Who should pay for our health care?

1

In a different discussion, an interesting discussion developed and at Shannon’s suggestion, I thought we should continue it here (anyone who already made a comment in the other discussion, feel free to copy it here). So that people that aren’t interested do not need to read it and people who ARE interested can read and share thoughts.

Basically the question is about health care reform in the USA and comparing the USA system with systems in other countries. Of course every system has pro’s and con’s, but what do you guys think?? Should society (ie nationalized health system) pay for all people’s health care or should individuals be responsible for ensuring their own care is covered (through insurance or out of pocket). Would you be willing to pay higher taxes to have universal health care coverage?

2

Here are the copies of my ranting below:

I would just like to share my experience as someone who DID move from the USA to Hungary in Central Eastern Europe (which is a developed country BUT by no means as wealthy as the USA). The Hungarian system still needs a lot of reform-- so I don’t claim that it is perfect, but I would like to share my experience as an example that the system CAN be different if we CHOOSE to make it so.

When living in the USA and going to college, I had a (minimal coverage) health insurance plan. This was what I could afford then and as a healthy 20 year old, it seemed sufficient (just in case I broke a leg or something).

Then I was diagnosed with type 1 diabetes… with one year of college left to go. All of a sudden, my insurance plan with a $2500 deductible and no prescription coverage did not seem to be nearly enough. Though the generous support of my parents, doctors, diabetes educators, I got all the supplies that I needed. But I was worried about how I would enter the “real world” and still be able to afford all of this.

I had already applied for a scholarship to study abroad in Hungary. When I found out that I got it, I decided that I didn’t want diabetes to be the reason that I didn’t go. So I went through a lot of insurance paperwork and found a way to go to Hungary. But I had to keep my US insurance plan so that once I moved back to the USA, my diabetes would not become a pre-existing condition. Thankfully I had family to support me financially through this time. Otherwise it would not have been possible.

Four years later I am still here in Hungary, now married to a Hungarian. Because of this, I qualify to be in the national health care system for the price of 30 dollars a month. When I applied for my national health insurance, they asked me for a lot of papers (passport, marriage license, residence permit, etc). These things determined that I qualified to be part of the Hungarian health care system. NEVER ONCE DID ANYONE ASK A HEALTH RELATED QUESTION. They gave me my national health insurance card without even knowing that I have type 1 diabetes.

WHY?

Because it doesn’t matter to them. I qualify for the health insurance, not because I am low risk or won’t cost them too much, but because I am part of society here now and that means that I should be included in the health system too.

Now, I pay 1 dollar a month for insulin. On the receipt, I can see that the Hungarian government covered 99% of the cost, paying the market rate for insulin. I pay 10% of the market price for insulin pumps and pump supplies. Free doctors visits, blood tests, medical exams,…

The system isn’t free. But the decision is made that taxpayers should cover the cost of medical care for all. Because it is one society and there is greater security in knowing that all will be taken care of.

What are the disadvantages?
There is greater limitation in the supplies that are covered by the government-- so I can choose from 3 pumps and 6 meters (though some insurance companies have the same problem).
They are slightly behind the technology available in the USA-- CGMS probably won’t be supported by the government for a while (though some insurance companies have the same problem).
Taxes are high. Some reforms to make health care more efficient could significantly reduce that problem though.

I personally like the security of knowing that I can get my diabetes supplies at little to no cost no matter what my situation will be (employed, unemployed, disabled, stay at home mom,…). And I like knowing that there is a system that is concerned about taking care of others with health problems, not a system that only benefits the healthy. I have high-quality health care (equivalent to what i received in the USA) and affordable supplies to manage my health.

I know that many in the USA are terrified of the inefficiencies of nationalized health care. For me, this is a reason to build a nationalized health care system that has some measures to increase efficiency. I think we’ll find that government spending on health care might actually decrease, once all those in our country who rely on the ER for health care are able to get sufficient preventative care. Until this nationalized health care system is in place, I think that I’ll stay in Hungary.

3

I share the concern that the government is not always the best provider.

But I also don’t feel that private insurance companies are set up to oversee the best health of the patients.

Also, while taxes may be higher in a national health care system, the personal expense of health care insurance would be gone.

A nationalized health care system just looks at health care from a whole new perspective and says that health care is a right, not a luxury. And a person should not pay based on how much he/she uses the health care (except co-pays to reduce overuse), but on how much income he/she makes.

In Hungary, you pay 7% of your income into a separate national health fund that pays the health care expenses. That means that the higher your income, the more you pay. NOT the sicker you are, the more you pay.

Next to that you have to rely on good education to influence personal choices for things like smoking, poor diabetes control, etc.

This is a democratic society (which the USA used to be and hopefully will remain!), so they cannot intervene in personal decision about health. Only educate and hope that people make healthier decisions.

For me it is just a whole different philosophy for health care. One that says health care is a right that shouldn’t be given only to those who can afford it, but rather to those who need it.

I don’t know how realistic a similar system in the USA would be, which is a much more individualistic (or even selfish?) society than what i have experienced in other countries. But the health care reform proposals that I have heard would be extremely costly if implemented. Even just leaving things the way they are cost our governments a lot of money.

The city that I know the best is Detroit, where numerous hospitals have closed down because they went bankrupt. There were too few paying customers and too many people showing up in the ER, where they must be treated. These people cannot and do not pay for their treatment-- so one of two things happens:
(1) the government pays for it
(2) the hospital closes

So the government is forced to be involved.

Yes, ours is a system that takes care of the well off, the people who can be sure of employment with health insurance for life. For those people, reform in the system doesn’t seem necessary. But i like to remind myself that I did not choose the life that I was born into and the opportunities that were presented to me. Inequalities in the USA are significantly higher than any European country-- so we cannot argue that people have equal opportunity to employment and equal access to health care. If you saw an inner city school in Detroit, it would be obvious…

So we need to find a way to keep individual freedoms (as Shannon correctly emphasizes!!) and a system that says that the health of our society is important. I know that I am expecting too much by wanting the wealthy to pay higher taxes for a socialized health care system. I know that our society doesn’t work that way. I just wish that it did. Certainly some changes need to be made to confront the problem of uninsured in the USA.

I open to other ideas, but nationalized health care is the only one that I can imagine that would really make a difference!

(Sorry for the ranting, this was one of my passions even before I was diagnosed with type 1 diabetes!)

4

In response to a question about why people who make more money should pay more for health care:

It’s based on the idea of social welfare. Those who have more, pay more. Those who have less, pay less. But we are paying for something that should be a right guaranteed to all. (Note: Those who do not pay any taxes are required to pay a monthly fee of 30 dollars to be included in the system.)

It’s the same reason that income taxes are a percentage of income. The goal here is to fund the country’s health care system, not to fund only your own personal care.

It is just a different approach, which is based more on social solidarity than individualist ideology. Just a different way to look at life, I guess.

5

My current pet peeve…mail in pharmacy

My insurance demands that I use mail in for all “recurring” rx’s

this means I have to get a minimum of 3 2pakcs of epi-pens, three months of backup insulin pens, 3 months of back up syringes…

instead of going to the localrxand getting a single fill when necessary (usually once a year, sometimes twice) its wasteful…and sure driving prices up for the non-insurd because theses big pharmas get such a deep discount—the uninsured are paying for the insured–and it is crazy!

Just like the SUPER HUGE discounts the insurance co’s get aat the hospital—and again the uninured carry the insured…which is not how it is supposed to go.

6

I think that a national sales tax, which would replace income tax could fund everything it does now, plus national helath care, that covers eveything except cosmetic stuff at 100% for all.

The reason for being national slaes tax based is that the more you spend (have) the more you pay, and the illegals who are here, and people who work under the table–also pay their fair share, cause they pay everytime they buy something!

7

Interesting idea!

The usual argument against sales tax is that is disproportionately taxes the poor because they spend more of their income on consumption than the rich (who save and invest, etc.).

But your point is good that it would be harder for people to avoid a sales tax. And most sales tax exclude food, right? I think that food definitely should not be taxed!

8

On average they still spend way more than we do, sales tax on a luxury car or two, more expensive clothing…etc…and they do invest–but that helps interests rates…so…

I also beleive that most food should not be taxed–the exeption–fast food and restaurants…if you can afford to eat out, you can afford the tax…

And all those not on payroll pay their fair share, which they do not do in either case now.

9

Get the government out of the health care business, they are really bad at it.

10

Unfortunately I have morre than 2 cents worth of opinion about this topic. I am very much against universal health coverage, Priviacy is an extreme issue with me. Ane the experience with universal health care for some of my family members is very bad. I have already posted on another site about this and am sorry to repeat it. But one of my sisters-in-law is quadriplegic after waiting for surgery for a herniated disc in her neck. This is permanent. But it was considered an “elective” surgery under the universal health care. An uncle in England is a type 2 diabetic and his medical care and supplies allowed are so poor he has lost portions of both feet and then portions of both legs. An Aunt living in Canada needed her gall bladder removed, but that too is called an “elective” surgery. She has waited for so long now she is down to 81 pounds and is dying. She would not live through surgery now. This is universal health care that limits surgeries and supplies that you can have to a waiting list when it isn’t an immediate, llife or death thing.
And i object to paying for all those people who come to the US to “retire” because our government gives them health care and dental and vision care and money and foodstamps every month
I may be very selfish, but I think all those things i listed above are just wrong. I came from a poor family where we had no trips to the doctor. Our shots and vaccinations were when schools had clinics. And our only trips to the dentist were when we had a tooth pulled. I put myself through school and we struggled to put our kids through school and they worked and helped out too. And I want all of our grandkids to work and help out too. I think all of us are better for the working and helping each other. I think it makes us stronger and better people. But i don’t want the government making my decisions about what medical care I can have or the supplies i get for taking care of my diabetes or when i can have surgery for some bad problem.

11

I can accept that the government is “bad at health care” and I’m sorry for all the people that suffered waiting in universal health care systems or who were limited in their choices of care.

But the question is:
WHO is good at health care?

How can we get a system that can take care of those who are uninsured? How can we get them insured? Sure there are lazy people out there who don’t want to work, but there are many that do and still don’t get insured, there are others that work really hard for hourly wage and no health insurance. What’s the solution to make sure that we don’t have a health care system that only benefits those above a certain social standard? How can we make sure that EVERY child is insured and gets preventative care?

I don’t think any country has a system that answers all the problems. There will always be tradeoffs, but health spending in the USA is extremely high and the results (i.e. the health of the population) is not so good. How can we change that?

12

I’m not sure who would be good with healthcare. Right now it is rough to try to get a decent plan for a reasonable amount of money as someone with diabetes. For example, my mom has type two diabetes and is a cancer survivor. She joined up with a insurance company before those conditions manifested and was therefore grandfathered into that system. They keep jacking up not only the co-pays but the month-to-month cost of the plan - she is paying $1,500 a month last I asked. Currently she cannot switch because in the state of Florida insurance companies are allowed to “cherry pick” - meaning they will only take the healthiest of the bunch into new plans and are allowed to bar people with pre-existing conditions from even purchasing a plan.

A lot of people are uninsured because they cannot even purchase a plan or, if they are offered anything then it is little by way of coverage and too expensive for them to afford.

Something does need to change in our current system - it is broken no matter how you look at it. We need it to be affordable and accessable to everyone, not just the rich and/or healthy.

13

More then likely you won’t be turned down by your next company - but by Florida law the insurance company could turn you down. Have you had a lapse in your coverage? So long as you are able to carry some form of insurance you should be safe. Also, Charlie Christ just set up a new statewide affordable insurance option - it would be $150 a month, you wouldn’t be turned down because of your diabetes and diabetes supplies are covered.

14

This is quite an interesting discussion.

Harry S. Truman proposed a national health care system after WWll and proclaimed quality health care should be a right for every citizen. It was duly squashed by both political parties at the time.

PBS did a documentary on healthcare where a journalist travelled to several countries and looked at the good and bad in their systems and what might work in this country if our leaders were willing to take a look. Check your local listings. Very interesting and very informative.

15

Why does BEING less fortunate feel like a punishment? (just the other side of the coin here)

I am struggling with two diseases, but hold a decent job. Yet I always feel I am being financially punished for two things I had absolutely no control over.

Honestly I my feelings are very torn over national healthcare because it is cutting edge technology that is keeping me a live right now and I am afraid that would be lacking if the competitive market went away.

16

Sweden has some of the most advanced medical research-- how do they do it???

Despite how it is portrayed, the USA does not have a monopoly on innovation. To be honest, a lot of the innovation that I see in diabetes care is ridiculous. Why spend millions of dollars to get a meter where I don’t have to enter the code from the test strips??? The market in the USA wastes lots of money…

Much of the funding for research comes from government sources. I don’t see how the current system is “small” government. I think the current system is “BIG government”, BIG private companies, small patients.

We need to rethink our priorities.

17

I get what you’re saying, and I quite agree with you - a lot of the programs that we currently have to help those less fortunate are being taken advantage of. I think one of the things we need to clean up here in the U.S. are the amount of people who milk the system. With that being said, doing away with the programs wouldn’t do any good either. They should be in place because there are some individuals who just happen into a rough run of it and need the aid. I think we as a nation have become jaded with these programs because of the bad eggs.

Part of living in a society means helping sometimes, even if it does come out of our tax dollars. I personally have no problem with my money - I work hard, pushed myself through college, T1 diabetes to pay for and all - going towards people who genuinely need it.

And I honestly think that if everyone was given a choice in the ‘matter’ then very few people would want to have their money go towards any organization or towards any individual in need. Maybe I’m just jaded with some of the reactions I’ve seen on discussion boards lately (i.e.: “why do we need to pay for schools I don’t have kids in the system?”, or, “I’m not sick right now why should I pay for national healthcare?”). I feel that we’ve kind of become a selfish national community - it isn’t about the greater good it’s all about gimme gimme gimme.

18

OK, I’m probably gonna take some arrows for this one. I am self employed and currently the government takes about 40% of my income (under the threat of throwing me in jail)
I don’t get to deduct my mortgage like everone else, I can’t deduct my children, like everyone else, and now they want me to pay for everyone elses health care.

Let me see if I get this, people don’t want to pay for the cost of their own health care, they want me to…hmmmmm somehow, I am not motivated to carry more of the burden as I am already very tired of carrying a huge burden currently.(probably 3 to 4 times more than most.
I work 60 to 80 hours a week…I think that if everyone worked 60 to 80 hours a week, they too would make enough money to pay for their own health care…and not have to come ask me to pay for theirs along with mine too…If they are working 40 hours a week and are saying that they don’t want to work more or pay more for their own health care, then I am not willing to listen.

If you want to lower the cost of healthcare, make it non taxable…it is wrong, and I believe immoral that the government taxes healthcare. Currently, the first 11% of health care is taxable and it becomes duductible after that…except to me. I continue to pay taxes on all my healthcare as the deduction disappears as you start to make more money.

Tell your government to stop taxing you on your healthcare…Healthcare is almost a non cost compared to what we pay in taxes…Taxes are the true outrageous cost, not healthcare.

19

I wish my cruddy lungs would allow me to work 60 to 80 hours a week! I love my job and would love to work more, but I just physically can not.
What do you suggest about the disability system? Just curious, not trying to start a fight.

I would love to see the insurance system work as a non-profit agency.

20

Bob, actually I will not shoot any arrows in your direction :slight_smile:

I think that you have identified another HUGE weakness in the US tax system and health care system-- the bias against small companies and the self-employed. The system treats every company as if it is a large employer. And definitely is biased against the self-employed.

BUT one of the ideas behind our health care system is to POOL risk. I don’t see how everyone buying their own health care pools risk. IT puts more power and control in the hands of insurance companies.

We don’t necessarily need to move straight to a nationalized health care system (I actually think this is not even a feasible option in the short-run). There are some things that we could do to improve the situation without huge costs.

Like regulating the insurance companies more heavily. Setting limits on how much they can charge for those with pre-existing conditions (but then we have the problem of WHO will insure us). ((So perhaps the better answer is to keep health insurance through the employer ESPECIALLY FOR THOSE WITH PRE-EXISTING CONDITIONS-- John McCain’s plan will take this away and every person will be evaluated individually. This is the worst for people like US!!!))

Like providing health care for children. They do not choose which family they are born into. Can we decide as a society that it is a priority for our children to get adequate (and preventative) health care. Perhaps you believe that this should be the responsibility of every individual family, BUT we must recognize the inequalities that exist in our society. Inequality in the USA is higher than any other developed country. We can’t say that everyone gets an equal. Sure, you CAN work hard and rise above challenges, but there is NOT an equality of opportunity in the USA. Our society would be better off if we accepted that.

We already decided that individual parents should not be solely responsible for the EDUCATION of their children. In addition to education, can’t we say that we should ensure a minimum level of health care to every child in the USA???