receive a life saving heart surgery what they think of our private, and profit driven system. They will say that it is the best in the world, because they are alive. They likely would have been left to die untreated in in their country.

Robin

[Alex]

Thought I'd look at some research, not to wonk out too much on numbers but they tend to beat anecdotes:

World Health Organization; world health statistics

Unfortunately they only have up to 2006 compiled, but you have to make do with what you have. I'm inclined to trust the WHO numbers, as they try to avoid left or right-wing tendencies; and rely on professionalism to maintain credibility with the international community.


Rankings:

Life expectancy at birth
1) Iceland
2) Japan
3) San Marino
4) Australia
5) Canada
9) Sweden
10) Switzerland
21) France
22) Germany
28) United Kingdom
29) Belgium
30) USA (tied w/ Costa Rica)


Infant Mortality Rate (Lowest per 1000)
1) Iceland
2) Singapore
3) Japan
4) San Marino
5) Monaco
6) Sweden
7) Norway
8) Finland
9) Italy
10) Switzerland
14) Spain
15) France
16) Germany
17) Belgium
23) Canada
29) United Kingdom
34) USA (ties w/ Croatia)

Maybe we're better off going to Canada for treatment.

Of course it could be argued that many of the treatments were developed in the US. We should feel good that our healthcare costs are subsidizing the rest of the world, like Monaco. Sort of an outreach program.

By the way, Luxembourg outranked us both times. I love that little country.

[sarah]

Monaco, hmmmm Love your wit

[Douglas]

robin said:

As far as comparing our system to Costa Rica, Costa Rica's system has little to be desired when you look at the problems that face the American health care system. Costa Rica is just another third world country that is piggy backing on the innovation and success of the American system.
Robin

There are 3 things that want to say about this.

First is that Costa Rica has been very innovative in their approach toward health care. They have a combination between public and private care so that all people are covered publicly but you can always opt to go the private route if the service you need in not available through the public system. I am very aware of the failing of many public systems as i note earlier in the conversation. (See first post)

Second, it is good to remember that the USA was also once a 3rd world nation and all our achievements have built on the foundation of innovation and success we received from others.

Third referring again to the world health organization, in their latest evaluation of world wide health care systems Costa Rica outranks the US by one in terms of overall care. (CR #34 US #35) www.who.int/whr/2000/en/whr00_en.pdf See page 200. Not only are they providing above US level health care but they are doing it at about 1/10 of the cost.

[robin]

I've been meaning to return to this thread but it has slipped my attention for some time. Today I was reminded of this thread while sitting in on some meetings where the topic was the future of the US health care system.

I would like to point out that Life expectancy rates have little to offer in either endorsing or indicting any current health care system. These numbers are determined almost entirely by Genetics and lifestyle. Health care systems, whether public or private, have virtually no impact in either area.

Another misconception is that it costs less to fund a socialist system. As of today Canadians pay 45% of the income to taxes , half of which funds their health care system. our taxes would almost double and even at that we would have to make deep cuts into the current system and start shutting down hospitals do the the lack of funds. Also, Canada's system is grossly underfunded and lacks the ability to meet the basic health care needs of the public. Recently the supreme court in Canada confirmed this in a ruling that said it is a denial of basic human rights not to allow individual to pursue health care options outside of the publicly funded program.

Now it is true that the US at one time could have been considered a third world country by todays standards. However the US has achieved its leading economic standing in the world based on free market enterprises, with little governmental intrusion. The US has recently suffered economically do to the over reaching hand of government, and this includes the health care crisis we are in today. My solution would be to not introduce more government into an already over taxed segment, but to remove government intrusion all together. And it is still a fact, that is yet to be challenged, that without the US private system shouldering the burden of R&D and taking in those cast out by their failing systems (Canada, Mexico), Those socialist systems would collapse.

Overall I think this is the most important thing to keep in mind. Health care is not a basic human right!

Robin

[Josh]

Robin,

Admittedly, the philosophical grounding for "rights" has also been a been shaky, but I'd prefer to go beyond "rights" and think about justice and mercy.

I haven't said much on this topic because a) I don't know enough about the details and b) it seems almost unsolvable.

That said, what do you say about the plight of low-income kids without health insurance? I know quite a few.

I'd love to see the church meeting the needs of those in poverty and in crisis, the elderly, and the children in our society. And I hope that we see a return more and more to the church making an increasingly signficant impact in reaching out to the weakest, most fragile members of our society. However, that's no where near to being realized. And in the meantime, masses of virtually helpless people are suffering. So, it seems to me, that the government does have a responsibility to those people, if not because of rights, at the very least as a kind of "insurance policy" for the future of America.

Kids can't be blamed for the choices of their parents when it comes to issues of life and death.

The aid that does comes to these folks in the American system did come from the US taking a step away from laissez-faire economics toward something approaching socialism.

Are you advocating just that we be leary of heading too far down that road (which I am concerned about as well, as socialism has it's dangers too) or would you really like to return to yesteryear and see the end of the social programs we do have?

[robin]

Hi Josh,
I'm not one to deny that this need exists. My question back is who is best qualified to meet that need? This need should be filled by the compassion of the church, and other organizations where people give voluntarily. If I choose to volunteer my time and income to meet the needs of the underprivileged, then I can see to it that the time a dollars spent are used in the best and most effective way. When I give my money to the government to meet those needs, I have no confidence that this will be done responsibly. As a matter of fact, I'm quite sure that the money will be wasted, and most of the money that I could give away and see that it is used in the most responsible fashion will be wasted in bureaucracies. The more money the government takes out of our paychecks to waste on governemt programs, the less I have to meet the needs of the poor around me.


We as Christians should stop shifting our responsibility to be compassionate to the government and start shouldering the load ourselves. The more I ask the government to take on charitable giving on my behalf, the less Christ like I can be.

God bless,
Robin

[Douglas]

Apr 10, 2008 17:19:01 GMT -8 robin said:

Overall I think this is the most important thing to keep in mind. Health care is not a basic human right!

Robin, I agree from a political perspective but disagree heartily from a Christian ethical perspective. I believe that it can be shown clearly from scripture that we as Christians have a God given responsibility to do all Good things that are in our power to do, especially for the marginalized of society. More over i believe that it can be shown that to withhold good when it is in your power to do it is a sin against your neighbor and against God.

While there are many examples of this principle throughout scripture i think the clearest and most powerful is the the parable of the good Samaritan. Those who passed by the man on the road commit no sin other and to withhold the good that was in their power to bestow. They lacked mercy and compassion. The man who loved his neighbor was the one who went out of the way to bind up his wounds and provide for his medical care out of his own pocket.

Biblically we as the people of God have a very clear social responsibility to care for any that are in need. To neglect this duty is to incur the wrath of God. A common charge brought against the nation of Israel in the OT was the neglect of the poor, the alien, the widow and the orphan.

Now i want to be clear that i am not advocating a particular way in which we ought to be doing this. Providing health care for the poor has been a work that the church has voluntarily taken up since its earliest years. In every age and in virtually every context the church has has worked diligently to care for the sick.

I argue that providing basic health care to every human being ought to be a goal of the church, how to do it is another matter. That it ought to be done, i believe is without question. I believe that of all people the church has the greatest mandate to make sure that basic medical care is extended to all people.

i want to emphasize basic care because i believe that part of the problem is that everyone expects to have it all. They want their nose job and the second quadrupedal bypass for their 95 year old granddad to be covered. Their is a great sense of entitlement that has swept over our nation and this is a key part of the current problem with health care.

This being said i do not believe that the Church as within itself the ability so self support medical are in the current system for the millions that are without care much less the rest of the 3rd world. i believe that a solution must be found that is a joint effort between the church and government / insurance companies ect. I think their is a great opportunity for the church to involve itself in the process to ensure that it is fair and that as many as possible are covered.

I fully agree with you that to throw my money into the deep dark pit of government project is for the most part a waste and possibly a way to pass off my responsibility to others. We clearly need something that works, is economically possible and fair. The question is how to best go about it.

[sonlyte]

Douglas, hey good to talk to you, it has been a while.

Your case above has one danger that I am conscious of, it has the potential to add guilt in too great a measure to be productive.

While it may be true that mercy and social justice are biblical biproducts of a society where the church is a driving force, it doesn't seem right to me to hold a wholistic result as the responsibility of God's people; rather it should be the motive.

To illustrate:
The apostles give Paul the mandate of caring for the poor, but they did not give him the mandate to ensure that all the poor are cared for.
The first describes a behavior coming from a motive which is easily accomplished: caring.
The second describes a result which may or may not be truly accomplished: end of poverty.

If you see the responsibility of the church as solving the problem, government may be needed as a tool because of the severity of lack.
If you see the responsibility of the church as reaching out to those in need, government would be a handicap because of the nature of politics and the tendency toward corruption.

I truly don't know which responsibility God has given us, but I can see ways which the church could meet some of those needs without government.

If each church sponsored one soul to go through medical school to offer services to the poor and suffering, many could be reached. This person would have to see their life's purpose as tied to that end. The church would have to be very serious about the long term solution.
Could happen; probably not very often.

[Josh]

sonlyte....
I loved that last post especially. Great thoughts and questions on what the ultimate goal for the church is and what our responsibility toward society should be and interesting suggestions (churches sponsoring medical school, as an example). I think the church should be thinking along the lines of your post more purposefully.