This has probably been discussed to death but....my best friend is moving to the United States as an entrepreneur. As an entrepreneur, he obviously will not have "employer health insurance". We have been looking at Individual health insurance plans in the State of New York and we cannot believe how little you get for what you spend.

For example, for $372 a month (almost $100 a week!!) he will still have to co-pay ALL of his medical appointments, and in the event of hospital visit, he will have to pay $500 per night!!! Also, this $372 doesn't cover, dental, physiotherapist, or alternative medicine. It seems it only covers you if you have a massive medical issue such as knee operation or organ transplant.

I cannot believe how little Americans get for what they spend!!! There is no logic to it!!

In Australia, we are taxed what is called a Medicare levy. (Medicare is the name given to Universal Health Care in Australia). The levy is generally 1.5% of your salary, however people who are on lower incomes generally do not pay it.

Why can't the US introduce something similar in their tax system to provide similar Universal Health Care for it's citizens? I understand some people's reluctance to pay it, however I was in their boat until I had an injury in May last year. I hated paying around $500 a year (which is around $10 a week in retrospect) for something I never used. Then I broke my arm in a football injury. I had to be taken by ambulance to the emergency room. I had to to have an ER doctor look at my arm. He couldn't diagnose so a physiotherapist had to look at it and then I required x-ray and then I was put in a cast. 1 week later had surgery with 5 screws permanently implanted in my arm. 7 weeks later had the cast taken off. Total Cost = ZERO! That $500 a year...... will never complain about paying it again. Also, I had 6 months of bi-monthly physio which was subsidized by Medicare.

How can the US not have a similar program. It's fellow members of the UKUSA Alliance all have it - Australia, New Zealand, Canada and the UK and our economies aren't doing so bad!

??

For some reason when I bring up the subject of universal healthcare in the Netherlands to my American friends I often get a reply like "yes but you pay a lot more taxes" or even "that's because you live in a socialist care state". Both of these statements are quite wrong (The Netherlands is actually one of the most open and capitalistic countries, hell, we INVENTED modern day capitalism), and our universal healthcare is not government run, like a lot of people think.

There are no fixed prices and most of the insurers are commercial capitalist for-profit companies.

Maybe an interesting read, an American living in the Dutch care system (NY Times);

http://www.nytimes.com/2009/05/03/ma...e/03european-t.html?pagewanted=all

In short our system works like this;

- All individuals must be insured

- All individuals purchase health insurance on the private market

- Individuals can choose to get their health insurance through their employer–if the option is available–but the employer does not have to offer health insurance. If the employer does not offer health insurance or if an individual is unemployed, then they must purchase health insurance on the private market.

- Health insurers are free to charge each individual any price they please for health insurance. Of course, market forces limit the price that the insurers can charge the consumers before they switch to another plan. After the reform was implemented, however, there was significant consolidation in the health insurance market and now there are only four or five large plans. This may reduce the amount of price competition in the market.

- The cost of health care is more transparent to consumers since they see the price they are charged for health care. In most national social health insurance programs, individuals do not know the value of health care they receive since the amount of money they pay into the system is proportional to their income and thus unrelated to actuarially fair value of health insurance.
- Health insurance is subsidized by the state. “Insurers get risk-equalization payments for patients with about 30 major diseases.” Thus, people who are sicker receive a larger state subsidy than healthy individuals.

I think the gest of all of this can be summarized by the last sentence of the NY Times article;

“One problem with the American system,” he said, “is that if you lose your job and are without an income, that’s not just bad for you but for the economy. Our system has more security. And I think it makes our quality of life better. My American friends say they live in the best country in the world, and in a lot of ways they are right. But they always have to worry: ‘What happens to my family if I have a heart attack? What happens when I turn 65 or 70?’ America is the land of the free. But I think we are freer.”

Quoting AA7295 (Thread starter): Why can't the US introduce something similar in their tax system to provide similar Universal Health Care for it's citizens?

Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

Quoting lowrider (Reply 2): Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

But in most countries healthcare is seen as important as the police force, fire brigade, infrastructure, etc. If you don't think healthcare is a valid function of the federal government, than why is the police force a valid function?

[Edited 2011-02-10 04:41:38]

Quoting lowrider (Reply 2): Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

Be that as it may. It is certainly not defined by the founding documents of Australia. Also, the role of FAA was not defined by the founding documents but aviation regulation is administered by the federal government??

Is it an issue Americans feel that they should not carry the burden of paying for their fellow countrymen' medical costs?

[Edited 2011-02-10 04:45:19]

Quoting travelavnut (Reply 1): My American friends say they live in the best country in the world, and in a lot of ways they are right. But they always have to worry: ‘What happens to my family if I have a heart attack? What happens when I turn 65 or 70?’ America is the land of the free. But I think we are freer.”

I would agree with that statement. Even with existing insurance it isn't always enough. My dad took care of my grandmother at home for the final six months of her terminal cancer. Even with her coverage by Medicare, there were still $43,000 in out of pocket costs when she died her savings couldn't cover. How long do you think it took before those bills started arriving??

Quoting AA7295 (Thread starter): I cannot believe how little Americans get for what they spend!!! There is no logic to it!!

It's illogical but so is our cost structure - much of it to cover administrative overhead and high insurance premiums for malpractice to protect against unfair litigation.

I had an echocardiogram done a couple years ago when living in Japan and under their NHS the co-pay is 30% of any kind of routine testing service. My co-pay was around $70 which would suggest the overall cost of the service was $250 or so. I recently had the same test here in the US and was shocked when the claim summary came. The total billing for the identical service was $1,300. Clearly we are doing something wrong here.

Quoting travelavnut (Reply 3): If you don't think healthcare is a valid function of the federal government, than why is the police force a valid function?

What is the purpose of federal law enforcement? At the risk of using a term in its own definition; to enforce federal laws. What is the value of a law you cannot or will not enforce? If the federal government does not have the power of enforcing its laws, does it actually have any power? Healthcare has absolutely no bearing on this.

Quoting AA7295 (Reply 4): Is it an issue Americans feel that they should not carry the burden of paying for their fellow countrymen' medical costs?

I pay 150 euro's a month for my insurance, but that covers everything. No co-pays, including dental, home visits by my GP, the works. A big part of this money will go to people with serious illness like cancer, heart conditions, etc. I don't mind this at all. Because of the very simple reason that IF something happens to me I don't have to worry about my income, job, family, etc

Quoting lowrider (Reply 2): Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

If all services were rendered by government hospitals with government-employed doctors under government-run insurance, that would be one thing, but that's not even remotely the case in the current or any other proposal. Stop dreaming.

Quoting AA7295 (Reply 4): Is it an issue Americans feel that they should not carry the burden of paying for their fellow countrymen' medical costs?

Even if they feel that way, they're still doing it, which is why the ignorance on this issue is profound. The standard of care in this country involves hospitals not turning people away. Which means if an individual is underinsured or not at all insured, someone ends up footing the bill, usually a local government. We double-pay for this standard via higher premiums and taxes. It's totally illogical and idiotic that so many people prefer to do things this way, but whatever, that's what we've got.

Quoting AA7295 (Reply 4): Also, the role of FAA was not defined by the founding documents but aviation regulation is administered by the federal government??

Not directly, but it would be cumbersome for the President to administer this function directly. As in many corporate structures, this function and the authority to carry it out has been delegated to a subordinate. In this case the Administrator of the FAA. The Supreme Court has ruled in the past that the Federal level of government is the correct jurisdiction for the administration of the National Air Space System.

Quoting lowrider (Reply 6): What is the purpose of federal law enforcement? At the risk of using a term in its own definition; to enforce federal laws. What is the value of a law you cannot or will not enforce? If the federal government does not have the power of enforcing its laws, does it actually have any power? Healthcare has absolutely no bearing on this.

Granted, but laws can be changed. I think that the purpose of a government is providing a safe country with an infrastructure in which the people can live happily, work and contribute to society. Having a good universal healhcare system is a prerequisite for that.

Quoting Aaron747 (Reply 8): If all services were rendered by government hospitals with government-employed doctors under government-run insurance, that would be one thing, but that's not even remotely the case in the current or any other proposal. Stop dreaming.

Also not the case in the Netherlands, the majority of the hospitals and insurance companies are private and for-profit. For some reason a lot of opponents of universal healthcare (I mean, HOW can you be against it is beyond me) always think it's a government run operation.

Lowrider, you should read the link in my reply #2.

[Edited 2011-02-10 04:57:07]

[Edited 2011-02-10 04:57:22]

Quoting lowrider (Reply 2): Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

I am sure you can find at least a dozen other things the US federal government is doing that is not defined by the founding documents.

Quoting Aaron747 (Reply 8): If all services were rendered by government hospitals with government-employed doctors under government-run insurance, that would be one thing, but that's not even remotely the case in the current or any other proposal. Stop dreaming.

It is not currently within the authority of the federal government to require citizens to participate in any health care scheme. I am not the only one who thinks this way. There is also no mandate for the federal government to administer the health care of private individuals. And to pretend that these services being conducted by proxies is does not amount to the same thing is being deliberately blind.

Quoting travelavnut (Reply 10): I think that the purpose of a government is providing a safe country with an infrastructure in which the people can live happily, work and contribute to society. Having a good universal healhcare system is a prerequisite for that.

While that may be true in the Netherlands, I think the purpose of the US Federal government, as currently constructed, is to protect the rights of individuals while leaving them free to pursue their own goals to the maximum extent possible. Whether or not they contribute to society is entirely up to the individual.

Quoting JJJ (Reply 12): am sure you can find at least a dozen other things the US federal government is doing that is not defined by the founding documents.

I am sure I can, but that is beyond the scope of this thread

Quoting travelavnut (Reply 11): Lowrider, you should read the link in my reply #2.

It probably has some good ideas, but I will have to come back to this later. Right now I need to go make sure I stay gainfully employed.

Quoting lowrider (Reply 13): There is also no mandate for the federal government to administer the health care of private individuals.

How is Medicare at all valid then?

Quoting lowrider (Reply 13): And to pretend that these services being conducted by proxies is does not amount to the same thing is being deliberately blind.

Surely no less deliberately blind than continuing a system where we directly subsidize those without coverage at both the private insurer and state/county tax level.

Quoting lowrider (Reply 13): Quoting travelavnut (Reply 10): I think that the purpose of a government is providing a safe country with an infrastructure in which the people can live happily, work and contribute to society. Having a good universal healhcare system is a prerequisite for that. While that may be true in the Netherlands, I think the purpose of the US Federal government, as currently constructed, is to protect the rights of individuals while leaving them free to pursue their own goals to the maximum extent possible. Whether or not they contribute to society is entirely up to the individual.

I do understand the cultural differences, and as stated in the NY Times article simply copying one countries sytem to another is not the smartest thing to do. But IIRC that in the US the percentage of un-insured people is the highest in the western world. That is not only a bad thing for the people that are un-insured, but also for the US economy in general.

People will pospone treatment or not take any treatment, which increases health problems and descreases productivity.

Quoting lowrider (Reply 13): Whether or not they contribute to society is entirely up to the individual.

It is not like you are forced to contribute to society in the Netherlands, I was merily stating it as an example. If you don't want to contribute that's fine, but eventually you'll end up in the streets (even in the Netherlands). Although even our homeless at least have medical insurance.

Quoting lowrider (Reply 13): Right now I need to go make sure I stay gainfully employed.

    

Quoting lowrider (Reply 13): It is not currently within the authority of the federal government to require citizens to participate in any health care scheme. I am not the only one who thinks this way. There is also no mandate for the federal government to administer the health care of private individuals. And to pretend that these services being conducted by proxies is does not amount to the same thing is being deliberately blind.

Yeah... currently. The US Constitution has an amazing ability to be amended. Especially for the betterment of US citizens. Also, you are talking about "participating in a health care system" when Universal Health Care implies medical treatment as a right.

Health care, the ability to be treated for illness and ailments, should be a given right to any human being regardless of citizenship. I can see where you're coming from, and kind of thought on a similar wave length previously until I had an injury that was treated with Universal Healthcare, but put yourselves in the position of others. Imagine being a parent and having a sick child and not being able to give them proper medical treatment. Or imagine being a child and watch your parent age in a not so graceful way due inability to afford appropriate medical treatment.

Most people on A.net... I dare say have been dealt a card in life where they can make something for themselves. There are many people who haven't, and the ability to stay alive and function (and also for their families), should be provided to them in the form of medical treatment.

[Edited 2011-02-10 05:31:19]

Quoting AA7295 (Reply 16): Most people on A.net... I dare say have been dealt a card in life where they can make something for themselves. There are many people who haven't, and the ability to stay alive and function (and also for their families), should be provided to them in the form of medical treatment.

While that is true for the most part even a universal health care system has downsides. The previous Dutch system was way too cheap (they were practically giving everything away, highly subsidized). It actually makes people lazy, because they don't have to worry about it at all.

I think our new system is a lot better in that respect, you actually have to pay a decent amount of money (unless your below the poverty level, in which case the government helps you, which is a good thing IMHO) and the government doesn't have to subsidize it so heavily.

Fun fact; our previous system was put in place by the Germans when they payed our country as visit (during the 40's).

Quoting AA7295 (Thread starter):

For the benefit of those not familiar with the system in Australia it is not perfect and it is not entirely funded by Medicare. However, the system does mean that treatment must be given ,on basis of need and not ability to pay. No one can be turn away without treatment for essential health care simply because they do not have insurance. Elective surgery in a public hospital is subject to a waiting list but if you are privately insured you can be treated sooner in a private hospital.

The Commonwealth of Australia is enabled by the Constitution Pt 5 s.51 (xxiiiA) to establish pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), a power that provides a protection to those in the medical profession not enjoyed by any other sector of the community.

The existence of Medicare in Australia does not rule out the option of obtaining insurance for private treatment, either as a private patient in a public hospital or as a patient in a private hospital. Insurance may also cover ancillary items not covered by Medicare, such as optical, chiropractic and other services. Private hospitals are included in the Medicare system but Medicare will only pay the scheduled fee. If the hospital or health service provider charges more than the scheduled fee, the patient must pay the gap or have insurance to cover the difference.

People who earn more than a certain threshold amount and who do not have private health insurance for hospital cover are subject to a Medicare Levy Surcharge of 1% of taxable income. For 2010 -2011 the threshold is $77,000 for singles, $154,000 for couples and for people who have children the threshold increases by $1,500 for the second and each subsequent child.

The Australian Government provides a 30% Rebate on appropriate private health insurance cover. There are higher rebates for older people: 35% for people aged 65-69 years and 40% for people aged 70 years and over. In other words, you will get at least 30 cents back for every dollar you spend on private health insurance. For example, if your premium is $2,000 a year, you will get at least $600 back. If you are paying $1,000 you will get at least $300 back.

A person may claim the health insurance rebate if they are eligible for Medicare and have a Complying Health Insurance Product that provides hospital treatment, general treatment (also known as ancillary or extras) cover or both.

The rebate can be 30%, 35% or 40% (as applicable) of the actual cost of premiums paid. Therefore, the rebate will increase if there is any increase in the premium. It is a condition of the rebate scheme that increases in premiums must be approved by the Government. To date this requirement has not prevented competition between the various health insurance funds.

[Edited 2011-02-10 05:56:38]

Quoting Aaron747 (Reply 14): How is Medicare at all valid then?

Because the US Federal Medicare program for the elderly is not mandatory and does not provide universal coverage.

Yes, we are all required to pay 1.45% up to $106,800 of earned income in 2011 (2.90% for self-employed). However, that is a contribution to the health care of the elderly. It is not 'purchasing insurance' for ourselves.

When a person reaches age 65 (Medicare eligibility), they have to make a series of choices. If they are still employed with a health plan, or covered by a spouse's health plan - they will normally not participate in Medicare except for Part A.

Part A basically covers in-patient hospitalizations only with high deductibles. It is free to people with more than 40 quarters of employment covered by social security withholding. There are premiums for those with 39 quarters or less.

Part B is the 'normal out-patient' type of insurance - if you have other health coverage - you do NOT want to enroll in Part B. It costs $96.40 per month (if covered in 2009), $110.50 (new in 2010) or $115.40 (new 2011 participant). If your income (AGI) is higher than $85,000 (single) $170,000 couple - the cost for Part B will be higher. Up to $396.10 per month if joint income is over $428K.

If a person elects to participate in Part B, they must continue to pay for the rest of their life. If a person elects to not participate in Part B at age 65, they will have to pay 'back premiums' from the month after their 65th birthday to the month of regular withholding from their social security payments if they choose Part B coverage later in life. (If a person was covered by another health plan - they can avoid back premiums)

Most people with Medicare Part A and B need to purchase a 'MediGap' policy to provide supplemental coverage for the expenses which are not paid by Medicare. My 86 year old father's MediGap coverage is $328 per month for him alone through the group plan his union negotiated with his old employer - International Paper.

Part C is "Medicare Advantage" which is a combination of Parts A and B with separate premiums that resembles a private insurance plan. Medicare Advantage is not available everywhere. The program basically puts the Medicare eligible person under a non-government health insurance plan with complete coverage. The Medicare Part B premium, the person's additional premium and a supplement from the government to the private insurance company for Part A coverage pays the cost of the coverage.

Part D is optional coverage for prescriptions - at an additional cost.

But basically in the US

If you still have a job with insurance or coverage from a spouse - Medicare is not part of your plan, except as a supplemental insurance for in-patient hospitalization.

If you don't have a substantial income - Medicare is the only option.

If you have a substantial income - you can ignore Medicare and provide your own coverage at personal costs, or be a self-pay patient with no insurance.

That makes Medicare an optional, voluntary insurance program with private alternatives available.

Quoting Quokka (Reply 18): The Commonwealth of Australia is enabled by the Constitution Pt 5 s.51 (xxiiiA) to establish pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), a power that provides a protection to those in the medical profession not enjoyed by any other sector of the community.

The answer to the original question lays in this response. Unlike Australia (or many of the other countries discussed) our Constitution provides no such protections. So why don't we do it? Because to do it would be unconstitutional.

Quoting rfields5421 (Reply 19):

That seems quite complicated!

May I ask what kind of plan you have and what you generally pay for that?

Interesting to note how many Americans vehemently defend the right to:
-) pay far more money to get far less protection than anybody else in an industrialized nation,
-) pay nothing at all and bear all the risk.
Just because of ideological reasons which in this case are quite wrong even, as demonstrated by many free and equally prosperous industrialized nations from all over the world!

Somehow, it seems a given to me everybody wants to see himself and his family as well protected as can possible be done, for as cheap as possible. If that's the case indeed, then a compulsory system we all contribute to and which does not aim to maximize its own profitability, but rather strives to maximize the coverage, is the best way forward really.

Healthcare insurance isn't something to make as big a profit as possible on: it's not like offering leisure activities or package holidays for instance, so it's definitely not something you should be able to opt out off.

A government that pretends to do everything it takes so its citizens can persue their dreams to the fullest, should at least make sure these citizens are well protected and covered in case they (or somebody in their family) has a mishap! Otherwise, it's just grandtalk of that government and a cheap excuse for not caring about the people at all....

[Edited 2011-02-10 06:43:46]

Quoting lowrider (Reply 13): I am sure I can, but that is beyond the scope of this thread

So can you agree with me that a XVIII century document cannot dictate or limit what a society can or cannot do?

On a different level, that's akin to taking the Bible literally.

Quoting JJJ (Reply 23): On a different level, that's akin to taking the Bible literally.

Well, that's a whole different discussion, let's not get OT here.

Quoting lowrider (Reply 2): Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

The very first sentence of your constitution says:

Quoting United States Constitution: The Constitution of the United States Preamble We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

Note "promote the general Welfare". Now to me, health care is essential to my welfare if I'm sick. Isn't it?

[Edited 2011-02-10 06:52:53]

Quoting travelavnut (Reply 21): May I ask what kind of plan you have and what you generally pay for that?

Up until March 1992 - I was a member of the US Navy with health coverage provided by the government. Mostly military doctors and corpsmen.

My children were covered by a program called CHAMPUS while in the US. Since I was stationed in an area with almost no 'excess' military health care available - their health care had to be on the civilian market. Because very few doctors accepted CHAMPUS as an insurance plan - 70-80% of their health care cost was out of my pocket. I had to pay 100% and file for reimbursement. For a typical $90 doctor visit, I usually got about $22 in reimbursement. They had no dental coverage.

(I was divorced in 1984 and had custody of my kids. like most military single parents - I was over 30 and 10 years service when I became a single parent)

From March 1992 until March 1998 I had no health insurance except retiree CHAMPUS. I paid almost all health expenses except one hospital emergency room visit for a possible broken leg cash out of pocket. Including dental. Had I had a major medical issue, retiree CHAMPUS would have paid about 65% of the hospitalization costs.

From March 1998 through July 2009, I was covered by an employer sponsored private health care PPO plan. In July 2001 I have a major medical emergency and was off work for 3 months, and on daily medical treatment until May 2002. That cost me $34,000 out of pocket in addition to the approx $145,000 paid by my health insurance. Health and dental coverage for myself and my wife was about $270 per month over that period.

My wife, married in 1998, is a few years older than me. She became eligible for Medicare near the end of my employment.

In August 2009, my extended company coverage ended (I was part of a large IT layoff in Dec 2008 - technically I retired early).

We are now under health coverage provided as a military retiree - which has changed substantially since 2003, largely thanks to the efforts of Senators McCain and Clinton. Additionally, the large number of reservists and National Guard members called to active duty to serve either overseas or in support of operations since 2003 from the Dallas area has greatly increased the number of doctors who accept military coverage.

We had to move my wife to Medicare Part B. She also has a cost-free supplement called Tricare For Life. That means she pays no out of pocket expenses for Medicare Part B or Part A coverage. Though we have noticed that her primary care doctor is basically trying to get her to leave. Every visit she has to listen to 15 minutes of complaints about how he loses money on Medicare patients. She pays no co-pay for doctor visits - that is paid by Tricare For Life.

I now have Tricare Prime HMO administered by Humana. I had to leave my primary care doctor and choose one who accepted the current plan. My premiums are $230 per year. My co-pay for a regular doctor visit is $20.

I have chosen to continue to receive quarterly treatments and monitoring from my specialist at a cost of $125 per visit out of pocket - a reduced rate he charges me.

I also participate in the military sponsored retiree Delta Dental plan - $66.06 per month premiums for both of us for up to $1,000 per year each in care, with two routine visits and cleanings free.

There are two major changes from the company sponsored 'cadillac' health care plan as they explained it to us and my current coverage.

1. I have less freedom and flexibility in choosing doctors and referrals. In the old plan I did not have a primary care physician who was required to obtain permission to refer me to a specialist. Under this government plan, I have to do a bit of paper work.

2. My and my wife's prescription plan is substantially better. We paid about $2,300 per year in co-pay under the company sponsored plan. We pay about $500 per year under the government plan - with much more flexibility.

As an example - I broke the thumb in my right hand last May - requiring surgery and many doctor visits due to an ingrown nail after the old one fell off. My total out of pocket was less than $200. Under my old company plan, I estimate the costs would have been close to $1,800.

@RFields5421 Thanks for your extensive reply!

Quoting rfields5421 (Reply 26): That cost me $34,000 out of pocket

Damn, that would put some people into bankruptcy.

Quoting rfields5421 (Reply 26): Health and dental coverage for myself and my wife was about $270 per month over that period.

That is not too bad, but I guess there is a whole variaty of co-pays and deductibles?

Quoting rfields5421 (Reply 26): CHAMPUS

Quoting rfields5421 (Reply 26): employer sponsored private health care PPO plan

Quoting rfields5421 (Reply 26): eligible for Medicare near the end of my employment

Quoting rfields5421 (Reply 26): In August 2009, my extended company coverage ended

Quoting rfields5421 (Reply 26): We are now under health coverage provided as a military retiree

Quoting rfields5421 (Reply 26): We had to move my wife to Medicare Part B

Quoting rfields5421 (Reply 26): She also has a cost-free supplement called Tricare For Life. That means she pays no out of pocket expenses for Medicare Part B or Part A coverage

Quoting rfields5421 (Reply 26): I now have Tricare Prime HMO administered by Humana.

Quoting rfields5421 (Reply 26): Delta Dental plan

I'm not a dumb guy (I like to think), but this really does sound complicated. Wouldn't a much simpler system be more cost-effective?

Wow, that sounds all fairly complicated to me!

Do you spend a lot of time comparing all those plans to make sure you have the best plan possible at all times, thus swapping while always remaining covered?

I just have it deducted from my gross salary and everybody in my country is insured in exactly the same way: we can visit ALL doctors and ALL hospitals (even abroad): the only thing we need to chose is which insurer we want for our universal compulsory health insurance, but they are all working with the same 'plan' as this is laid down in a law, so it doesn't really matter: they just try to attract you with extra's like additional coverage for eyewear (or corrected sunglasses, no kidding)

Very straight forward and easy to understand really.

I can imagine many Americans do not know exactly the full extend of their insurance, and may think they are far better protected than they only are... Private insurances are known for one thing: extremely complicated plans which always seem to have a problem with your specific case when you call them into action.

[Edited 2011-02-10 07:32:30]

Quoting AustrianZRH (Reply 25): Note "promote the general Welfare". Now to me, health care is essential to my welfare if I'm sick. Isn't it?

That view is not held by most voters in this country at this time.

Even though the cost of health care is high. And the un-insured / under insured are a tremendous drain on our economy.

You often hear that small business is the strength of the US economy, and the source of most new jobs. What the people who repeat that keep forgetting to say are the qualifiers. If the small business does not sponsor a healthcare plan and at least 90% of the employees participate - that small business is a drain on the economy - not a source of growth or positive economic impact.

One great fear many people in the United States concerns old age health care coverage. Even for someone with advanced Altizhimer's and legally indigent like my mother was for the last 14 years of her life - health care is a profit source for a provider company.

We in the US spend a tremendous amount of money, much of it government money, to support a huge for-profit industry that tries to extend life for a few years for the oldest, sickest members of our society. Old people are a gold-mine for a well run health-care company, even with extensive medical issues.

Our understanding is that in other 'civilized' countries, the decision is made that such care to extend life for people with terminal conditions is not available nor a justified expense in nations like France, The Netherlands, Canada, etc.

That may be untrue, but on a per-capita basis, our old people receive much more medical care, faster and usually better at more expense than the elderly in other westernized countries.

We expend tremendous effort to provide almost all the elderly with advanced care - at the expense of providing the least level of care for the very young of any major industrialized nations.

Quoting rfields5421 (Reply 29): Our understanding is that in other 'civilized' countries, the decision is made that such care to extend life for people with terminal conditions is not available nor a justified expense in nations like France, The Netherlands, Canada, etc.

Quoting rfields5421 (Reply 29): That may be untrue

It is very untrue. Old people receive the care they need, doesn't matter if they are terminal, chronic or just having a bad day. Also the life expectancy numbers wouldn't be higher in The Netherlands (79.4 years vs. 78.1 years in the US) if this statement where true.

source: http://www.wolframalpha.com/input/?i...+united+states+vs.+the+netherlands

Quoting rfields5421 (Reply 29): but on a per-capita basis, our old people receive much more medical care, faster and usually better at more expense than the elderly in other westernized countries.

Do you have a source for that?

Quoting travelavnut (Reply 27): Wouldn't a much simpler system be more cost-effective?

Probably not.

No matter how it is done - it is my belief that every large organization in every country is quite capable of hiding costs to enable them to provide a bureaucratic process with unnecessary employees and good profits. And every government agency in every country is in-efficient. In my travels around the world, I've seen several variations - but unnecessary government oversight exists everywhere.

Quoting slz396 (Reply 28): Do you spend a lot of time comparing all those plans to make sure you have the best plan possible at all times, thus swapping while always remaining covered?

Not really.

Under my civilian employer - we had two choices, and that was not really a choice due to the way the two health care companies worked. Basically if our current choice of health care plan changed one year - we called our main doctors and asked if they accepted the new plan. What the doctors accepted mandated which plan we chose.

Most people covered by employer based plans in the US realistically have only choice - take it or leave it. A small percentage have two choices of plans. There are variations about how high of a deductible which can lower the premiums.

Across the US, there is not a free market for health care coverage. The major companies have ended up with a system where each major population area has only two large insurance coverage companies, with one holding about 65-70% of the business and the other near 30-35% of the business.

The elderly Medicare coverage provides a bit more flexibility and requires a bit more study. People in the Part C Medicare Advantage program do have options and choices and need to examine the options yearly.

Due to the way the Tricare program works - my wife and I really don't have any choices expect to abandon coverage and pay as we go - something we definitely cannot afford.

Quoting lowrider (Reply 2): Because there are many of us who believe it is not a valid function of the federal government, as currently defined by the founding documents.

And what you are now starting to see, from a foreign perspective, is that your belief makes no sense and will ultimately bankrupt the country.

Quoting rfields5421 (Reply 29): Our understanding is that in other 'civilized' countries, the decision is made that such care to extend life for people with terminal conditions is not available nor a justified expense in nations like France, The Netherlands, Canada, etc.

I can say for a fact that that is NOT CORRECT.

I've never hear anybody in Western Europe tell a story about his 80 year old grandma not being given a pacemaker operation, because she was simply too old, for instance...

My grandma was 88 when she got one, within a week of the doctor deciding she needed one, and all was paid for by our healthcare system, so whoever is telling you differently is simply trying to scare you off with awkward stories of doctors 'selecting' their patients according to life expectancy graphs or something.

We're not at Auschwitz railway station, you know?

Quoting rfields5421 (Reply 29): That may be untrue, but on a per-capita basis, our old people receive much more medical care, faster and usually better at more expense than the elderly in other westernized countries.

Then why is the life expectancy in many westernized countries WITH universal healthcare significantly higher than in the USA? Because they don't spend money on their sick oldies any more?

Something isn't matching up, is it?

Quoting rfields5421 (Reply 29): We expend tremendous effort to provide almost all the elderly with advanced care - at the expense of providing the least level of care for the very young of any major industrialized nations.

Correction;
you expend tremendous effort to provide almost all of the WEALTHY with advanced care - at the expense of providing the least level of care for the LESS WEALTHY of any major industrialized nation.

I say that is a MORAL ISSUE: the refusal of Government to care for ALL its citizens in the same way

Quoting rfields5421 (Reply 26): We had to move my wife to Medicare Part B.

I didn't mention the cost of my wife's Medicare Part B

$1,156.80 per year, however because of the Lump Sum Retirement payout in 2009 and it's impact on our 2009 income/taxes, her payments for 2011 will be $480 higher.

Quoting AustrianZRH (Reply 25): Note "promote the general Welfare". Now to me, health care is essential to my welfare if I'm sick. Isn't it?

The US Supreme Court has consistently held that the general welfare clause in the Preamble is not a separate source of power for any branch of the national government. Note that the US Constitution creates a system of limited federal powers. It specifically grants each individual branch of government certain powers. Article I creates Legislative Power. Article II creates Executive Powers. Article III creates Judicial Power.

Think about the mess that interpreting the Preamble differently would create. The phrase "to promote a more perfect union" would mean that each branch of government could do what it wanted to further that end. Laws would no longer be written by the Legislative branch. If the President decided he wanted to make driving while texting illegal (something that I think we can universally agree is a good thing) he could do it by fiat. Likewise, a judge could "promote a more perfect union" by ignoring the legislatively created criminal punishments for a crime, sentencing a sex offender to life in jail even if the statute said the crime was punishable by 10 years. It would effectively create anarchy amongst the branches of government.

Quoting rfields5421 (Reply 31): No matter how it is done - it is my belief that every large organization in every country is quite capable of hiding costs to enable them to provide a bureaucratic process with unnecessary employees and good profits. And every government agency in every country is in-efficient. In my travels around the world, I've seen several variations - but unnecessary government oversight exists everywhere.

Exactly. And the thing I'd like to point out is, the sheer size, diversity and differences in life styles in the different regions of the US. People keep comparing the US to this European country or that European country, when quite frankly, the comparisons don't make sense. I can't imagine the EU going to a single healthcare plan for the entirety of its members, which would be very similar to the US going to a national healthcare system.

Quite frankly, if (and only if), voters feel we need a reformed health care system, it needs to be done at the state level, not the federal level.

-DiamondFlyer

Quoting rfields5421 (Reply 31): And every government agency in every country is in-efficient.

But that's the point I'm trying to make and that doesn't seem to land with my American friends. In the Netherlands at least there is nothing government run about the health care system. Absolutely nothing, nada, zilch! The only thing the government does is implement the following laws (simplified by me);

1. Insurance companies must offer a basic package consisting the most important procedures (heart surgery, broken bones, basic dental, etc);

2. Insurance companies are completely free when it comes to pricing;

3. It is strictly forbidden for an insurance company to deny an insurance based on chronically illness, age or habits (like smoking). So everyone pays exactly the same for the basic package at a certain insurer, whether your 18 or 88, smoking or non-smoking, cancer patient or not, obese or thin.

4. The government has a fund from where the insurance companies that take on expensive client (ie; people with cancer or in need of a donor transplant) are compensated.

5. If you are below a certain income (ie; if you're poor) the government will help you pay for the basic package

6. If you want you can add extra's (like extensive dental plans in my case) to the basic package

[Edited 2011-02-10 07:52:55]

[Edited 2011-02-10 07:56:26]

Quoting DiamondFlyer (Reply 36): Quite frankly, if (and only if), voters feel we need a reformed health care system, it needs to be done at the state level, not the federal level.

And the states with the most liberal laws will be open to all sorts of abuse. That won't work at all. It needs to be done at the federal level.

Quoting DiamondFlyer (Reply 36): I can't imagine the EU going to a single healthcare plan for the entirety of its members, which would be very similar to the US going to a national healthcare system.

I assure you it would not, the Dutch system is perfectly scalable. It's not perfect, but it's a lot better then having 16% of the entire population without health care insurance.

Quoting travelavnut (Reply 37): In the Netherlands at least there is nothing government run about the health care system. Absolutely nothing, nada, zilch! The only thing the government does is implement the following laws (simplified by me);

But see, that's not really the whole story. The Dutch government does limit lawsuit damages for medical malpractice at the national level thereby reducing the number of defensive tests physicians in the US order.

The Dutch government creates one licensing system for all physicians, not the 50 state boards of medicine we have in the US.

The Dutch government implements all sorts of policy, procedures, regulations and practices that have a direct impact on the entire health care system and its cost that aren't present in the US. For example the ability for paid maternity leave encourages breast feeding which improves children's immune systems and reduces long-term care. There is no US national paid maternity leave system in the US.

My point is not that the US is better than the Netherlands or vice versa. It's that health care is about more than about who pays. There's a whole infrastructure and mentality that allows the system to work in the Netherlands that simply doesn't exist here. If we want the same outcome in the US, we'd have to adopt many of those same laws.

I thought this thread got off to a good start with "travelavnut"'s Reply 1 that contained that link to the article by the American writer living in The Netherlands". That guy tried to probe the Dutch psyche (polder mentality) to discover why they are more amenable to doing things in groups that are Americans.

You might come to the conclusion that Americans are more selfish trying to keep more of their earnings for themselves and more individualistic being less likely to take part in group efforts that would benefit all. And you could further take that to thinking that Americans aren't as nice as other people like the Dutch.

But having travelled in both countries, on average I find Americans still a little more likable than the Dutch.

So to me the answer to AA7295's original question is still a mystery, and I guess to a lot of other people, as this question comes up so regularly!

Quoting gatorfan (Reply 40): The Dutch government creates one licensing system for all physicians, not the 50 state boards of medicine we have in the US.

Quoting gatorfan (Reply 40): The Dutch government implements all sorts of policy, procedures, regulations and practices that have a direct impact on the entire health care system and its cost that aren't present in the US

Quoting gatorfan (Reply 40): My point is not that the US is better than the Netherlands or vice versa. It's that health care is about more than about who pays. There's a whole infrastructure and mentality that allows the system to work in the Netherlands that simply doesn't exist here. If we want the same outcome in the US, we'd have to adopt many of those same laws.

Those are all valid concerns and I in no way think our approach would work 1 on 1 in the US. Not because of scale, but because of difference in law and culture. Nothing bad about that.

It also goes the other way around, a lot of Dutch people look at immigration policies of the US for example we Dutch should be a bit envies on the American approach. Where we have quite a few problems with immigrants (namely Moroccans) in the US people are actually proud to become an American and at least try to learn the language. Something where we in the Netherlands really screwed up in the last few decades. People immigrated for economic reasons, starting living in the same neighbourhouds, didn't want to learn the language or anything about the Dutch culture.

The point I am trying to make is that often our health care system is being slammed for being a socialistic welfare state tool, something it absolutely isn't. And that it can actually reduce the role of the government by letting the insurers do "all the work".

Quoting ronglimeng (Reply 41): But having travelled in both countries, on average I find Americans still a little more likable than the Dutch.

Quoting ronglimeng (Reply 41): And you could further take that to thinking that Americans aren't as nice as other people like the Dutch.

I think that is a bit of a stretch ronglimeng. No one is making that claim and I don't see any connection between a health care system and how "nice people are". It's just a pragmatic approach.

In my experience Americans are one the most welcoming people on the planet, except for that idiot in Virginia who pointed a shotgun at me, my parents and my car-sick little sister (who was 9 at the time) who was vomitting on his property. Dutch people are bit more reserved, but if you get too know them they CAN be quite Ok   We do have an arrogance problem, I admit, but luckily the French out do us in that respect  

[Edited 2011-02-10 08:30:59]

[Edited 2011-02-10 08:31:48]

[Edited 2011-02-10 08:35:31]

Quoting travelavnut (Reply 30): Also the life expectancy numbers wouldn't be higher in The Netherlands (79.4 years vs. 78.1 years in the US) if this statement where true

I disagree. I think it is our lack of health care in youth and early adulthood (especially the poor pre-natal care so many receive) - and our lifestyle choices which make the difference.

First you have to remember that the majority of people whose deaths impact that number were raised and lived most of their lives under the US high meat, high carbs, high cholesterol dietary standards. That number is also heavily influenced by a large percentage of heavy industrial workers who were often exposed to chemicals we now consider toxic and unacceptable. Also the fact that we retire several years later in life (avg about 67) than much of Europe I believe contributes to our shorter life expectancy.

The generation over age 65 was born during WWII. They lived through a period of expansive growth, increasingly non-local food sources, increasing additives to food, what we now see as unhealthy lifestyle choices - and very low regulation of industry environmental pollution. Unfortunately many of the 'weaker' members health wise of that generation in The Netherlands, and much of Europe, did not survive into adulthood. They did in the US.

Another 'advantage' is that many Europeans of that generation did most of their youth / early adulthood in a growing country where infrastructure and industry was built to new, better standards after the destruction of the war. Those in the US had to live with the old, less environmentally friendly leftovers from the wartime rush economy.

The US generation age 40-64 did not begin to learn of the need to change to healthier lifestyles, food choices or to benefit from environmental regulation until they were in 30s. Which I'm sure impacts our life expectancy.

Quoting travelavnut (Reply 30): Do you have a source for that?

No. It is often quoted in our media by people both for universal health care and against universal health care, but I do believe it to be true.

Average annual total health care costs for people over age 65 who live at home runs something like about $14,000. Those who require extended nursing care in runs about $80,000, for those requiring advanced medical care such as ventilators or feeding tubes can run near $150,000.

We see people in their 80s receive organ transplants. We routinely see people into their 90s have third and fourth coronary bypass surgery for their fifth and sixth heart attacks.

We see elderly people who have had strokes and are unable to communicate verbally, unable to walk or care for their bodily functions sustained at over $100,000 per year for 10 or more years. They die from secondary infections, not the stroke.

My mother had Altzhiemer's. She was in a nursing home for a little over 13 years. After the first six months which was paid from her estate, the Medicare and Social Security system paid her full care. That was about $84,000 per year, with a couple of two week long hospitalizations for infections each year in her last three years additional. She did not die from Altzhiemer's, she probably died from aspiration of food or vomit. We did not request an autopsy. It was long past her time when she was found dead in the bed one day.

Quoting slz396 (Reply 33): My grandma was 88 when she got one, within a week of the doctor deciding she needed one, and all was paid for by our healthcare system,

Why did it take that long? In the US, it would be done within 12-18 hours of the doctor decision.

If my 86 year old father were to have a heart attack, if he was medically able to have surgery, he would have coronary bypass surgery in less than 24 hours. It would only take that long because he lives in a rural area and they would have bring in a helicopter to fly him to a hospital in the state capitol. The only real question is would he survive the 20-30 minutes to get him to a rural hospital with equipment to sustain someone with a failing heart (a very common level of equipment and staff in rural areas with a large elderly population).

Two 1/2 years ago, the VA doctors decided my father's vision would be better if he had surgery. The procedure he had was basically a cosmetic eye-lift to trim away excess skin that was sagging above his eyelids. Day surgery, though they did put him out. The approval for elective surgery took about 2 hours after the doctor recommendation. We could have scheduled it within 48 hours, but he chose to wait a couple months to think about it.

Quoting rfields5421 (Reply 43): We see people in their 80s receive organ transplants. We routinely see people into their 90s have third and fourth coronary bypass surgery for their fifth and sixth heart attacks.

So do we. My Grandpa received lots of surgery and medical treatment in the final phase of his life, terminally ill with cancer. My Grandma received a new hip at the age of 76. I have never heard of any old person in Austria, Switzerland, Germany, or France being excluded from med treatment because of her age.

Quoting slz396 (Reply 33): Because they don't spend money on their sick oldies any more?

That is not what I said.

We in the US routinely expend insane amounts of money to extend life of people who are dying, for no other reason than to continue to bill the insurance/ government for that person's care.

The concept that one's life is over and it is time to let them go is still not followed across much of the US. We have been conditioned in the past 50 years to fight for every last second of life, even if that life if filled with pain and suffering, or if that life is no longer capable of coherent thought (i.e. Altzheimer's, strokes, etc. - a vegetative condition)

While there is much talk about "Living Wills" and advanced medical care directives in the US, people really never sit down with their doctors and talk about how their life will end and how they wish to be treated. It is usually left to the children, or surviving spouse. In my mother's case I am certain she survived for several years because my father refused to let her go. And he's going to have to answer for that some day because her long term care was definitely against her spoken and written wishes.

But how does a child tell Daddy "No - don't let the doctors give mom extra physical therapy and a feeding tube"

I will also tell you after watching most of the parents of the kids from my home town die - that as soon as the extended care become a cost and not a profit for the hospital/ doctor/ nursing home - the conversation turns to "quality of life" and "letting go".

But when there is a dollar to be made - the doctors, hospitals and nursing homes push to provide every possible profitable treatment.

Quoting slz396 (Reply 33): I say that is a MORAL ISSUE: the refusal of Government to care for ALL its citizens in the same way

From a very basic start of the thought of creating a different government in the colonies, it is not the moral responsibility of government to provide for anyone. Our country was founded on the concept that we don't have a king, and in that concept the king (government) is not responsible for the welfare of his subjects.

We rejected the concept of the government being morally responsible the care of its citizens from the start of our nation.

I know that's an old odd view - but it is the world view we have been raised with for generations. It will take several generations to change that view.

Quoting ronglimeng (Reply 41): You might come to the conclusion that Americans are more selfish trying to keep more of their earnings for themselves and more individualistic being less likely to take part in group efforts that would benefit all.

In general I agree. We are trained from birth that no one is going to take care of us or our family but ourselves. We need to distrust the 'government' on all levels because it is not in the business of serving us - it is in the business of promoting its own growth.

We are also as a people trained from birth that our government is going to give our tax money away to people who are lazy and unwilling to try and work for a better life. That we have to get what we can from the government, because they wil cheat us out of what is rightfully ours to give it to those unworthy. We are trained to look down on the disadvantaged, the disabled, the infirm as not meriting our help on a daily basis.

We have a tremendous capacity to be altruistic when emergencies happen and people are at a temporary disadvantage. But that does not extend to those who have fallen by the wayside in the course of normal life.

Quoting gatorfan (Reply 40): The Dutch government creates one licensing system for all physicians, not the 50 state boards of medicine we have in the US.

That is the basic problem.

You have one government in The Netherlands.

We have 51 governments.

When comparing the health care system of the US federal government, you need to compare it to the European Union healthcare system, not the individual national systems. Those you could compare to individual state health care systems - but only if the European Union provided most of the tax dollars, and several overriding regulations about how those health care dollars were to be spent.

Imagine the political turmoil if the various nations of the EU tried to combine into one health care system. If the people of Germany were told their health care taxes had to double because the people of Bulgaria could not afford the overall system. To some extent - that is the debate occuring in the US.

As mentioned above - we have 50 different states which have different licensing requirements for doctors, nurses, lab technicians, radiology techs, etc. We have 50 different state sets of regulations and standards for hospitals.

We even have 50 different state systems of regulating insurance companies - what they cover, don't cover, etc and premiums. All of that duplication add tremendously to our overall health care costs, both on the provider level and the government oversight level.

While I am personally covered by a national health care program, if I move 250 miles to a different state (my original home) - I go under a different set of regulations about the coverage provided. I will also probably not be able to find a primary care doctor who accepts my coverage, so my out of pocket costs will skyrocket.

Now some are going to say we have a stupid system of so much state level variations.

They might be correct.

However they have failed to emotionally grasp what the United States is and is not.

We are a United group of fifty States which allow the federal government to have limited control over certain aspects of our government. We are not one United Nation.

Yes, in a practical sense we do have a strong national government.

People tend to forget this is our second government concept after the confederation of independent states failed. This government, this constitution was created to expand the power of the federal system over the states, but to place strong limits on that power.

While in many areas, the 'states rights' have disappeared, they are still very strong in many other areas.

Wow -- I thought these threads died out about a year ago. Obviously still a hot topic.

Quoting gatorfan (Reply 20): The answer to the original question lays in this response. Unlike Australia (or many of the other countries discussed) our Constitution provides no such protections. So why don't we do it? Because to do it would be unconstitutional.

One of the biggest impediments, IMHO, to the US ever solving this issue. I agree the Constitution is a wonderful document; leading edge political philosophy when it was written. But it's nearly 250 years old and needs a revamp. Health care problems need to be solved as a country and the Constitution clearly gets in the way of that. We had a similar problem when health care was set up in the 50s -- but with only ten provinces (as opposed to 50 states) the solution wasn't quite as cumbersome. God knows we need to fix ours too, but the ten provincial health care systems operating under federally-imposed standards has worked reasonably well. Our biggest problem (like everyone else in the world) is dealing with the changing demographics, meaning geezers like me are going to really really tax the ability to pay.

Quoting slz396 (Reply 22): nteresting to note how many Americans vehemently defend the right to: -) pay far more money to get far less protection than anybody else in an industrialized nation, -) pay nothing at all and bear all the risk. Just because of ideological reasons which in this case are quite wrong even, as demonstrated by many free and equally prosperous industrialized nations from all over the world!

What seems to be lost on a lot of Americans is that they are the only developed country in the world that doesn't take a national approach to health care and provide universal access to the system. That's why the US system is twice as expensive as everyone else's system, and produces average outcomes in the middle of the pack. It's the administrative costs that sinks the US out of sight -- how ironic for a country that prides itself on small-government. If I were an American, that would infuriate me.

Quoting rfields5421 (Reply 29): That may be untrue, but on a per-capita basis, our old people receive much more medical care, faster and usually better at more expense than the elderly in other westernized countries.

That's just not true in any way. My 93-year-old mother is well looked after in a high quality, government-run nursing home that charges her $2800 a month. If she couldn't afford that, she wouldn't have to pay it. All of her medical needs for the last 10 years -- and there have been many -- were looked after quickly. including a hip replacement done 24 hours after the diagnosis. The right wing in the US has done Americans a huge disservice by constantly, and erroneously, dissing all the other national plans -- particularly ours.

Quoting DiamondFlyer (Reply 36): Exactly. And the thing I'd like to point out is, the sheer size, diversity and differences in life styles in the different regions of the US. People keep comparing the US to this European country or that European country, when quite frankly, the comparisons don't make sense. I can't imagine the EU going to a single healthcare plan for the entirety of its members, which would be very similar to the US going to a national healthcare system.

This is a red herring. Are you trying to tell me that the country that put a man on the moon can't design a universal health care system to benefit all its citizens? You won't find a more diverse and geographically humoungous country than Canada, never mind how small it is, and we made it work here.

It always amazes me that so many Americans (including a large number of my relatives) can't grasp one of the fundamental tenets of developing low-cost insurance -- spread the risk as widely as possible. One insurer covering the entire population on a non-profit basis is going to be far, far more cost effective than a couple of hundred (thousand??) private insurers with much smaller pools of clients and the need to make a profit. What my wife and I pay for medical coverage here, on an annual basis, is about the same as our US relatives pay on a monthly basis. How do they respond to that little factoid? Well, they come up with all the canards the right wing has been fostering for decades about our system: government tells you who your doctor is (not true); you'll wait forever for care (no you won't); your taxes are higher (no, they're not) etc. etc. etc.

I don't see a solution down there anytime soon. Obamacare didn't go half as far as it needed to and now you've got the worst of both worlds. What's worse is your conservative politicians are now determined to turn the clock back. The danger, IMHO, is that failure to get health care costs under control down there will have a HUGE impact on the country's ability to compete globally -- and this is coming at a time when the Asian economies are rapidly ascending. We already get lots of murmurs from some of those protectionist politicians down there that our health care system is a countervailable subsidy because US employer health care can't come close to matching the costs. Ask GM, for example, about the differences in health costs between its US plants and its Canadian plants.

Quoting Arrow (Reply 47): One of the biggest impediments, IMHO, to the US ever solving this issue. I agree the Constitution is a wonderful document; leading edge political philosophy when it was written. But it's nearly 250 years old and needs a revamp. Health care problems need to be solved as a country and the Constitution clearly gets in the way of that.

Agreed. But the way to fix any problems that exist with the Constitution is not to start by ignoring what the Constitution says. The Constitution sets forth ways it can be amended. To say that Congress has the power to ignore the Constitution is to say that it has the power to ignore the very document that grants to it the powers which it has.

Quoting gatorfan (Reply 20): The answer to the original question lays in this response. Unlike Australia (or many of the other countries discussed) our Constitution provides no such protections. So why don't we do it? Because to do it would be unconstitutional.

Our original Constitution did not provide for health care being a federal constitution, but a subsequent amendment was put before the people and voted on. It gained a majority of both the voters and the majority in a majority of States as is required and was adopted as an amendment to the Constitution.
One of the problems that people overseas often have is accepting the idea that a Constitution is fixed and for all time. Yet even the US Constitution provides means for amending it, however cumbersome that may be. Perhaps the issue should be put to a referendum.

I have found this thread particularly informative because it has allowed for people within the US and overseas to exchange and compare ideas about how health systems do or can operate. It has been free of the useless partisan point scoring typical of many threads and has been all the more beneficial as a result. Well done everyone!