> David Forslund wrote:
> > Tim Cook wrote:
> > > -----BEGIN PGP SIGNED MESSAGE-----
> > > Hash: SHA1
> > >
> > > ivhalpc wrote:
> > >
> > > >
> > > > I wonder how this is all going to end and I fear it will end
> badly as
> > > > in Nationalized medicine in the US
> > >
> > > Would that truly be a bad thing? I'm not sure how a transition would
> > > work but answer these questions:
> > The transition is already underway with Medicare and Medicaid, both
> of which
> > are about to go bankrupt in the US.
>
> Sorry for my ignorance, but how can govt-funded health insurance/payment
> schemes "go bankrupt"?
So I guess this speaks of the curious way that the US works. Medicare
and Medicaid
are not paid for out of the general revenues, but out of a specific
tax. Since this
involves "entitlements", i.e., obligations into the future, the
projected income
won't meet the projected outgo in the years ahead. This is a "classic"
definition
of bankrupt. Much of the problem comes from unfunded mandates, where any
hospital ER can't turn anyone away based on their ability to pay even if
they
aren't covered by Medicare or Medicaid. This is one of the reasons that we
have an immigration problem here as people can come from Mexico, for
example,
illegally and get healthcare coverage.
>
> > > 1) What western country spends the largest portion (by a wide
> margin) of
> > > GDP on healthcare?
> > This, by itself, doesn't mean that healthcare in the US is bad. It
> > might mean the opposite.
>
> Despite having one of the highest per-capita spends on healthcare in the
> world, the US ranks in the bottom half (and often right at the bottom)
> of all OECD countries on just about every health and health outcome
> measure, on a population basis. Sure, for wealthier people in the US who
> can afford good health insurance, health outcomes are excellent, but
> those people represent about 50% of the total population. The rest of
> the population have really very bad outcomes, so the overall results are
> remarkably poor given the overall expenditure. And even amongst the
> insured, the quality and nature of the care is very patchy, due to the
> incredibly fragmented nature of the US healthcare system.
Where do you get your numbers? The percentage that isn't covered is
much smaller, I believe, particularly since people who haven't applied
and thus don't show up on a list are, in fact, covered. The quality
of healthcare is patchy, but not necessarily based on income, but on
locality.
I've heard horror stories from other countries, too, but I largely
discount such
reports.
>
> > > 2) What western country has the largest percentage of citizens
> without
> > > healthcare?
> > Do you have any idea what the percentage of citizens in the US is
> > without healthcare
> > coverage? The main stream media and some politicos grossly
> > misrepresent this
> > number. The fact is that healthcare for those that need it in the US
> > can't be denied.
> > The type of coverage isn't the same for everyone, but essentially
> > everyone has coverage
> > of some sort. People may not have signed up for it, but, in fact, may
> > have coverage.
> > Take a look at the sign in every ER room in America, e.g.
>
> It may be that acute, emergency care is mostly available to everyone in
> the US (but I constantly hear horror stories of denied or badly
> truncated emergency care in the US due to lack of insurance or cash,
> stories which you never hear here in Australia or in the UK - they are
> just inconceivable).
The problem here is that ER care is the most expensive and is the one
that can't be legally denied. In northern New Mexico, ER is the primary
care for a number of people. There is a continuous effort to provide
care in a different way which will reduce costs.
>
> However, it is lack of access to ongoing, routine medical care for
> poorer people in the US which is the problem. It may be that even the
> struggling single parent unskilled casual worker in the US can have
> their myocardial infarct treated at an ER, but it would have been better
> if they had had free or subsidised access to regular care by a family
> physician or community clinic for the decade before that, as well as
> access to subsidised antihypertensive and cholesterol lowering drugs
> instead of paying the full, ridiculous inflated US market prices for
> such medications.
The problem also is how healthcare insurance is paid for as part of
one's employment. One doesn't have a real choice in healthcare
in the US, which would make a difference if a real free market could
take place. We have neither a free market nor a federal system, and suffer
as a result. But most people I know would much rather have their
operation in the US rather than going to another country for the same
or similar procedure.
The IT problem of rigid stove pipes of proprietary systems contributes
to the problem but
probably isn't the biggest contributing factor, in my opinion. I'm not
sure how FOSS
works in countries that have nationalized healthcare. Aren't their
requirements that
one use the "national IT system"?
Dave
>
> Tim C
>
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