Here is another thought I have been mulling over the weekend: The thing that I find the most disturbing about our current system is that there are thousands of poor Americans who die each year due to inability to pay for health care. I don't know what the ultimate solution should be, but this seems terribly wrong. And I can't help but wonder why it is that those who cry the loudest about the "sanctity of life" are often the same ones most adamantly opposed to universal health care. Why are we outraged at the loss of life in one case, but not the other?

What evidence do you have that thousands or any number die due to inability to pay?

From most data which I've seen, I can't any credible numbers to support this concept. It comes from alarmist camps, but doesn't seem supportable.

For starters, there were quite a few cases in Sicko that were profiled (and in the extras) where this happened. MM claims that 18000 people die per year, but I have no idea what the real number is.

In any case, it makes perfect sense. If someone can't afford health insurance and they get cancer, what do you think happens? The money for the treatment just magically appears? Where is a poor family going to get $100K? $200K? $300K?

The part that I find odd is that most people just plain don't want to pay a tax to support the system, which is fine, except that they're already paying a fairly high tax (we all are) to cover the federal/state cost of writing off care for those who have no coverage.

Do you that any system doesn't have gaps where people fall through the cracks?

Have you heard of the concept of "rationing" which occurs in ALL systems, despite what the omniscient MM says?

The important question is very central, does our system kill more people than other systems?

And a follow up, what can be modified without negatively affecting the overall system?

For example, I remember hearing somebody from a health care systems analyst, who asked the question, should society pay for a ninety-seven woman to have quadruple bypass?

And should so much money be invested by society to overcome cancer?

I had a friend and client, who had leukemia, and had enough money to save himself. He spend a lot of money going to UCLA and the chemotherapy killed him. Did the fact that he had money kill him faster than if he hadn't? In this case, it did. Should society be held responsible for killing those who pay for it and die faster?

What data have you seen? Would you like me to put together a bibliography? What counts as an "alarmist" camp? May I assume the medical literature is acceptible?

No system is perfect. But while we save money (presumably) on health care (or taxes) in the US, the price we pay is in human lives. Nobody is dying in Canada due to lack of access.

Forget about MM. Go back to my original question: If a poor person needs $100K for chemo, where does it come from?

Your last part seems like a red herring. But to your first point, I will ask a question in response: Is there a dollar amount that you would be comfortable spending on cancer treatment per person? What is the value of a human life?

Why do poor people tend to get sick more than rich people?

you can't work and be productive if you're sick half the time.

It looks like the Archaean understood that. He's saying he would prefer to subsidize lifestyle changes as a vehicle to improve health, rather than a system that would result in excessive use of the medical system.

understood. so he's saying medical care is more analogous to prison spending for the uneducated.

Lots of reasons, I imagine.

- poor diet (healthy food costs more)
- less free time to exercise
- less healthy working conditions
- poor choices/lifestyle (poor people are often poor due to lower intelligence and/or learning disabilities)

etc.

Are you aware what rationing kills people in Canada? I could do the research, because most of my data is old. But for example, it takes time to MRIs, sometimes the denial of an MRI can miss a cancer which if it had been diagnosed earlier would have been cured.

I believe it is a red herring that people "die" due to lack of access. People in other countries die to lack of access to high cost care through rationing.

And I haven't seen Sicko, because MM lies and distorts evidence. And Medicaid is imperfect but I believe it does pay for cancer treatments, but I'll have to research it.

There are many high end medical treatments which are deferred due to lack of timely diagnosis in other countries.

At some point, a nation has the right to say, "that costs too much money, we won't pay for it." Other countries such as Britain and Germany have tiers of what is available and what is not. Don't be deceived.

You could not as an indigent person go get the same health care as the Queen of England could.

There must be a cost analysis which ends up rationing the health care.

And I agree that if we are to spend money on the poor, let's spend the biggest bang for the buck, "health care in preventive modes by improving lifestyles."

We won't do that because that requires responsibility on all parts.

Do you know that many indigent persons are so unmotivated that they won't even complete the applications to be eligible for Medicaid? I've represented small hospitals, who have a significant number of the poor who won't even help themselves by turning in forms which will pay their health providers. I would wager the poor's refusal to work within the system kills more of them than lack of access.

Then they qualify for Medicaid.

There are a lot of issues regarding Health care Let me weigh in on a couple/

1. 97% of health care transactions are non-insurable events

the act, system, or business of insuring property, life, one's person, etc., against loss or harm arising in specified contingencies, as fire, accident, death, disablement, or the like, in consideration of a payment proportionate to the risk involved.

Generally insurance is involved to secure against a possible large loss of money. 97% of health care is going to doctors appointment, getting a prescription filled, having a test done etc...

Thus creating insurance for non insurable events is problematic. This is why Health savings accounts will only be increasing in america as time goes on.

2. Moral Hazard

Thus if you have "insurance" you will use it. This of course costs more, Governments counter this by rationing the health care. Insurance companies counter this by deductibles and co-pays.

Note on Costs: 96% of health cost for a person occur in the last year of their life.

Now I oppose National Health insurance for a variety reasons. One of the chief reasons is that I believe the government setting prices is immoral. Would it be right for the government to say to the Lawyer "The amount that you can charge for your services has been determined in D.C." How about if they said to the mechanic this how much you can charge for fixing a car?

BTW... I am a free market guy so I would be fine if there was not public schools.

That's exactly right. We're not talking about the lowest rung here. They qualify for Medicaid. It's easy to forget that. We're talking about working class Americans whose employers do not provide health care but who do not qualify for government programs.

Among the uninsured:
70% work full time or have a spouse that works full time.
64% have incomes that exceed the federal poverty line (20k for a family of 4)
35% have incomes that exceed double the federal poverty line.

Data from the Kaiser Commission 2006 report on the uninsured.

To get back to JL's question: What happens when the uninsured are diagnosed with cancer? Well, data show that the mortality rate for an uninsured woman with breast cancer is twice as high as for her insured counterpart.

I'm pretty sure that 96% last year statistic is WAY off.

The govt. already, it can be argued, sets the rates for medical care (medicaid and medicare).

In Britain they have both the national public system and a parallel private system.

In psychiatry, for example, many of the docs I know don't take medicare, medicaid, or even private insurance. They only take cash.

I haven't seen the recent data, but it has frequently exceeded ninety percent. End of life care is the most expensive care most of us will ever see.

In most socialist countries they have dual systems, even if initially one didn't exist. The rich will not tolerate the quality of care rendered by socialized systems.

I have the source ... it would take some digging (I knew I kept my college notes for some reason :)

As for medicaid and medicare they don't completely set the rate they just mess with the market.

As for the parallel system doesnt that mean that the rich can get good care while the rest of us have to settle?

Medicare impacts rates as most insurers do theirs as a percent of Medicare rates.

Medicare is socialized medicine.

research shows that private school doesn't do a better job of educating than public school.

why does the USA fail in so many areas as compared to other industrialized nations when it comes to health? if public care were inferior, wouldn't the USA dominate, instead of bringing up the rear?

it impacts the rates but does not set them. many insurers rates are moved as much by market forces then by Medicare.

the only thing we "fail" in is access. If you want the best doctors, best hospitals best technology where do you go?

we are the best at screening and preventative medicine?

"Without the private medical insurance the law had denied him, Bill Murray paid out of pocket for this medically necessary treatment. But after successful surgery on his left hip, Murray encountered pain in his right hip. Again, the medical specialist recommended Birmingham hip resurfacing.

But this time, Alberta denied him the surgery outright - the province wouldn't even let Murray pay for it himself. (He eventually paid for the treatment in Montreal.) Murray's experience with the government's health care monopoly is not unique.

Canada's health system forces people to wait for months, even years, for necessary medical treatment. Many suffer irreparable harm to their health in the process. Physical pain is compounded by psychological suffering: the inability to work and to enjoy life."

Gee, let's talk specifics here ... Sorry, but the linked story is hyperbole and propoganda.

"Schumann said he's glad he made the decision he did."

Even more detail here!

"We are renowned for our health care system, and when I am in the deepest need as a cancer patient, and they don't have what I need to save my life, that's very sad," she said in a recent interview.

But Ms. Aucoin is not alone. Whether it is to get life-saving medication for cancer or a hip replacement, an increasing number of Canadians are travelling abroad for medical purposes. Long hospital wait times–it can take more than a year to get a hip replacement–have been identified as the reason most Canadians seek treatment overseas."

A little more info but again more hyperbole! I'm not trying to diminish the frustration of some of these people, however the reality is, despite potential long waits they have access to the care whereas 1 in 7 Americans don't have insurance. And, you failed to recognize that health tourism is equally on the rise in the States. You would rather deal in half truths and fear mongoring.

True of false: nationalized healthcare would lead to a burst of entrepreneurial activity as more people are willing to let go of jobs that had previously guaranteed health insurance?

My post validated what you said. You are one of the few posters who appears to understand at least in broad outlines how our system functions. Most just deal in meaningless anecdotes.

Sometimes anecdotes can be insightful, sometimes they are useless.

This is simply an untrue statement -NO person is denied a proceedure such as an MRI. They sometimes have to wait, but eventually receive the care.

If an American is uninsured cancer will not be detected in that person because there is ZERO chance of an MRI! That is the comparison argument to your incredibly poor logic!

The delay can kill.

And your definition of emergent and elective is different than ours.

My point is that all systems make cost judgments and no system delivers all things to all patients. That simply is untrue; all systems ration and deny some patients some things.

We simply need to discuss the value systems for these denials and their related costs, not engage in debates about scare tactic anecdotes.

That's an awfully self-serving summary of the discussion on this thread.

I am not "dealing" anything. You said all was well, and no one that you knew was denied care or waited long. I provided some counterexamples. These are just public articles I found in a quick Google search. They are real, but feel free to write them off as hyperbole and "half-truth", until its YOU waiting months in pain or worry for a procedure because you your or your family member's problem is not labeled "life threatening".

As I said, I know the situation in America has its own flaws. One good thing about the set-up in England is that you CAN get private insurance and with that you can get better care. Same with India. Sure, its a two-tier system but there is practically nothing in this world that is not. Buses are often provided subsidized by the govt, but if you can afford it, you can drive a car or take a taxi, etc. You can go to a JuCo or a University. UMass-Lowell or Harvard, etc.

One big problem with replicating what is done is Canada in the US is the cost. The disparity in pricing of prescription medications in the US vs Canada has been well covered in the US press. The disparity in the pricing of a lot of other products and services is often worse. What is happening is that the US with the strict (and often arbitrary) rules of the FDA, historical precedent as "the worlds richest country", and the tort situation in the US, all contribute to a situation where the US subsidizes much of the R&D costs of new drugs, procedures and devices for the rest of the world. At some point that cost has to be redistributed, at least among the developed countries.

Here you go:

http://www.urban.org/publications/411588.html

From the abstract:

As of 2006, 15% of Americans (43.6 million) without any health insurance,

http://www.cdc.gov/Features/Uninsured/

I'm with Mike. I call BS on that 96% stat. Let's see some substantiation.

The bizarre thing is that we're paying far more than any other country for health care...over $4000 per capita. Canada is at $2300. The closest to our level of expenditure is Switzerland, at $2800 per capita. That cost is even more striking when you consider that we're paying that much more to cover only 85% of our population; whereas the other nations are paying considerably less to cover 100% of theirs.

But when compared to other industrialized nations, we fail at almost every quantifiable measure of health care system performance. It's really a pretty sorry state of affairs.

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Gentlemen, I tried to track down the 96% stat. The closest I can find is that Medicare pays out an enormous percentage of each person's total payout in the last year of his/her life. It's possible that in one of the studies it came out as 96%, though I didn't find that particular one. If you think about it, that makes sense. Medicare is only available to the elderly, so they're only on it for a few years, and with the last year being so expensive with residential care, ICU stay, etc, it could end up being in the 90% range.

Anyhow, that's the only thing that I can find that would approximate MRD's claim.

Calling Michael Moore movies Documentaries is a slap in the face to real documentaries.

The truth is I DID NOT say "all is well". You are making that up to bolster a weak argument that is not based in fact but rather hyperbole. Where are the facts in those articles you linked? They are mysteriously missing, why? Because, as I stated in my original response the stories ARE NOT as straight forward as you have made them out to be.

The reality is in the past I have offered personal stories about my experiences with each respective health system:

http://cougarguard.com/forum/showthr...ht=health+care

Beyond my own personal story I offer the experience of father in-law who survived prostate cancer. He was diagnosed when he was 75 and received the very best immediate care available to anyone in North America. There was no institution telling him he’s too old for this or that procedure. The one article you linked, I might ad, is not demonstrative of a fundamental breakdown of the entire Canadian system but rather some peculiarity in the way in which it is administered in a specific province … the person was in fact able to go to another province and have the procedure done ;)

Furthermore, I do not, nor have not suggested that the US should adopt the Canadian system –that would be a mistake. But the point of this thread as started by Lebowski is not to suggest the US adopt the same system, but rather to learn from the system in the development of it’s own unique system. As an American who lives with the Canadian system I offer FACTUAL knowledge on the subject that should help dispell the myths and fear mongoring.

True -especially in the US with such vast resources of people and materials.

Now you are playing lawyer with your words ... you prefer the harshness of the word 'denial' to describe what occurs when in fact no one is denied anything. The system must carefully measure how quickly it adopts new treaments and proceedures and therefore is slower to change but it does not willfully deny proceedures.

Wait times are due to a shortage of doctors, staff and facilities not a scheme to 'deny' and cut costs.

It's arrogant and ignorant is what it is.