An American Civil Conversation

ObamaGrav.jpgBeginning Monday we will begin a series on President Barack Obama’s health care proposals (Obamacare). We want to exhibit to the American public that a civil conversation can happen, that it can happen over serious issues, and that it can happen when folks disagree with one another. Please join us — Monday.

What are the most pressing issues to discuss?

  • Steve S

    Abortion and Obamacare.
    This is the topic that seems to get avoided consistently.
    I have heard people bend over backwards to explain that the Health Care Plan won’t mandate euthanasia, and then they don’t even mention abortion. I have heard pundits act real aggressive in their interviews, asking ‘hardball questions’ about the bill, but ignore abortion. Makes me think they are hiding something…

  • Rick

    cost/financial impact on future generations

  • Deborah

    have churches abdicated their role of caring for the sick, poor and widows…therefore creating this issue that the government feels compelled to legislate healthcare for all?

  • http://communityofjesus.blogspot.com/ Ted M. Gossard

    Does God not hold nations accountable for their society, and how people, especially the poor- are treated?
    I think in relation to nations having kings in the past, who were considered shepherds of the sheep (people) of their kingdom/nation/state.

  • James

    Judicial oversight: Is it present throughout, or are there measures in the bill that specifically call for exclusion from judicial oversight?
    Option: Is this one more option in addition to the 30,000 or so private companies, with no built in advantages like our President claims, or are there mechanisms to force people into the public option and is there unfair (tax subsidized) advantages against private plans.
    Stewardship: How will this plan be different from other government run health plans? If there are billions of dollars of savings available in Medicare, why not impliment those first?
    Unreasonable Search: Are there provisions in this bill that give the federal government free and w/o warrant access to personal financial information of every American?
    Honesty: Has President Obama and the Senators and Congressman putting forth this plan been honest? Have they been caught on camera speaking out of both sides of their mouth?
    Those are important off the top of my head.

  • Ryan Boyls

    Deborah,
    Yes, if churches followed the commands of Jesus, we wouldn’t even be having this conversation. Conservatives say government has no place helping those in need and that those in need of help would be better served through private organizations. It’s a shame they don’t put their money where their mouth is.

  • Barb

    Why are we as Christians so afraid that someone may get something given to them that they don’t deserve?

  • AHH

    Agreed on the passing on of debt to future generations. Gratification today and leaving future generations to deal with the bad consequences is not good from a Christian standpoint — of course deficit spending for health care plans is not only this issue where we see that (climate change policy being another).
    Don’t know if you would want to get into it, but another thing perhaps worth discussing is factors making so much of the current discussion so un-civil with ranting about death squads and so forth. And why some Christians (e.g., Sarah Palin) fan the flames of incivility and if churches should rebuke such behavior.

  • ChrisB

    How many people are actually unable to get health insurance? How many people actually go without health care?
    Is there anything less than “universal coverage” that is acceptable?
    What care should and should not be covered in government subsidized health insurance?
    Are there market reforms that could improve the availability of health care or insurance alongside or in place of government-centered measures?
    How are the other industrialized nations’ health care systems different from the British and Canadian systems? Which system(s) do current Congressional plans most closely resemble?

  • RJS

    Ryan,
    I don’t think that is true. A hundred years ago maybe, but not today. Health care is expensive and effective. Health insurance is about spreading risk so that everyone has access to this effectiveness.
    My family of four, through my employer, has good access to this healthcare. It costs $1203 a month of which I pay $209 out of pocket.
    But many don’t have access to healthcare – and can’t afford it if they do. And pre-existing conditions are a nightmare. The church is not going to handle this – we have to do it at a national level.

  • James

    AAH especially, and for everyone…
    I’d love for us to attempt to civily discuss what the president meant in this April 2009 interview with the New York Times:
    ———————————————————————
    THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
    I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
    LEONHARDT: So how do you — how do we deal with it?
    THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
    ———————————————————————
    I guess to keep it civil we should talk about “independant groups” instead of “death panels”. I tend to agree with you that polemic titles don’t add towards the ease of civil discourse. I still hope we can talk about the substantive item behind the dramatic flair, though.

  • Nitika

    What Ayn Rand said.

  • Ryan Boyls

    RJS,
    The church should be doing something to financially help people who have legitimate difficulty paying their medical bills. This brings to mind the concept of relational tithing.

  • RJS

    James,
    We have independent groups now who determine who gets extraordinary care at which stages – who is eligible for transplants and other types of particularly expensive or limited care for example, but it goes beyond this.
    Insurance companies also make these determinations everyday.
    And the rich or famous work around it.
    How will a national system be any different?

  • Barb

    I pay “out-of-pocket” for all our care up to $5000/year. Therefore, I get to see how much a simple blood test now costs, not to mention some pills that are widely advertised on TV. Cut the ads, the pills could be cheaper–I’d think.

  • Nelson Moore

    I think a good starting point is to ask why health care costs so much today. I asked my office administrator at work to pull up the cost of family coverage from the year 2003, when I started at the company.
    From 2003 to 2009, the consumer price index has gone up 17%. But my health care premium has risen 67%. I want to know why this has happened and I want to know where the money is going.
    So in addition to the questions of how to pay for health care and how to extend it to all, we need to understand why the costs are at their present levels.

  • Rick in Texas

    Please include in the discussion the topic of tort reform, and the way a society prone to litigation and lawsuits pushes medical costs up by means of liability insurance that costs a huge amount (passed on to patients) and has forced some physicians right out of practice; and also forces physicians to do a lot of tests that are perhaps often being done just (or primarily) to cover the doctor’s backside legally; and whether either or both parties are willing to back reform in opposition to a powerful lobby in the Legal professional organizations.

  • Jjoe

    I would like to understand why Canada’s system is something we want to avoid. There are pros and cons, so see this impartial analysis.
    http://prescriptions.blogs.nytimes.com/2009/08/14/health-care-abroad-canada/?hp
    It is prompted by this message from a lady in Canada who inquired about shipping an item I had for sale on ebay. I asked, in a very neutral way, her opinion on health care.
    Hi Joe
    In regard to our health care system, I think it is great! I am very happy with it. Everyone is entitled to proper care regardless of income. No matter how much money you have you are able to see family doc’s, specialist’s, MRI’s, x-rays and anything else you may need. I know this for a fact as I have many medical issues. I just had a MRI 2 months ago. You do have to wait 2-3 months to see a specialist for a general check up though but if it was needed sooner you would get in. Also in Canada no one has to pay for any medical appointments, MRI’s, x-rays, surgeries, etc. You only need to pay for prescriptions. If you don’t have the money the government will make sure it is covered. Also most companies have benefit packages that cover any expences that would cost you. We do have to pay for eye doctors and dentists but if you qualify the government also covers them. Personally I would not want to have your health care system.
    I hope I have answered your questions.

  • Joey

    I consider myself mostly uneducated when it comes to care for the elderly but I have a very close friend who is an activities consultant for nursing homes who is a huge proponent of end-of-life counseling because it protects the elderly and respects their wishes. The conversation is never about “how do you want to die” it is always about what their options are as far as care and making sure that they determine what happens to them. These conversations and counseling sessions cover Will and Testaments, What forms of care are available, what hospitals and care facilities the person wishes to use, organ donation, life support, etc. These conversations happen to ensure quality of life, not end it early therefor saving money. That is absurd.

  • RJS

    Rick in Texas,
    Excellent point. In a not uncommon situation – a friend who is a GP in a rural community no longer handles births because of liability insurance costs.

  • Maria

    I’d love to talk about a few things:
    How much will new programs cost and how do we cover the costs? Are we willing to increase taxes? Our national deficit is a huge issue right now, and we should make sure we are doing what’s best for our nation in terms of both healthcare and balancing the budget.
    Can we have a discussion of the ethics of end-of-life and what may be a Christian position? I have to say for myself, honestly, if I have reached old age and need a lot of very expensive procedures to prolong my life, I’d like to think I’d be willing to just let go. As Christians, should we prolong life as long as medically possible? Or are their other ways to think about this? And what does it mean for a healthcare plan?
    What is being done to promote preventative medicine and personal responsibility in caring for our own health? Smoking and obesity drive up health care costs enormously- what do we do about that? How can we promote health and prevention? Can we give people incentives to take care of themselves?

  • Jjoe

    My second question is why we are satisfied with our shameful infant mortality rates. The following data is from the CIA and represents
    the number of deaths of children under one year old, per thousand live births.
    Of course there are many factors at work, but please note that the US is the *only* nation on this list which does not guarantee health care to mothers and babies – only seniors, through medicare and medicaid. Isn’t that a little ironic?
    United States 6.26
    Cuba 5.82
    European Union 5.72
    Italy 5.51
    Isle of Man 5.37
    Taiwan 5.35
    San Marino 5.34
    Greece 5.16
    Ireland 5.05
    Canada 5.04
    Wallis and Futuna 5.02
    Monaco 5.00
    New Zealand 4.92
    United Kingdom 4.85
    Gibraltar 4.83
    Portugal 4.78
    Australia 4.75
    Jersey 4.73
    Netherlands 4.73
    Luxembourg 4.56
    Guernsey 4.47
    Belgium 4.44
    Austria 4.42
    Denmark 4.34
    Korea, South 4.26
    Liechtenstein 4.25
    Slovenia 4.25
    Israel 4.22
    Spain 4.21
    Switzerland 4.18
    Germany 3.99
    Czech Republic 3.79
    Andorra 3.76
    Malta 3.75
    Norway 3.58
    Anguilla 3.52
    Finland 3.47
    France 3.33
    Iceland 3.23
    Macau 3.22
    Hong Kong 2.92
    Japan 2.79
    Sweden 2.75
    Bermuda 2.46
    Singapore 2.31

  • http://bobbyorr.wordpress.com MatthewS

    My brother has Downs Syndrome. He had a life-saving, somewhat risky, expensive heart surgery that is commonly needed by Downs children due to a common heart defect. Without the surgery, prognosis was that he would be dead by age 8.
    It’s hard for me not to get emotionally involved in this discussion. Some of Ezekiel Emanuel’s (bioethicist, indirectly a counselor to the White House, brother of Rahm Emanuel, White House Chief of staff) statements bother me. On NPR they recently mentioned that Rahm and Ezekiel’s brother Ari is the real-life Ari of the show “Entourage.”
    Emanuel: Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
    An article at National Review has this:
    Now, I don’t think Soylent Green-style solutions are coming down the pike. (Government cheese is people!) But every nationalized health-care system to one degree or another rations care based on the quality of life and number of “life years” a procedure will yield. That’s perfectly reasonable. If you put me in charge of everyone’s health care, I would do that, too. That’s a really good argument for not giving me — or anyone else — that power. http://article.nationalreview.com/?q=OTNiMTY0NTQ0YmEwYmY3MTBkMDg5YzlhN2E0NDNmZWM=
    The government will have the same problem as the private sector: not enough money to go around. So who gets left out?
    Any system that requires me to prove that a member of my family deserves care on some other basis besides the fact that they are human (cf Emanuel’s “participating citizen”) creates a visceral reaction for me.

  • http://communityofjesus.blogspot.com/ Ted M. Gossard

    Good thoughts here for discussion.
    Also a discussion on what a nation’s budget should look like. Of course that will vary from nation to nation.
    And a discussion between those who would want an emphasis on free market, those who want a balance between free market and government involvement (the reality we live in- more how this is to be realized or played out), and those who would favor more of a socialized (a dirty word) or government approach to it, certainly not losing the free market aspect all together.

  • stephen

    The high cost of educating doctors.
    If we are going to insure 50 million more people, we are going to need more doctors, especially primary care / general practitioners. New grads can’t afford to go into those fields because of the lower pay and high cost of education.
    If you can handle the classwork, there should be some way to get a medical degree at a reasonable cost. Maybe with a commitment to do some public service for a few years after graduation.

  • MattR

    I think there needs to be a serious discussion about public good vs. private interest.
    For example… how is the current private system wise, ethical, and sustainable when the incentive is for health insurance companies NOT to provide care when someone needs it the most?
    AND we need to have serious conversation about the current LACK of options. In my state at least, health insurance companies have a virtual monopoly! There are only one or two that oversee everything.
    I also think as Christians we need a serious conversation about systemic injustice…
    Like, why is the profit motive in a health care system good? How can we change our current system from really only providing sick care towards preventative? And how do we make health care available to ALL? Shouldn’t it be a basic human need, and not a privilege only for those who can afford it?

  • http://bobbyorr.wordpress.com MatthewS

    I have three issues for discussion that I can name:
    1) One narrative seems to be that the private sector is hopelessly corrupt and broken, therefore the government needs to step in and fix things – this raises a question about the viability of capitalism and the efficacy of the government.
    2) People, human beings, people, for God’s sake! are presently left out, suffering, neglected and need care. Therefore we need this plan. But my question is: how do you know this plan will be better? Someone is still going to suffer. Who decides who, on what basis, and will the end result be a substantial improvement? My lefty friends seem to argue based on the value of the individual, as if the government plan will care about individuals. But what if the government plan were to prioritize greater good over individual good? (Emanuel’s comments about the Hippocratic oath play into this). This is the question of individual vs. greater good, as well as a question of how bad the current system is and how well the new system will perform.
    3) I find it ironic that friends who normally refuse to trust any power structure, and until recently spoke as if the US Government were the devil, are now willing to trust the government very deeply. Maybe I’m cynical and paranoid, maybe they are naive or inconsistent.

  • BenB

    I would like “free market” people to acknowledge that life and health are not something to be bought and sold. When they become that – I struggle with the ethical condition of that culture.
    Other than that, I like a lot of what I’ve been seeing here. A lot of tough questions for both liberals and conservatives. Sadly I doubt that our congress is having these discussions and asking these questions (in an honest fashion that is).

  • RJS

    MatthewS,
    I think that we need to frame the discussion a little differently – because your three points are the way it is currently being framed.
    I don’t think that the private structure is hopelessly corrupt or broken, and I don’t think that government control is the cure-all.
    But I do think that things have changed so dramatically in the last 50-100 years as far as the effectiveness and expense of healthcare are concerned that we need a societal mechanism to deal with it. A mechanism that provides basic access to all.
    I would like us to discuss the best mechanisms – and to do so realistically.

  • Dave S.

    My question is why the big rush? My picky Swedish grandmother would say “Make haste slowly”. Our medical delivery system is very complex why do we need to do a big deal all at once? No one is arguing that what we have is perfect, but if one is really ill, it’s the finest care in the world (I’m a little biased, my dad was on staff at the Mayo Clinic). We need to do a better job extending access to poor folks and people who aren’t covered in an employer plan, but it seems like the congress is trying to do too much too fast.

  • Michael Rainey

    Why would taxes have to be raised? Under single-payer, or a variation thereof, wouldn’t the money now being paid to insurance companies go instead to the government?
    A number of countries have demonstrated that it’s possible to have a more effective health care system than ours, and at a much lower cost per person. With these proven systems available for analysis, there’s no justification for the attitude that we need to take baby steps to “see what works”.

  • http://virtuphill.blogspot.com/ phil_style

    Will the media be able to let the US public disucss the issue without hyperventilating the debate?
    What have other nations learned?

  • http://www.precipicemagazine.com Darren King

    It seems to me that, just as with the mess on Wall Street, when it comes to health care and bending the costs to a sustainable level, incentivization is a key issue to consider. Ultimately, whatever system we opt for will produce the results that we have incentivized it for.

  • Dana Ames

    I’ve worked as a medical transcriptionist for nearly 20 years. My 5 doctors have combined experience of more than 100 years. This is what I think, seeing things “up close”, both as a patient and within the current system:
    There’s no reason why we can’t figure out how to offer universal health care. This is not “socialized medicine” if the following are in the mix:
    People should be able to choose their doctors.
    Doctors should not be employees of the government.
    Not-for-profit insurance companies could be an option.
    We need to look, not so much at Britain and Canada, but at France. My understanding is that they have the costs under control, and their citizenry are extremely satisfied with their health care.
    Dana

  • http://bobbyorr.wordpress.com MatthewS

    RJS,
    Here’s to a respectful, creative discussion about those mechanisms might be.

  • http://paulwilkinson.wordpress.com Paul from Canada

    Watching the debate from a distance, as I am, is probably a good thing because this debate is certainly heating up and is dividing communities, families and even churches.
    As a Canadian, comment #16 (Nelson) resonated with me the most as the big question American consumers and taxpayers need to answer. Who is benefiting under the current system? Why are medical costs so high?

  • http://krusekronicle.typepad.com Michael W. Kruse

    Why should the great majority of Americans who are satisfied with their health care put their health care at risk through a total revamping of the system? That is the question that has to be answered before broad support can be achieved.
    It is clear to many what is at risk through major changes but not so clear what they are getting in return. People don’t fear change … they fear uncertainty.

  • http://www.samandress.blogspot.com Sam Andress

    Scot,
    The fact that you put (Obamacare) in parenthesis to start this post is problematic. This is public code word for many on the right who want to liken Obama and Democrats to socialists, communists, and worst of all Nazis.
    Mike Kruse, I am not so sure how all of us who do have health insurance will be put at risk by there being an expanded government based option for those who do not have the means to buy private insurance or are employed in low-paying jobs in which employers cannot afford to provide private insurance benefits.

  • Scot McKnight

    Sam you can say what you want but imputing motives to others, including my use of “Obamacare” as code word for socialism, is not only groundless but indicative of one of the biggest problem in American culture: rhetoric.
    Why not believe that I mean nothing more with that expression than what I said in my own words: President Obama’s health care reform proposals?
    Unless I’m seriously mistaken, I see it used by Dems too. I mean nothing by this other than “his proposals for health care reform.”

  • http://www.sonday.cc RevKathi

    Big mistake for Americans to embrace socialized medicine. As a Christian I am opposed to on demand abortion that would not only be sanctioned but paid for by my tax dollars. This president can’t even tell the truth about his birthplace or release papers of his college days, when he filed an a foreign student in the US. Until we get some clarity and honest answers from this administration, I wouldn’t trust them to wash the laundry, let alone take over 1/7 of the US Economy. Are people insane, or just ignorant? Quit watching ABC, CBS, MSNBC, NBC, and CNN. Tune in for the truth; try Rush, Savage or Hannity; at least you’ll hear both sides.

  • http://www.samandress.blogspot.com Sam Andress

    Scot,
    My apologies if my pointing out how “Obamacare” is widely used offended you.
    My intention was simply to make clear how it is popularly used. If you google “Obamacare” you will find it used as in a dergatory manner. I did not mean to imply that you were using it in the code word context in which these others are doing so. Just simply wanted to make clear the social connotations it has right now.
    I have yet to find democrats and or supporters of health care reform refer to it as “Obamacare.” And besides at this point the 5 or so bills floating around are not Obama’s making they are the result of sausage making on the hill.
    Again, I did not mean to insult or lump you in with those other parties.

  • http://krusekronicle.typepad.com Michael W. Kruse

    Sam #38
    “Mike Kruse, I am not so sure how all of us who do have health insurance will be put at risk by there being an expanded government based option for those who do not have the means to buy private insurance or are employed in low-paying jobs in which employers cannot afford to provide private insurance benefits.”
    Don’t tell me. Tell the public. :-) I was merely offering a question Scot would use in his series.
    If it were as simple as you say, I don’t think it would take a bill 1,000+ pages long to say it. My point is that people don’t have a clear idea of what is happening and it touches a deeply personal part of their lives.

  • http://krusekronicle.typepad.com Michael W. Kruse

    Just thought I’d share an epiphany I had this week. I was at one of my favorite eateries and on side-by-side tubes they had CNN and Fox coverage of the town-hall meetings in closed caption. As I followed them back and forth it dawned on me, “The day I knew was coming is here … Baby Boomers in charge.” :-)

  • AHH

    Since abortion has been brought up a couple times (although I can’t tell for sure if RevKathi #40 is for real or somebody’s attempt at an outrageous parody of the right fringe), it can be mentioned that the current proposals (to the disappointment of some on the left) maintain the Hyde amendment in force, which prohibits the use of tax dollars to pay for abortions.

  • Scot McKnight

    Well, Sam, I’m hearing folks from both sides. (It’s much easier to say it than “Obama’s health care reforms” and, sure, the Hill but the point is that Obama’s responsible.) I don’t want to use “Obamacare” if it simply code words for the rightist critique. I think the first time I saw it was on Slate by Timothy Noah — way back before the election.

  • http://bobbyorr.wordpress.com MatthewS

    AHH, so says Susan Cohen at RH Reality Check but not everyone agrees it is that open-and-shut. http://news.yahoo.com/s/ap/20090805/ap_on_go_co/us_health_care_overhaul_abortion “The health overhaul would create a stream of federal funding not covered by the restrictions.” There seems to be concern on the side of abortion opponents that abortion is not being guaranteed while abortion opponents believe that tax dollars will in find their way to abortion clinics. I don’t know the details, but this piece (http://healthcare.nationalreview.com/post/?q=NGI1YjEwOTNjYmMzODBiYjJkNjliOTljODk2ZTBjOGE) claims that three republican representatives each offered an amendment to remove provisions that allow this but each amendment failed.

  • MatthewS

    sorry, it was supposed to say “There seems to be concern on the side of abortion proponents that abortion is not being guaranteed while abortion opponents believe …”

  • http://browardemergent.blogspot.com/ Steve

    Lots of good comments. I am especailly interested in the role of the church in health care. Some have said the church has abdicated its role here and needs to step up. But I can’t really imagine how we would pay for society-wide health care coverage by passing the plate (even if we gave the “hidden tithe”) or even by selling all the church real estate. We have several poor, uninsured women in our church who need cancer surgery or other treatments. (One even wants to start giving part of her tithe for a benevolence fund to help others, which is a great idea!) Our entire congregation will never be able to afford the expensive medical tretments our sisters need to live! As “the church,” I am working for health care reform, including a public option.

  • Rog

    1. How can any credible proposal to control health care costs not have tort limits/reform as a major ingredient? (I’m assuming it’s not, as I haven’t heard protests from lawyer groups.)
    2. Why was there such pressure to rush to vote on a proposal this complex, impactful, and (apparently) little understood? (That, and the ad hominem attacks on protesters’ motives rather than simply explaining/defending the proposal itself are enough to make me say “no”–for now.)

  • angusj

    RJS (#10) said: “My family of four, through my employer, has good access to this healthcare. It costs $1203 a month of which I pay $209 out of pocket.”
    My wife and I live in Sydney Australia and pay $AU260/mth (~$US216/mth) for top private health cover (and get 30% of that back as a tax rebate because we’re less likely to burden the public hospital system).
    Here we have a universal public health scheme called Medicare. While it’s far from perfect (and I don’t believe any system will ever be perfect), it works pretty well and in tandem with the private health insurance industry. Almost no one here would want to see Medicare dismantled. Before retiring due to illness over 10yrs ago, I worked as a medical specialist both in public teaching hospitals and in private hospitals and believe the health care provided in both systems was and is still very good to excellent. (I also worked for a year in England back in the 1980s and the public health care there seemed comparable to that in Australia.)
    While the very best medical care in the US is undoubtedly a little better than that here, that alone can’t explain the enormous cost differences in private health premiums (and health care costs in general) between our two countries. Medical practitioners here generally earn very good but not exorbitant incomes both in the public and private sectors (as fair reward for the many years of training and the longer hours of work that includes after-hour care.) There’s very little incentive for over-servicing. However, what I suspect is the biggest restraint on health care costs is that private health insurers have to compete with the public system. Private insurers have to balance maintaining affordable premiums while still offering a premium service over that provided by the public health system. Insurers simply can’t afford to make huge profits for their shareholders.
    Medical practitioners in Australia were fearful of Medicare when it was introduced in 1975 – fear mostly that the government would end up controlling their incomes. After 30yrs, I think it’s fair to say those fears haven’t been realised.
    Finally, I hope and pray that your government does enact legislation that provides decent and affordable health for everyone.

  • Kate

    My question is: why does US healthcare cost twice as much as the UK and others (per capita and as %of GDP), but has poorer ourcomes(high infant mortality, high maternal death rates, low life expectancy)?
    As a British doctor, I have been concerned about the perverse incentives of private care: my NHS patients get quality treatment according to the best evidence, my patients who choose to go private sometimes get operations and investigations they don’t need. A surgeon working under the NHS will operate or not according to need. A private surgeon has a financial incentive to operate, prejudicing their good judgement. Similar perverse incentives apply with expensive investigations.
    Given the choice, I would far rather go to an NHS doctor than a private Dr. (British or American.)I would never trust a health care system to deliver the best for patients where the profit motive is active.
    The NHS has its problems, (what system doesn’t?), but I would reccomend it any day above a system that buys unnecessary treatment and investigation for the insured, and leaves millions without quality care at all.

  • Barb

    OK,
    Our family of three pays $634/month out-of-pocket for our $5000 deductible plan. We are retired with child in college.
    That’s the best deal we could find. This was after 30 years of employment with a major company–where we paid an increasing share of the cost each year. I’ve learned to ask about costs, but doctor’s are blissfully unaware that one pill costs $5, or a simple blood test is over $150.
    The costs are TOO high.

  • James

    RJS,
    You said:
    “We have independent groups now who determine who gets extraordinary care at which stages – who is eligible for transplants and other types of particularly expensive or limited care for example, but it goes beyond this.
    Insurance companies also make these determinations everyday.
    And the rich or famous work around it.
    How will a national system be any different?”
    (referencing the “independant panel” POTUS Obama mentioned in a recent interview)
    Is that an honest inquiry? A prompt for an obvious answer? Have you just not seriously considered this?
    A private insurer is engaged witha customer who can take his money and go to a different company. Competition in the market will allow for equilibrium between premium, copay, and cost of coverage. The government option is a trojan horse for a single payer system (Obama, Sebelius, and Frank have all said as much on camera). When the government is the only health care provider, and they say something isn’t cost effective, then where do you turn? You might want to watch that AARP townhall again. It’s chilling what Obama doesn’t answer, and to some extent, what he does (heart risk, pills, elderly woman getting pacemaker…)
    ALSO, under a private system, if my insurer won’t buck up for the latest and greatest, which I really want, I have the option to pay for that myself (or go bankrupt trying). Do you know if that’s legal in Britain?

  • Michael Rainey

    “Private Pay” exists in Britain for those not happy with the NHS.

  • Michael Rainey

    “Private Pay” exists in Britain for those not happy with the NHS.

  • Ton in CA

    I am dismayed that a conversation of this sort didn’t start by defining the problems in some order of consequence. The American system is definitely not perfect. But one can argue from data, if the data is properly understood, that, to paraphrase, it is it is the worst system in the world…except for all the others. It can be argued from the data that the system is currently working as desired for upwards of 95% of the population. Do yu really want to turn a system that works into the health care version of DMV or IRS?
    What, specifically, are the problems with the current system? How can you fix those without screwing up the rest of it? Answer that and you can be the next President.
    Tom in CA

  • Tom in CA

    There is a perfect example of how statistics are poorly, maybe even misleadingly used. Jjoe asked about the infant death statistics and why the US leads the world. It is quite simple really…at least in general terms. The reason is because the US has better, more, and more widely accessible medical technology than any other country in the world. As a result, doctors can work to save a baby born at, say, 25 weeks. But, of course, those babies have a very high mortality rate. Of course, in any other country the baby would never live long enough to be considered a live birth.
    If you’re going to use statistics, please, as a matter of intellectual integrity, make sure you understand what they really do or do not say. Because apart from a clear understanding, your conclusions will be wrong and the discussion will be fruitless.
    Tom in CA

  • Kate

    Tom- So you don’t believe there is anything wrong with the high infant mortality in the US. Then why is an American mother so much more likely to die in childbirth than a European? (USA ranks 41st in the world for maternal mortality rates)Is it really nothing to do with lack of access to care among the uninsured?
    “the US has better, more, and more widely accessible medical technology than any other country in the world” – in what way “more widely accessible” than the free quality care available in Europe?


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