Why would that satisfy Americans? $135/month for 17th rank worldwide, versus $234/month for 37th rank, and the Dutch include dental care 'til age 18, and we don't. We pay for our meds also and we are in our 80's - otherwise I'd be tempted to relocate.

I've now got Sicko on DVD. Yes, the portrayal of the French system in operation is correct. Michael Moore has a running gag about 'the government paying for laundry'. Yes, but only because,under the French system, free aftercare is available for new mothers. A mother has someone attend every day to help her. That helper would be happy to do some relevant laundry as part of the service.

The British system is also correctly described, save that the family doctor in the film is certainly on more than £85,000 a year, say £100,000 when his free pension is included. The doctor in the film mentioned the incentive or bonus payments. These amount to about a third of any family doctor's income; the basic pay of £85k/£100k does not include these.They are for a range of services such as getting a high rate of immunisation and taking other steps which could be seen as preventative.As the doctor put it, smiling, if he got none of his patients smoking he'd earn more .Well, perhaps, but he's certainly paid bonuses for blood pressure monitoring and other tests which are not incidental to any treatment but which are essentially health indicators. His practice will send out flyers reminding relevant people to get flu injections and it will insist on encouraging mothers to get their children vaccinated. The national average pay for a family doctor is now £126K, a good deal more than the basic of £85k given, if in fact, 85k is still the current 'basic'. One in ten earns more than £150k. A thousand or so earn more than £200k.(Just double the figures for US $ ).The top earners would usually be partners in practices where there's an in-house pharmacy.Incidentally, a doctor isn't paid per treatment or procedure (save to the limited extent of incentive, bonus, payments above for a listed range of tests etc). To pay per procedure could be a temptation to the unscrupulous or fraudulent.

Remember that the taxpayer pays.(One result of that is that healthcare is under constant public scrutiny.There are votes in it and the voters, in the end, have control over it and choose the party that they think best delivers it). The more treatments than can be prevented, the more cases of illness that are detected before they are advanced, the more that the vulnerable are immunised, the cheaper it is for the taxpayer. That's not the moral reason but it's one that might appeal to Americans . The moral reason is the one that created the system in the first place, in 1948, when we had a country devastated by war and still under food and clothing rationing (which incidentally, was more severe in peacetime than it had been in wartime).We don't expect people to pay privately for other services, such as libraries or the fire service or repairing the streets.These exist on the public purse because they are necessary, and held to be in the public interest. Somehow we hold healthcare to be in that category. Americans hold the other three to be in that category but not healthcare. Well, that's the way you like it. I've never been refused access to a library because I hadn't got insurance or I had but it didn't cover reading in Cambridge or I'd not disclosed some supposedly pertinent fact, or I'd run out of funds, or the librarian had to telephone headquarters to get clearance for my having a particular book.

Before seeing the film I hadn't thought the American system through. It's like dealing with insurance companies here.You can have many a battle over what is covered and whether there's an excess. There's an appeal procedure in that we can go to the Insurance Ombudsman.That is fine if all that's at stake is money or property. With health insurance the appeal might be too late in resolution to help the patient.And there's an incentive not to insure people who might give rise to expensive or repeated claims (try insuring a 17 year old to drive a 160 mph Maserati and see how far you get !) Our system wants you to be treated to avoid claims: it cost less in the long run. And because nobody is dissuaded from seeking help they will present themselves (perhaps after nagging from their family, but not because of cost but concern ). We reinforce this with a 24/7 NHS helpline service, where you can telephone anytime for help and advice from doctors or nurses.

The Cuba stunt in the film, when Moore gets healthcare for helpers at 9/11, has little to do with Cuban healthcare.If, as opponents suggest, the Cubans treated it as a propaganda coup and if the hospital was unique, who cares? The fact is that these people could not get that care in the USA . The fact is that detainees in Guantanamo Bay, according to the military, got the same high standard of medical care as (fully insured) Americans get. As Moore points out, there's some irony in those sworn to kill Americans being better treated than Americans,some of them American firefighters, who helped after 9/11

I don't think that any of them have thought about the concept of introducing market pressures to bring health care costs down naturaly.

McCain comes the closest.

Government-regulated health care would be a disaster both to our quality of care, our research and development, and our economy.

quote:

Originally posted by Veteran of OIF OEF and OSW:
I don't think that any of them have thought about the concept of introducing market pressures to bring health care costs down naturaly.

.

But why don't market forces bring down the cost at present, anyway? Do you approve of government interference in a free market?

What, if anything, is wrong with US healthcare now?

The health sector of the economy doesn't have the same market pressures as other products or services. You never use a doctor until you're desperate (sick or injured), and you will always seek out the CLOSEST respite, not the cheapest. Nobody checks prices before going in, right? It never occurs to us.

Instead, we have insurance and government health care paying for us. (Do you think they check prices for us?)

So tell me, where in this market is the concerted downward pressure from the demand side?

Who goes to a doctor or hospital only when they are ill and 'desperate' ( and so ill that they'll take whatever's nearest regardless of its terms )?

Insurers are in competition with one another. You don't buy car insurance or life assurance without checking the market. So they should be competing to give the best deals. Aren't they? A problem may be that one way that they can save money and improve their profits, like the car insurers, is by refusing some customers or by imposing terms that customers can't comply with.

Anyway, what's wrong with American healthcare?

quote:

Originally posted by FredPuli:
Who goes to a doctor or hospital only when they are ill and 'desperate' ( and so ill that they'll take whatever's nearest regardless of its terms )?

Better questions:

Who goes to the doctor when they're NOT sick?
Who goes to the doctor when they're NOT injured?

Are there people out there who are so desperate to part with their hard-earned cashola that they plan trips to the doctor only to eagerly await being billed?

It is a fundamental of all markets that you buy only the products and services that you want or need, you choose the time, you choose how much you're willing to pay. This is the definition of "demand", and it is the only counterbalance to the supply side of the equation.

quote:

Who goes to the doctor when they're NOT sick?
Who goes to the doctor when they're NOT injured?

Everybody should. Prevention is better than cure. In fact, in Canada, we're supposed to have an annual check up as part of our Medical Services Plan - this saves money and lives by identifying potential problems early on. There are many things in life that the 'free market' model just does not adapt well to, and health care is one of them.

Wasn't it Bush who said that everyone in the US has access to health care because you can always go to Emergency? How silly.

Markets don't operate in the world of theory. Whether people "should" or not is irrelavent.

People don't, and that drives market response.

(Or perhaps you didn't know that when you have an annual checkup, you might be finding things wrong that would heal on their own, and you might possibly creating a demand that wouldn't otherwise be there. This demand drives the wrong side of the equation. Higher demand pushes prices up, not down.)

quote:

...you might be finding things wrong that would heal on their own, and you might possibly creating a demand that wouldn't otherwise be there...

If doctors find things that would heal on their own, its in a free market system (or a poorly designed socialist one), where they've got to sell things to make a living, that there's a pressure to treat - creating a demand that wouldn't other wise be there.

The advantage of non-free-market health care is that it can be more efficient, with health carers being rewarded for preventative medicine, for 'putting themselves out of a job' (in the free market paradigm). A capitalist pharmaceutical industry has an interest in creating artificial demand - for cold 'cures' and the like, as we can see in the real world.

The best health care systems probably take elements from both centrally planned and market systems. In any case, a system that encourages check ups rather than crisis intervention is undeniably more efficient and humane.

Better Question:

Who doesn't go to the doctor when they ARE sick?

Millions of Americans who can't afford it. A national disgrace.

I never go to the doctor when I'm sick, I duke it out at home.

I feel proud because I live in a country where I can tell the government to go to heck and do it my way, and when I need it, the hospital is still there.

One difference between the candidates is that liberals will (again) try to force health care policies upon us whether we want them or not, and that represents a loss of freedom.

Liberals who complain about the Patriot Act will likely not notice this nuance of Hillary Care. It's not because they believe our liberties are precious, or that the right to choose on our own should be protected, it's because their sock-puppet controllers in the media will tell them what to say and they'll remain obedient no matter how much it contradicts what they said yesterday or last year.

You watch. All liberals wait for the media to give them their cues, and they are fully obedient.

quote:

Originally posted by Veteran of OIF OEF and OSW:

Are there people out there who are so desperate to part with their hard-earned cashola that they plan trips to the doctor only to eagerly await being billed?

Sorry Vet, I wouldn't know. In Britain nobody gets billed,and so nobody eagerly awaits being billed, but the prescriptions cost the equivalent of $13 for any quantity of the drug (unless you are 60 or over, 16 or under, or otherwise exempted e.g low income, drawing benefits etc). In France it's similar.No insurance company decides on treatment in either country . The doctors do. Nobody says you can't be treated because you have diabetes, or HIV/AIDs, or alcoholism, or anything else currently or in your past. Nobody turns up at an emergency department and lies to get treatment (as you have said they sometimes do in the States)

It's that bad that nobody in my family has private health insurance, nor did my parents (but not because they needed the money for their yacht on the Med; they paid for that anyway), and my daughter-in-law is going in for a Caesarean on Monday. My poor son ! He earns $180,000 a year basic and she is earning $140,000. You'd think they'd pay for a private hospital, but they don't! I mean, it's my new grandson I'm talking about. I can't imagine why they don't. (Of course I can.Why would they bother with a private hospital? )

One day you people who seem to talk, or think, of healthcare as though it's something you must pay for,or argue with insurers over, whatever the cost, as though there isn't a duty to provide good health for every citizen, will join the rest of the civilized world.

quote:

Anyway, what's wrong with American healthcare?

I think I see the problem now - it's that namby-pamby liberal Hippocratic oath. It's a distortion of the free market and a restraint of doctors' trade.

Doctors should be free to sell whatever pills, potions or cures the market will swallow. It's up to rough, tough individualistic consumers to watch out for themselves.

Doctors should be allowed to operate on free-market principles, maybe like cable TV companies; "No you can't have the tonsillectomy unless you also pay for the breast enhancement..."

This is just too good.

America never needed health insurance until it was invented, now we can't live without it, and it's a disgrace if the president doesn't give it to us.

America has never had socialized health care, but liberals seem to be helpless without that, as well. I don't take this to be a necessity, I take it to be a weakness of liberals, and no amount of complaining about suffering people will convince me.

Health insurance doesn't cure people.
Universal health care doesn't cure people.
Neither will stop people from getting sick.

Nature doesn't work that way. But nature does create screwballs and theives who can work the system. The moment the government offers to pick up the tab, doctors arbitrarily increase their billings. They do the same with insurance. It's like candy to them, and liberals want to just open the box and give it all away!

(The reason why the sob stories don't impress me is because it's the stock and trade of communism. You can see it in any third-world country that has a national "people's" movement, such as the NPA in the Philippines. You liberals are always the first to be suckered because you just don't have the brain power to see through it.)

quote:

Originally posted by Veteran of OIF OEF and OSW:
The moment the government offers to pick up the tab, doctors arbitrarily increase their billings.

They don't in Britain (or France). In Britain, a family doctor on the National Health Service has a contract (currently worth c $200,000 a year basic, without the incentive payments below). He is not paid per treatment or procedure.He can't increase the payments . The incentive is to stop people getting ill, not profit from illness. The only extras he gets are some incentive payments for getting vulnerable patients immunised, blood pressures checked regularly and anything else on a set list of procedures or treatments which are preventative.Ill health costs money. It's in the interests of everyone that diagnosis and treatment be as early as possible and that any problem be prevented or mitigated.

This isn't Britain or France.

This is America, the Land of Opportunity. Last time I went for glasses, they asked what insurance I had, I replied, "none", and they said, "we give a discount for those paying cash--half off!"

Translation:

If you're covered, the bill doubles.

(Do you know how many salesmen I've met who do the same thing the moment they find out no one is watching the invoices?)

quote:

Originally posted by Veteran of OIF OEF and OSW:
If you're covered, the bill doubles.

Or triples. In February, I took my son, who is uninsured, for medical tests before entering a rehab facility. The bill? $450. Because he was uninsured, they cut it to $150.

Put together with Fred's comment about how, in a properly planned system, the carer is not paid per treatment or procedure, the two comments above would seem to prove how inefficient and corrupted the US's private-insurance-backed health care is.

Your cash discounts might work for glasses and one-off tests - but what if (god forbid) you needed a course of more complex treatment?

(In Canada, it seems, we have a mixture of 'fee-per-service' and alternative, contract or salary, methods of paying doctors. But prices for various services and procedures are negotiated nationally, I think. I'm not sure - to be honest, I haven't looked into it properly.)