You can be young, fit and healthy, but get hit by a car and your life is over. Once you're bankrupted by medical fees, you'll never have good credit again - and in the US, this is like the mark of the beast.
It's no wonder that American streets are filled by the homeless and disabled. This is a great country, with wonderful people, but in some ways it's medieval.
Of course, that presupposes you don't need to pay out-of-pocket for major medical care more than once every 5-10 years.
Neither can those of us who live here.
I mean, I can kind of understand the series of historical accidents of how we got here. What I can't understand are the politicians promising to fight tooth and nail to roll back the very minor reforms just enacted, and all of the people who enthusiastically just voted them into office last election, based on that platform.
So what? We live in a litigious society, laws are verbose because they have to be. Make it too vague and you just force the issues to be resolved in the courts making it even more confusing because the rules become written in case law.
Call me an idealist, but I think that's bad.
Like a tax code, usually these kinds of things end up working out mostly to the benefit of the larger parties who pay the most lawyers and professional staff to find and execute on the loopholes.
I do engineering for government contracts. The spec for the system I work on covers thousands of pages. I've read about 6" thick worth of it and that is less than 10%. But they detail down to the most minute thing what you are allowed to do and not allowed to do. The big picture stuff fits on the first 10 pages, and then they drill down into exactly what kind of thread you can have on a fastener and exactly how you are allowed to stress a weld for the next 1,000 pages. But it stems from previous experiences and errors, and it leads to a better product (though a more expensive one).
So I don't think "# of pages" should ever be a metric for judging a law.
Yeah, well what you said is just a tactic to try and sway people to think what you believe. See where that line of reasoning goes?
I do engineering for government contracts. The spec for the system I work on covers thousands of pages. I've read about 6" thick worth of it
I've read and implemented big specs too and I know how much work they take to produce. And I know darn well it wasn't some committee of smart and well-intentioned elected representatives that wrote it.
then they drill down into exactly what kind of thread you can have on a fastener and exactly how you are allowed to stress a weld for the next 1,000 pages. But it stems from previous experiences and errors, and it leads to a better product (though a more expensive one).
Are you seriously claiming the health care bill is so big because it's a precise engineering document which "stems from previous experiences and errors, and it leads to a better product"?
If so, how much does 10,000 pages of high-quality engineering documentation cost to produce?
Who do you think paid for it?
I think you're just imagining that it's what you want it to be.
But the bigger reason is probably that ultimately they know the key to maximizing their long-term profitability is to funnel as much money into Washington DC as they possibly can.
There will be more laws regulating healthcare in the future.
Baby boomers are going to be using a lot of healthcare in the coming decades and retired people vote. The debates will be no less political.
The vast majority of costs borne by and in the US healthcare system are the results of overeating, oversmoking, and underexercising. Period. Heart disease, many forms of cancer, diabetes, most forms of pancreatic, gallbladder, and adrenal conditions, are largely the result of personal choice.
Setting aside for a moment the fact that congenital defects, hereditary disorders, infections, and accidents are no fault of the victim/patient, it should be important to note that a system that REQUIRES those who take care of their health by eating and exercising properly to subsidize the consequences of the choices of those who do not, is taken by many Americans to be fundamentally unfair.
If legislative initiative were taken to find a way to exclude universal coverage of lifestyle diseases, while still permitting universal coverage of non-lifestyle conditions, many people would not have such a viscerally negative reaction to the notion of universal health care.
Placing a tax on fat content would increase the proportion of earnings used for the NHS by those who would use it the most. It would also provide a disincentive to eat unhealthy in the first place. Of course, many many people think this smells a lot like social engineering (what isn't at government level?), so this wouldn't pass in the UK, let alone the US.
Lots of good background on Fat Tax in the References at http://en.wikipedia.org/wiki/Fat_tax
That played no small part in getting me back in shape.
A single-payer/public system has a strong incentive to preventatively fight lifestyle diseases in a way that bickering insurance companies simply do not.
The US health care system is melange of many complex and perverse incentives. I recall a study saying unhealthy behavior adds at most 50% to costs but costs have increased many more times than that in the last thirty years. The billing system, medical education system, end-of-life-care, the health insurance system, ad-nauseum. It takes a LOT of crazy schemes to eat up 20% of the GDP of the once-most-prosperous country in the world.
It's simply that some people make irrational, bad choices, and the incentives on the whole make no difference.
Such as the choice to smoke, or over-eat. Yes, they can be addictive, but there are supports and cures for both, and involve willpower and sacrifice, but they're there.
I say this as a fatarse who has lost 20Kg by eating less (The Horror!) and doesn't blame anyone except himself.
If the potential future cost of dying of lung cancer doesn't deter people from smoking, then the potential future cost of bankruptcy from paying for lung cancer treatment isn't going to, either.
It's about the mispricing of future risk rather than moral hazard. If you brought the cost up-front, by giving them health insurance but charging additional risk premiums to smokers, then you would likely find more rational decision-making around smoking.
Insurance (which is a horrible system for health care, since insurance depends on people who buy it not to use it, and all of us need health care, usually multiple times per year) and government programs merely mask the root of all of this, which is that health care is completely and utterly unsustainable at its current rates. Something has to change about the way we administer medicine because nobody can afford it.
Everyone outside of the US has seen that people can't afford it and instead of fixing it, they've just said "the government will pay whatever it costs, don't worry any more, peasants!" In the US the problem has existed so long because we've covered it with insurance companies, but that system is crumbling as it gets harder for anyone without a job at BigCo to get reasonable care.
Our options are to figure out how to make health care cost a reasonable and affordable amount of money or let the government print money to fix it all for all of us (in the short term, ignoring the consequences of printing a bunch of money to keep an unsustainable system alive).
The current plan to force everyone in the United States onto an insurance policy with minimal modifications from existing policies is a pretty bad plan imo. The rates will be about the same and I'm sure the insurance companies are going to be thrilled to get tens of millions of new customers to suck dry by legal mandate. The people that will qualify for state subsidized insurance rates are only a handful more than the people that currently qualify for state medical programs like Medicaid anyway.
Simply because the insurance and billing drive costs so much higher
In my opinion, the "very minor reforms" you mentioned will probably accelerate health cost inflation by subsidizing more consumption of health care goods and offering no incentive for offsetting conservation. They may ease the symptoms for a time, but they will exacerbate the underlying illness.
It's the Republican Party. They serve a certain set of masters. This set of masters is not the everyday Joe. This should be old news. Unfortunately it is not. And yes some folks vote for them that probably should not, but we have a sort of Bell Curve of intelligence and education out there -- though everyone's vote counts exactly the same -- combined with a variety of different levels of empathy for others, combined with a propaganda-rich media environment. This is what happens under those conditions. Ideally, we want to change these underlying conditions.
In the US you can't leave your job to start your own business because your children might get sick and die. Even leaving for another employer is tricky because there is often a 6-12month gap before the new health coverage kicks in and anything you had treated in the past (like a broken leg in a childhood cycling accident) becomes a pre-existing condition and the new place denies you coverage.
This very effectively reduces wage costs since the whole 'importing people from africa' thing was banned.
As a relatively well-paid (when I wasn't working for myself) Canadian, it just never occurred to me that I might need to stick with a job just for the benefits. I had the freedom to move.
A six or twelve month wait is also unusual on switching jobs. Generally it will take ~60 days from hire for the new insurance to kick in, but rarely more than 90.
Instead I've only had to pay a nominal fee every time I need medication. Surgery, over a dozen MRI scans and visits to specialists over the years plus other tests and whatever else have all been paid for at no cost to me.
It scares the crap out of me to think what would have happened to me if I was in the USA.
To be able to see specialists or have expensive tests at times when I've been lucky to have $5 to my name is something I feel enormous gratitude for. I can't imagine the hardship having to pay for all this out of pocket would cause.
The problem is the government is broke and the health care bill was so bad that many supporters already have exemptions (including a few unions that backed the bill). Worse it really didn't address the big problem of why health care costs so much. It also had unwarranted optimism on cost savings.
At some point, I hope that the government will address: tort reform, drug trial costs, cost of medical training, bulk drug purchasing, "catastrophic" government backed insurance, and better medical savings accounts. I really expect more talking heads yelling at each other first.
"In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States."
http://en.wikipedia.org/wiki/Comparison_of_the_health_care_s...
I've been self-employed since 2003 and I've never paid a cent in health insurance, I just pay the Medicare levy like everyone else. I didn't pay any money at all for this stay or surgery, and also received free pain medication (endone, oxycontin etc.) upon release.
The surgery was successful and although I still have some pain sometimes, I can walk, run, play sport and do anything else I like.
If only the U.S healthcare system were my broken calcaneus :)
I saw 3 different doctors, including seeking multiple opinions from 2 different knee specialists. I decided not to have surgery right away, and got a brace.
A few years later, my preferred leisure activities changed, so I decided to have surgery done. It took 11 weeks to get an appointment (as it was elective surgery at that point). The surgery was done by an experienced surgeon (a few hundred ACLs under his belt), and he met with me 4 times himself during the following year to follow up on my recovery progress.
Total out of pocket cost was ~$300 for a couple optional recovery devices (icing machine, etc.).
Physiotherapy appointments were, however, covered by my employer's extended medical at the time. That was about $1-2k that I would have had to pay had I been completely uninsured. I probably would have elected for less and cheaper physio care in that case though.
Short version: after reading this article/thread, I'd honestly be scared to join YC in SV, especially now that I have a daughter.
(Side note, I tore my ACL in Ontario and had an initial appt there, but ended up getting treatment in BC. It seems a lot of posts here talk about which state you have coverage in? Is the paid-for insurance not country-wide either??)
There's the separate concept of in-network and out-of-network doctors, of course....
The MRI was on the order of $1200, and another appointment later (this time with a knee specialist), it turned out that I did, in fact, have a torn ACL. By now, however, it had happened nearly a month prior, and the doctor recommended waiting at least two more months for the swelling to fully subside.
Reluctant to make such a big investment and being fearful of such a major surgery, I waited about 9 more months before I finally had the surgery. Since I didn't go to a hospital, the costs were actually reasonably low: ~$2500 each for the facilities, the anesthesiologist, and the surgeon. From diagnosis through final checkup, the cost was about $10K, and I was fortunate enough to have my doctor advise me on personal rehabilitation (I didn't go to a single session of rehab).
So I was lucky to get into a good facility with a good doctor and get reasonably-priced care, and now I'm stuck in a job I don't like with high credit card bills in order to pay off a large cost for a fluke basketball accident. Call me crazy, but I'd be interested in taking my chances in Canada or the UK. I've only just now (a year later) paid off the anesthesia, and I'm halfway done paying off the surgeon.