# why can't everyone afford healthcare when they need it



## cheshirechat

Moving over from the what is wrong with your country discussion, i would like to discuss the issue of healthcare, especially comparing the US to countries with Universal healthcare. The new budget came out for my country two days ago and it cuts healthcare spending by huge amounts. I am ashamed of a country where people cannot afford to go to the doctor when they are sick, where mothers cannot afford prescriptions for their children, where people die because the ambulance ride is too expensive -- we have all this talk now about violations of fundamental human rights. Isn't allowing medical care to be prohibitively (did i spell this wrong? i think i did) expensive bordering on a violation of human rights?  If you live somewhere with universal healthcare, how does it affect your country? how do you see countries that don't have universal healthcare?


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## cuchuflete

That all depends on your political philosophy. Until the 1960s or later, there was effectively no federal government participation in the health care "industry" in the U.S. Doctors made house calls. Medical malpractice suits were almost unknown.

In a few decades, people have come to just assume that healthcare is government's business or responsibility. Given the frequent ineptitude of governments to do things effectively, is this where healthcare belongs, or are there other solutions?

Part of the healtcare problem is based in the economics resulting from the legal/insurance mess. Part of it derives from the very limited number of places for would-be doctors.
I don't think medical school enrollment has kept up with population growth, so there are more patients per care provider. Does the AMA (American Medical Association...the doctors' guild) oppose having more doctors, in an attempt to keep prices high?

Why is the ability to either purchase, or have someone else pay for, medical care a "fundamental human right"? Should government also provide all citizens with food? Clothing? Housing?

I'm not sure I want to discuss the healthcare system's flaws without first establishing the underlying premises of the arguments. Am I entitled to food, clothing, medical care, education, happiness, just by dint of being born? Where are my own responsibilities, and where are those of state authorities, and why?


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## hald

Well, I'm afraid I can't have an opinion about US healthcare, since the only insight I got into it is a tv show (ER not to mention).

The only thing I can say is that french system while harshly criticized is not that bad. I broke my arm a few weeks ago so I went to hospital where I got an X-Ray, saw a doctor that checked everything was ok and finally got a plaster. I received a 16 euros bill a few days later, since most of the treatment's price was paid by the Sécurité Sociale.


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## cheshirechat

While I do not believe that things should just be given to people, I do believe that included in “Life, Liberty, and the Pursuit of Happiness” is the right to be able to afford healthcare.  I believe that a country should care for her citizens to the best of her ability.  I am not saying that every country should give everyone healthcare (maybe they should?) but I do think that a country should either ensure that healthcare is affordable to everyone or provide assistance in a manner that is well run and readily available when that healthcare is not affordable.
 
I also think that countries should feed and clothe their citizens to the best of their ability.  Why is it that countries can understand the importance of education (which is public in most countries, I  believe) but we can’t understand the importance of food and clothing in the same way.


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## diegodbs

I can't imagine a developped country without a Universal Healthcare System. At least not in the European Union. My sister has been on a sick leave for almost a year and she's been receiving free and regular medical treatment during all that period, and she's been regularly paid too.
Perhaps we haven't, and we will never, conquer Mars but a certain degree of welfare is all we can hope for, at least while on this planet.


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## kevinleihuang

I wish China would one day has such health care system......


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## cheshirechat

What kind of system does China have now? Is it more like the American system?


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## cuchuflete

> Life, Liberty, and the Pursuit of Happiness


OK, so when those words were drafted by Thomas Jefferson between June 11 and June 28, 1776, was there any governmental involvement in health care, or are we using them in a rather revisionist way to suit current thinking?

I don't mean that people don't or shouldn't have expectations that government will be involved, but please don't attribute that assumption to anyone writing in the 18th century. 

Should government be involved because it can, or because citizens in general cannot manage their own affairs? Adams, Hancock, Jefferson _et alia_, didn't take 'pursuit of happiness' to mean that it was government's job to provide it. Rather, they saw the role of government as allowing for it. Quite a difference!


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## cheshirechat

I am not saying they intended to cover healthcare or anything else in the words they wrote.  However, everything written is taken in the cultural context of the times -- we no longer read the Bible the way it was read 50 years ago.  We can no longer read the Constitution the way we did 50 or 100 years ago.  

Saying that government should be involved doesn't imply that people "cannot manage their own affairs".  That would imply blame on the part of the person who needs help with healthcare or food or whatever.  Perhaps there is a way to allow for government involvement without implying that blame?


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## Papalote

_Should government be involved because it can, or because citizens in general cannot manage their own affairs? Adams, Hancock, Jefferson et alia, didn't take 'pursuit of happiness' to mean that it was government's job *to provide* it. Rather, they saw the role of government as *allowing* for it. Quite a difference! (quote from Cuchuflete)_

Hello, forer@s,

Quite a play *with* words, Cuchu!

I can only speak for what I have lived, and only for the Province of Quebec, since although Canada does have universal health, each Province is different.

Lack of doctors and continuous lay-offs of nurses has created a health care crisis in this Province, although you won`t find any politicians agreeing with this. 

Because the service is so bad and the wait for tests in hospitals is appaling, doctors have changed their tactics. Let me explain myself. My boss`s wife went to her doctor at lunch time because she wasn`t feeling well and her skin had started to turn yellow. The doctor suggested she go to the hospital, *by ambulance*, *because that would be the only way *she would be able to undergo all sorts of tests to find out what was ailing her. Otherwise, one has to ask for an appointment at the hospital, which takes at least 3 months to get, then another 2 or 3 months before the right tests are completed, then 2 to 3 weeks before you get the results, unless they find out you really ought to be in the emergency ward! 
She stayed 5 weeks in hospital because they couldn`t find what was wrong (after 2 botched liver biopsis, change of medicine, etc.). After each battery of tests she asked to go home to await the results there, especially since this happened over the holidays. Answer: if you leave the hospital now it will take at least 2 months before you are allowed back if we find something wrong with you. So she stayed. 

Ten years ago the patient was sent to the hospital to make the first appintment himeself. My neighbour died of cancer because it took 4 months before he got an appointment at the hospital to find out about the lump in his neck.

The cost to taxpayers (in Montreal) is $2,800 CAN/day just for the hospital bed & meals, not including drugs. Naturally, we don`t pay for it, except through our taxes. I sincerely believe that the average Canadian cannot afford this, never mind the low-paid ones or the ones on Welfare. Ibelieve this is why we pay taxes, a collective effort so that the whole of the collectivity will be taken care of.

This Province is now going for the 2-tier system, where if you pay a fee you do not have to wait in line for anything. So far, most of my friends have opted for paying for a physician`s services instead of waiting 5 or 6 hours at the nearest clinic for a doctor to see them. Their company insurance pays for this. They haven`t stopped and asked what will happen to them when they lose their jobs or when they retire and can`t afford to pay the full fees.

Meanwhile, most of us keep hoping that we will be lucky enough to be taken by ambulance to one of the good hospitals and receive the care for which we have been paying taxes all these years. Reality is that most of us will end up in a hospital corridor.... waiting.

Papalote


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## Ignarciso

My opinion about the discussion is quite simple:

The state should pay the basic medical assistance, and I don't think it's not a matter of "managing your own affairs", it's a matter of being human. The state should cover a minimums of welfare for its citizens, so nobody should die of easy-curable illnesses nor starvation. And it's not free, because every citizen pays his taxes, so everyone must have access to Health.

I'm being a little utopic, but in some countries this is nearly this way (in health). I think there are resources to allow everyone live comfortably, but this would be another discussion...


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## lablady

Putting in my $0.02 as an insider to the healthcare system, I agree that healthcare in the US has some major flaws.  I am dismayed each time I hear that some government healthcare program has cut funding yet again.  

I can't speak for the entire country, but one factor from my side of the fence is that the California MediCal system pays so little for some procedures that it doesn't cover the cost of the supplies.  Couple that with the deals that many insurance plans make with the doctors and hospitals to pay less.  I heard that our hospital only receives $0.31 for every dollar that is billed.  As a result, the charges are raised to an exhorbitant level in an attempt to recover some of that loss.

I don't know what the solution is.  I understand the government's need to save money; I look at cost-saving opportunities with my own household budget.  But I have a lot of sympathy for the people who make too much money to qualify for government aid, yet make too little money to be able to afford their own insurance and/or their employer does not provide it for them.  These are the people who have to pay the full price out of their pocket.

I've often thought we need to look to other countries to see what ideas they have that we could possibly use.


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## whatonearth

I still struggle to understand how a developed first-world country such as the USA does not have free basic state healthcare...it truly baffles me. I believe that every person (*especially* in developed countries) should be entitled to an free education and free basic healthcare (in less developed countries without developed tax structures/public sectors this is obviously difficult). State healthcare is essentially an economic "distortion" and the USA is notoriously unaccomodating to such factors (you only have to see the cut-throat labour markets for proof of that) and while "eliminating" this distortions may lead to a more efficient economy (the US's unemployment levels and GDP are undoubtedly impressive) but this comes at a social cost. As I am sure other EU-based members would agree, such a social model would NEVER be accepted in Europe. While the EU's social model may have many downfalls, not caring for the weakest and poorest of it's citizens is not one of them. To me, in some respects, the US seems like a nation of "survival of the richest", which rankles me, as it probably would many of my fellow Europeans. 

As I said before, it truly baffles me...


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## BasedowLives

the concept of free health care is a good one, but then you read things like this

http://calsun.canoe.ca/News/Alberta/2006/01/26/1412129-sun.html




> Outraged relatives of an 83-year-old woman who spent five days in a Foothills hospital hallway says they're shocked by the indignity inflicted by a shortage of beds.
> 
> But a Calgary Health Region official said non-emergency patients are being shunted to hallways in overcrowded hospitals almost daily.
> 
> Randy Millis said his grandmother, Isabel Keen, spent two days in a seventh-floor hallway around the time she had surgery for a broken hip suffered in a fall two weeks ago.
> 
> He said Keen -- who suffers from dementia -- spent a further three days and nights in another hallway, where she received care a week after almost dying following surgery.


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## diegodbs

BasedowLives said:
			
		

> the concept of free health care is a good one, but then you read things like this
> 
> http://calsun.canoe.ca/News/Alberta/2006/01/26/1412129-sun.html


 
Those things may happen, a possible solution could be more money invested in health, and better organization. I would by no means be happy if my health or my life were to depend on how much a private hospital or clinic can draw from my current account. 
My point of view is that health and education are public services, not a private business. We can complain, indeed we complain about the faults of our National Health System, but I would rather have one than not.
Can you imagine the stress it takes from families having free education and health available?


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## tvdxer

This is a tricky issue with no quick, easy answers.

Obviously it is problematic when a great number of Americans do not have proper access to healthcare.  But on the other hand, I'm opposed to the creation of a federal, socialized health care system.  Do we really need to extend the government bueracracy to another part of our lives?  Do we really want an organization as gigantic and impersonal as the federal gov running an important part of our lives?

I think the best way to solve this problem is not through the creation of a megalithic nationally-run universal healthcare system, but through government *encouragement* of citizen-run (not necessarily commercial) health systems, something that can be accomplished through a variety of means.  It also may be necessary to extend regulation of HMOs, etc.  I am not a big fan of unrestrained capitalism, but I have equal distaste for the servile socialist state (which really isn't much different than a big business).  The public sector needs to support putting healthcare in the hands of (all) the people.  One example of this is allowing small businesses to pool together to get better deals on health coverage for their employees.

There are other lesser known examples as well: for example Robert Waldrop of the Oscar Romero Catholic Worker House, who has a big labrynith of a website on social justice, brings up the issue of dentists having lobbied for  laws against independent denturists, which brings up the cost of low-cost dental appliances, keeping the poor away from them (how would you rather look at a job interview?  without or with proper teeth?). http://www.justpeace.org/structures/health.htm

However, I must say, in all fairness, that I am no expert on this issue...


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## Chaska Ñawi

Some of these posts sound as if their writers assume that the citizens are there for the convenience of the government, instead of the other way around.

I find it morally reprehensible that a nation can channel so much money into "weapons of mass destruction" and yet not provide basic health care for its citizens.  It is my privilege, not my burden, to contribute to health care through my taxes for those countrymen who can't provide for it.  Their good health makes my country a better place.  Their untreated injuries and illnesses not only make it a poorer place, but they devastate the morale of the country as a whole.

I suffered a serious lung condition last year, requiring 4 increasingly invasive surgeries.  My care was immediate and excellent.  I paid nothing and was eventually able to resume my job (and consequently pay my taxes).  I met a younger woman who had the same condition living on the American side of the border.  She went into debt to get the condition treated the first time.  She could not afford treatment the second time, and is now unable to work at her profession.  Another episode may well kill her.  Cuchu, your philosophy seems to be that her own country owes her nothing in the way of good health.  What about her life itself?  

Without our universal health care, I would be dead or bankrupt by now, not out there making (I hope) the world a better place.....


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## cheshirechat

i think someone hit it on the head when they talked about the people in the middle, making to much money to recieve the little bit of government aid that the US has, but not enough to buy their own insurance.  It costs me over 200 dollars a month to fill my prescriptions.  It took me 5 years to pay off my surgery (not an optional surgery) because I didn't have healthcare at the time.  If I could live in a country with universal healthcare, I would be delighted to know that my tax money (higher though it may be) was helping someone else avoid the huge debt that no healthcare got me into.


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## cuchuflete

Chaska,
I would like to see my country provide good healthcare for all citizens.  I have severe doubts about the ability of the government to do it well.  It's all too easy to make the jump from "all people should get good medical care" to "the government should provide it".

I see ever more hundreds of thousands of burrocrats employed at the federal, state, and local levels, with no visible improvements to the quality of anything they are supposed to provide to the citizens.  Read the many threads about education.  My teacher friends spend more than half their time not teaching, but complying with administrative requirements.  That's why I'm cynical about government as the source of good healthcare.

What would I like to see?  I don't have a good, complete set of answers, but some pieces of a solution would be...

-Government subsidies of medical schools, and doubling or tripling the number of places for each of physicians, PAs, nurses.  That would offer immediate benefits in terms of both the availability of care, and considerably lowered costs.
-Rationalizing medical malpractice: get the repeat offenders out of the profession, and lower costs to the large majority who do a good job.
-Medicare/medicaid competitive bid negotiations with pharmaceutical manufacturers
-Changes in the tax codes to make all medical expenses subject to tax credits, not just partial deductions when they exceed a % of income

I've heard enough horror stories about British and Canadian systems to make me think that they probably offer lessons both in what to do and what not to do.

I still question the use of the term 'right'.  National healthcare is or will become a basic right when the majority of citizens want it to be that, and acknowledge that they themselves, however indirectly, are the "they" that should provide it.  

My state decided a few years ago that all 7th grade children have "a right" to a laptop computer, paid for by the taxpayers of the state.  While I happen to think that this is a very good use of tax dollars, I also think that calling it a 'right' is pure nonsense.


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## Saila

Guys, guys, guys..you should see the way the mexican social security treats the patients, if they find they can´t do nothing to help you ( even if it´s only a stomachache they tell to you to go to a private hospital which is so expensive these days..this is when you ask yourself why do I pay my medical service then?, why can´t the government help to be better on this matter? etc, etc, etc.


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## geve

From "the land of public service" (and correlatively, strikes), here's my opinion on why there should be a universal healtcare system as Cheshirechat said in post #1 (I think we might have two subjects here : the right to get healthcare, and the quality of the healthcare system)

Like Chaska said, let's not forget that we are the state (_with apologies to Louis XIV_).
If the state pays for something, we pay for this thing. It just means that the price is settled not upon one's consumption, but upon what one can afford, and so, that it will cost more for someone who is rich, than for someone who is poor. You might never get rich if you weren't able to receive decent healthcare when you hadn't invented microsoft windows _yet_.
I am willing to pay for my neighbour's leucemia - with the help of all my other neighbours - and knowing that they would do the same if it happened to me.
If one day I need very expensive health care, I will be glad to get my money back  
If the healthcare I need doesn't really cover all the taxes I've paid, I'll just be glad to be in good health


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## kevinleihuang

cheshirechat said:
			
		

> What kind of system does China have now? Is it more like the American system?


 

Well, it's more than a complicated thing to tell you what kind of system China have now. The problem is not whether we Chinese people have a good healthcare system, the problem is, however, whether we really have one. 

China has the world's largest population, and unfortunately, we have very very limited funds, most of which, as you all know, have been used to the endless high-way constructions (China has the world's second largest high-way system), costs of government employees (the Chinese government has more than 30 million employees!!! What an inefficient government it is!!!), military service, running cost of nation-owned institutions (about 1,000 institutions), and so on. So, the Government has very limited funds for public health issues. That's why the Government has to focus all sources to the Department of Health in 2003 when the threat of SARS became a real problem to China. Basically, there is no public healthcare system for all the citizens. If you want healthcare insurance, firstly you must live in the city area. People living in towns or villages are not eligible for any healthcare insurance. And you must be a formal employee of either private-owned or nation-owned enterprise, or government employee. Or, you have to be in the military service. 

Well then, let's move in to the point. Usually, if you are an employee in a nation-owned enterprise or a government employee, the number of healthcare insurance you can get every month is 3.5 percent of your income. If you are an employee of private-owned enterprise, whether you have healthcare insurance and how much you can get per month is totally attributed to the rules of each enterprise. In some famous companies, such as Kodak, Nokia, GE, Price Waterhouse, the healthcare insurance is up to 2.5-4 percent of your income per month. However, in some small local Chinese firms, the employer does not provide any healthcare insurance to the employees. Though there is law regulating that employers should pay healthcare insurance for their employees, there is always no judiciary involvement in the case of no healthcare insurance being provided. 

There is one special healthcare system for special people, who joined in the revolutionary business before October 1, 1949, the date that P.R.China claims to be liberted. This group of people, commonly, served in the military corps. Some of them were Secret Officers the Party sent to the enemy agencies or zones. These people had shown conspicuous gallantry in the revolutionary progress, and a great many of their warbodies were killed in the liberal business. Since 1978, this group of people have full access to all nation-owned hospitals, and the total cost, even hundreds of thousands of dollars or millions of dollars, of their healthcare insurance are fully paid by the country. In some sense, this group of people do have what people in some western countries, in which welfare are perfectly and fully set up and organized, have in common.

In China, relatively speaking, going to hospital is not that expensive as in America. But, I think there are still a lot of things the Government have to do to ensure all the citizens have fair and the same access to a well-designed and organized public healthcare system. After all, there are more than 920 million people living in the village who cannot benefit from the healthcare system.


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