Okay, I've taken a few weeks off. Well, nearly a month. But I've not had anything get me "fired up". Not that Piet's messages haven't been great, it's just that I haven't come home feeling like I needed to express what I'd received.
Then I was reminded about this whole "health care reform" fiasco. I mean, really, who decided this was needed? Who decided it was "health care reform"? And who really thinks that the government is the entity to run such an important and personal part of our lives?
I mean, the arguments FOR this reform aren't about "health care reform." We have the best medical system in the world. I have not heard even the most radical supporter of this "reform" give the vaguest anecdote about someone leaving our country for another country's health care. I'm sure one can find instances of someone with the money and influence leaving the country for treatment by a specific physician, or a specific facility because of their expertise or some other quality that makes them preferable. But has ANYONE honestly seen any indication that any other country has a better health care system - better doctors, better hospitals and facilities? Better pharmaceuticals could be argued - but only because the FDA is a flippin' joke. And there is just the beginning of a litany of reasons why the government is not the entity to put in charge of managing YOUR health care.
My assertion is, and has been for years, that there is no one on this planet who is even close to being as concerned about my health as I am. Therefore, I should be making the health care decisions for me. Not my doctor. Not my insurance company. And for damned sure, not some "civil servant" who is hired into a broken government system and whose performance review is based upon how much they cut costs over the past 12 months.
I'm not saying that American doctors are perfect. Not by a long shot. I've fired too many of them to believe that. But, I do believe they are, in general, the best on the planet when it comes to giving me medical counsel. And that, in my opinion, is what I pay them for. Not to lord the immense knowledge over me. Not to tell me how they believe I should live my life. But to give me advice, based upon years of education and experience. Any doctor who disagrees with my philosophy gets fired. Plain and simple. Because, you see, I am the one paying their salary.
And this brings me to the crux of the matter. The reason I felt like I needed to write this out. Because, you see, we do have the best medical system in the world and no one can argue to the contrary with any integrity at all. What has been argued for the past several months is "Who should pay for it?" Besides a few left-wing radicals, I've not heard anyone arguing whether or not our health care system needs reform, but whether or not how we pay for health care needs to be reformed. And, when you decipher what the radicals are writing, it still boils down to an issue of payment.
To be certain, I've heard some eloquent arguments for "public option", "single-payer system" and "government controlled system," among others. But, when you get right down to it, these are not going to work. No way, no how. The entire premise is laughable to any freedom-loving person. And even lethally frightening to people with obscure, or "un-sexy" diseases. If we were to put our government in charge of paying for health care, with what must be a limited budget, then nothing short of rationing care is possible. It happens today, only that it's private individuals who, through their level of financial resources, do the rationing. If any one entity, even if it's not the government, holds all of the money that can be spent on medical care, then that entity will have to determine who gets their treatment paid for and who does not. Or even who gets treated and who does not. After all, with only so much money, they can only pay for a certain amount of care. So, it is by definition a self-limiting, self-rationing system. The only questions are: Who makes the decisions on who gets treated and who does not? And how do they make that determination?
Let's look at something concrete. AIDS came to America in the late 1970's and came into the public eye in the early 1980's. I don't recall exactly what year this occurred, but prior to that it wasn't very well known. And it was, to most people - most voters, a source of off-color jokes for many years after that, but not a serious topic deserving serious concern. Then, one day, someone funded some research which led to a published study showing that everyone's flippant attitude about AIDS was actually helping the disease spread - and the fastest growing population of AIDS patients were not long-practicing homosexuals in San Francisco, but heterosexuals, in their prime, across the country. Then it became a serious issue. Something voters were concerned about. And that is when government-funded programs to research and treat AIDS would have been started under a government-run system. Not a decade before, when the disease was discovered. It was too inconsequential. As a "gay" disease it wasn't a political issue because the gay community wasn't all that influential. The openly gay community and those who sympathized with their cause was still pretty small and, frankly, seen as a political liability. The only reason AIDS research started as early as it did was because privately-held and publicly-held pharmaceutical and medical research companies saw the opportunity to make a profit by helping AIDS victims. Now, don't think I'm saying that a bunch of greedy bastards saw that there was a buck to be made. I'm sure there are enough voices out there raising that cry without me doing so. But I honestly believe the reason many people go into these fields of pharmaceutical and medical research and development is because they want to help make people's lives better. And they are funded by businessmen (and women) who, by definition, are willing to invest to make a profit. And, if that profit goes away, so does their willingness to pump money into new and emerging technologies, therapies and drugs. Sure, some will see an opportunity to be philanthropic or seek a tax shelter, but nothing like the money being poured into it today. And boosting the taxes to pay for a government-funded system will dry up that money completely.
Plain and simple, controlling the money gives options. The question is, who do you want controlling the money?
If the investors control the money to fund research and development, then they will invest in companies that will create a profit. And, in the medical world, that means keeping up with "the next big thing" coming down the pike. A cumbersome governmental bureaucracy is highly unlikely to be proactive about this. Just think about how long it took the state (whatever state you're in) to get the license bureau computerized to the point that it wasn't a day-long activity to get a 15-minute transaction accomplished. In some states, it may still be an all-day ordeal. In Missouri, I can now take care of a lot of government interaction on-line and trips to the license bureau take minutes instead of hours. A couple of years ago, it wasn't like that and it was a long, slow process getting there.
And if I control the money to pay for my treatment, I have the option of deciding whether or not to pay for a treatment I decide is or is not the best option for me. What this means is that I don't have some paper-shuffling clerk in a government office telling me I can't have a highly-promising protocol because it's not approved AND in the same breath telling me I must submit to a treatment/therapy/protocol that I find myself morally, ethically, or even health-wise objecting to OR risk being imprisoned (literally or via involuntary quarantine). As little attention as the people who currently pay for medical services give to "preventative medicine", and this includes Medicare and the VA, how can anyone believe it will change under a mandatory, government-run system. Sorry, but that's just some pie-in-the-sky scheme that politicians are selling people they want to control - something to win votes.
I find it amazing that people who spent the last 8 years protesting, sometimes violently, government control and government invasion into their privacy and everything that Big Brother "W" was doing are now blindly willing to fall into line and drink the Kool-Aid because of a change in administration. I just find a certain lack of integrity in that behavior.
Well, my "proof-reader" says their eyes glazed over back in the fifth paragraph, so I'll not go into this much more. But I would like to make one final point : without calling anyone's morals or ethics into account, I believe most doctors do what they do because (1) they are capable and (2) it pays "well". I've known enough doctors to know that some make highly enviable salaries and others would probably live better if they were to do I quit to go to college. So, I'm not saying they're all a bunch of money-grubbing jerks. But, the schools that educate them could be another matter. And I digress... My point is that if you take away the financial incentive, you will lose - quite possibly within a generation if not sooner - all of your specialists. Your neurosurgeons, your pediatric specialists, your infectious disease specialists, all of them. Not that you wouldn't find someone to do the job, but you would not have caliber people willing to dedicate 12 years or more to learning such a technical job just to come out of school and walk into a fixed income, living off of the tax-payer's dime.
So, you see, all of these articles in Rolling Stone and The Village Voice and what-not decrying our health care system would end up being self-fulfilling prophecies. Not an indictment of how things are, but of how they would become.
11 comments:
From the perspective of a Brit, now permanently over here (green card, citizenship on the way), I can offer a rather different perspective. US healthcare is really scary.
When I was a grad student, I had a pretty crappy medical insurance package (required for foreign students). It cost $300 per semester, and the only absolute guaranty was the my body would be flown back to England in the event of my death. I could go to a doctor's office or hospital for treatment, but there was a $25 fee for showing up, and had to pay the first $100 of my fees - IF I went to the right hospital. When I became very unwell out of town once, I had to pay out $500 for an examination and some pills - simply because my crappy insurance didn't cover any location in Columbia.
I have "good" insurance now. We pay out over $100/month from each paycheck for it, and I still have to pay the first $50 if I see a doctor, and up to $100 of the treatment costs. I do get to see the doctor once a year for free.
Conversely, I can walk into any doctor's office or hospital in the UK, Western Europe or Canada (thanks to treaties) - and pay nothing upfront for a consultation, any blood-work, follow-ups, and only the first $25 of prescription medications. I can go for any reason I want - from something serious, all the way down to dietary advice.
I used to see a doctor quite often in the UK. I avoid them here. (By the way, I could choose my doctor in the UK - and choose my hospital; I made sure I had a doctor I liked/trusted. Doctors whom patients didn't choose went out of business - sound familiar?)
In the UK, I had to pay "national insurance" - it's basically a tax on earnings. As a student/unemployed, it was free. Otherwise, it came to about 2% of my paychecks - a little less than we pay right now (and a LOT less than I paid as a student!)
Some real-world examples. My grandma (former post office employee, worked hard for years) needed a hip replacement. She had to wait a month, and her total costs came to - about $50 (depending upon exchange rate). A friend who had a heart-attack and needed about two weeks hospitalization plus follow-ups for a very long time paid around $75. That compares poorly with a friend's mom (social worker here in MO) who had a heart attack, and ended up declaring bankruptcy with over $50,000 in medical fees attached to her name.
A few other points:
* Approximately 18% of Americans have no insurance at all, meaning that the only care they are guaranteed is life-saving emergency care. They do receive that "free", although they will be billed after the fact. That's incredibly wasteful - most of the time, early care will save lives long before a condition becomes life-threatening!
* The US system is #1 only in cost. A 2000 WHO survey covering all aspects of health-care (time of service, quality, survival rates, etc.) ranked the USA 37th in the world (source http://www.photius.com/rankings/healthranks.html ) - admittedly improved from 72nd in 1997). The US ranks 14th in terms of preventable deaths not being prevented. The US is 24th in terms of life expectancy. However, the US does rank 2nd in the percentage of GDP spend on healthcare (behind the Marshall Islands, wherever they are). Current estimates are that 16.2% of GDP is spent on healthcare!
In other words, there's a real problem here. I fully understand not trusting the government, but one thing is very clear: the current system hasn't worked, doesn't work, and won't work. The US spends more than anyone on health - and receives less than many other countries. People die earlier, of preventable problems, and spend more money to do so. If that isn't a system in need of reform, I don't know what is.
You are absolutely right that nobody is more concerned for your health than yourself, and you absolutely need to be able to take control of your health care regimen.
Shortly afterwards, you fly off the deep-end into Bill O'Reilly levels of misinformedness (I'm pretty sure that's not a word - sorry).
Under the current system, you can fire your doctor (subject to regulations set out in your insurance plan - you can't go to any doctor you want, unless they accept your insurance card). Under the UK system - you can see any doctor you want; in fact, a lot of doctors operate private companies who receive their checks from a third party (the government insurance company - just like your doctor now receives checks from your insurance company). Under the proposed system, you'd STILL be able to fire your doctor - and still be subject to the terms and conditions of whatever insurance plan you purchase. However, insurance companies would be restricted in the limits they can place on you - so you have MORE choice, not less.
Patient choice of physician: you have some, you'll still have some.
How are doctors paid? Under the current system, they typically receive a flat-rate per consultation, per patient - and then a flat rate per procedure performed, based on an insurance company pricelist (heaven help you if you aren't insured). In the UK - you guessed it, they receive a flat rate from the government insurance company, per patient - and then receive a flat procedure rate based on a (government) insurance company pricelist. Under the new plan? The same! In other words, pay is STILL based upon the number of patients who choose you (and are allowed to choose you).
How physicians are paid: basically the same. Underperforming physicians make less. Period.
Rationing. The right love that word, but clearly thinks it means something other than it's usual definition. The current system is rationed. If you have insurance, the company can (and will) drop you if you become too expensive. Your premiums are based upon how much they have to pay out - and they ensure it's never too much for them to make a profit (think about the HMO arguments from the Bush/Kerry election - panels determining if a treatment is "medically necessary" and dropping coverage; insurance company death panels, really). If you are uninsured, you are even more rationed - you won't get treatment you can't pay for (other than life-saving treatments that bankrupt you). Rationing is here right now, and it beggars belief that anyone would want to keep it! In the UK, there is also a form of rationing. There are limited numbers of hospital beds, limited hospital capacity, and so on - just like here. You need a procedure, and the resources aren't around to pay for it? You join a waiting list, and wait until it's available - but it WILL become available (usually in under 30 days, or much less for anything serious). I'll take a delay over a "no" any day of the week. Under the new proposal, one of the major line items restricts insurance companies ability to drop you because you need treatment; in other words, it LIMITS the artificial rationing to which we are currently subjected by insurance companies.
We don't have infinite resources, there will always be some rationing.
Rationing: the new proposal means LESS rationing overall.
Your AIDs example is interesting. The US is generally used as an example of poor response to HIV in lectures overseas, because public education on safer sex is so poorly received, poorly funded, and treatments (what little there is) are incredibly expensive. Meanwhile, the UK responded with a massive safer-sex campaign, education at all levels, and government funded access to medications. The first documented UK case appears to have occurred around 1981, and it was big news - and the subject of a huge health campaign - by 1983. (It's also not a coincidence that the earliest research into HIV came from Cambridge, UK - they had public funding pretty much as soon as anyone realized there was an issue)
Towards the end, you inadvertently hit the nail on the head at the end:
And if I control the money to pay for my treatment, I have the option of deciding whether or not to pay for a treatment I decide is or is not the best option for me.
You do indeed have that option. However, do you have the ability to pay for it? If you were struck down with a horrid illness, and could no longer work - are you sure you could raise whatever it takes to get the treatment you need? Nobody (well, nobody nice) wants you to suffer, and nobody wants to deny you options in trying to recover. However, if you can't afford the treatment (and you can be sure after your first year without work, insurance isn't going to help very much) - you aren't going to get it. THAT is the moral driver behind the need to change the system. It's wrong to watch someone needlessly wither and die, while we enjoy our nice houses and cars.
I find it amazing that people who spent the last 8 years protesting, sometimes violently, government control and government invasion into their privacy and everything that Big Brother "W" was doing are now blindly willing to fall into line and drink the Kool-Aid because of a change in administration. I just find a certain lack of integrity in that behavior.
That's hardly fair, you don't have to go very far to find people arguing about health-care reform, Afghanistan (or AfPak as it should be termed), the dismal state of the economy, the bail-out, or protesting Obama's keeping parts of the unPATRIOTic act. It's more likely that you just aren't exposed to those circles.
So, you see, all of these articles in Rolling Stone and The Village Voice
I have to admit, that made me laugh. 16% of our GDP is spent on healthcare, while 45 per 100,000 more people needlessly die here than in France, and the Japanese and French have life expectancies 3-4 years above that found here.
There are 304,059,724 in the USA.
On average 334,465 people will die in readily preventable deaths in the US this year. If our health-care was as good as France's, that would only be 197,638. (And France only spends 11% of its GDP on health-care!).
Don't you think that saving 136,827 lives this year is worth the effort?
Cool. I always appreciate alternative perspectives. That doesn't mean I'll buy into them, but at least I'll know that I'm not as uninformed as, say, Bill O'Reilly.
So, as a grad foreign grad student, your insurance sucked. I won't argue that the insurance situation is not atrocious. Because I agree - it is. And I believe THAT, not the health care system, is why "we" pay so much for health care in this country. Because "we" don't pay for it, "the insurance company" pays. This sets up a system that promotes a mindset where nearly everybody will use (and by that I mean abuse) the system to its limits. And those who pay the least are almost certainly going to abuse it the most - because "it's free". They never see the cost.
And the fact of the matter is - health care costs money. I don't care what country you're in, it is expensive. And if you aren't paying for your health care, who is? Despite what BO seems to think, the government doesn't just crap money out and suddenly people get richer. If the poor aren't paying for their health care, then the less-poor are. And if you're less-poor, without a good tax lawyer, you're paying a substantial percentage of your income to cover those who don't. Wealth is not produced by paper currency, or electronic currency or any other currency except labor. People create wealth when they work. They must work effectively, mind you. Digging a hole to fill it up won't produce anything unless you plant a tree that will produce fruit that you can exchange for goods and services. Like health care.
So, just out of curiosity - what is "good insurance"? I don't know how much you get paid, but you can get in to see one of the best docs in town for around $70 - without insurance. Unless you plan to see the doc a LOT, or you get paid monthly, I would save the $100 on the insurance and bank it. Personally, I believe the best insurance out there is cash in the bank. Or, should you be so inclined, under the mattress. Paper currency, should you believe it isn't doomed. Or gold, Deutsch Marks, francs, Euros, whatever. If you think you could exchange it with a doctor to keep you healthy and their kids from starving.
I find it interesting that you feel limited by the doctors you can see. As I stated, I fire doctors who think I "must" do things their way. And I see any doctor I want, preferably those who aren't living on "insurance life support". That means doctors who will accept cash for payment rather than insisting on billing my insurance. You see, I have Lyme disease. As it stands, finding Lyme-literate doctors is hard enough. But finding one who takes insurance to treat Lyme disease is a impossible. They simply do not exist. Insurance companies do not pay them to treat Lyme disease effectively - period. And the IDSA, along with certain other "mainstream" medical associations, persecute them mercilessly. (http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284) So, I generally don't use my insurance except to pay for emergency (or "urgent care") visits and high-priced, American pharmaceuticals (and I really wish I had time and energy to tear into THAT can of worms).
And that is just ONE disease that the current medical regulatory agencies look down their noses upon. How does a single-source, all-ruling system make THAT better? Without turning a blind eye to every diagnosis or hiring on experts-in-the-field not practicing medicine to oversee the experts-in-the-field who are practicing medicine, it can't. Because there is no omniscient authority when it comes to anything - and especially not when it comes to health care. Even in the UK.
I'm glad your grandmother got her hip replacement - and that she lived in a country where she could do it with so little out-of-pocket expense. But I'm fairly certain that SOMEONE paid for the balance of that procedure. I'm not an expert, but I believe hip-replacement surgery takes more than an hour. And, unless doctors, nurses, anethesiologists, surgical techs, orderlies and hospital administrators work for pennies an hour, that adds up to SOMEONE working hard and coughing up money to pay for your grandmother's hip. Ditto on the heart attack. There is no way that a doctor/nurse/hospital administrator would stay in the UK, at $75 payment, when they could move to the US and make $50,000 to handle the same work load. Sure, the out-of-pocket looks great when you're the one not being billed. But for those of us who think that we should get paid our own wages and salaries, to give to charity as we believe is appropriate, we're wondering who picked up the rest of the tab.
I know there are statistics to show that our system is "broken", but I also know that there are lies, damned lies and statistics. Those numbers can be sliced and diced four ways to Sunday and never come up with the exact same "facts" twice.
Now, take those people here who are prone to misuse the system (like seeing a doctor rather than a dietician for dietary consults) and put them into a system where it's not an insurance company they have to pay every month, but the government! YIPPEE!!! IT'S FREE! THE GOVERNMENT IS PAYING FOR IT! Let's go ahead and schedule that hangnail surgery I've been putting off! Seriously, though, I believe that waste would fill the place of inefficiency in the payment system. It's been 20 years, but I can still spell HMO.
And then add to those people all of the people who could have insurance (and better health) under the current system, if only they just could afford it. But it's hard - with their payments on the 48" plasma TV, the 2010 one-and-a-half ton pick-up, the sub-prime mortgage on their four-bedroom home and two-pack a day addiction. No, I don't see this as an isolated evil in our society. I see it as more of a symptom of a much larger problem. Americans have no problem paying for an unhealthy lifestyle - until it comes time to pay for that unhealthy lifestyle. Then it becomes a "societal problem" that "only the government" is capable of fixing.
I'm not saying people shouldn't have these things, but when you can't afford health insurance because you've got $1000 a month in payments on unnecessary debt, I really have very little sympathy. And no, you don't HAVE to have a car payment. Or a Mastercard/Visa/American Excess payment. Or student loan payments. Have I had these? Yes. Could I afford health insurance if I didn't? Oh, hell yes. Turns out, Visa takes LIFE.
And I'm not saying that there aren't people who would choose insurance if they could. I know they exist and they just can't afford the premiums on insurance. But I also know that the 18% contains a high percentage of people who just have their priorities screwed up and want "the government" to pay for their lack of self-discipline. And what that amounts to is getting the government to take the funds from people who have worked hard to produce an income and a lifestyle, and hand them over to people who, for whatever reason, are making less money. I know that sounds like Robin Hood to some, but to me it sounds like simply robbing. Or, less simply yet more chic, socialism and redistribution of wealth. An economic system which would crumble faster in the US than it did in the USSR.
No, I don't want to see people suffering and dying needlessly. I don't think it's a good thing that people have to get ER ill in order to get care. But I also do not think that more government is the answer. For over 5000 years, it has been the place of the church to care for the widows, orphans, sick and infirm. Granted during a LOT of that time, The Church WAS the government in one way or another. And not always for the best. Yet, in the last 40+ years (in this country, at least) the church has been supplanted with the government. And what has it gotten us? An excessively expensive way to pay for health care. Why? Because people want to be free from religion. They believe that they'll be judged if they have to seek help from a charity or a church. So they create a new charity and call it a "social program" and make it mandatory that the not-so-poor pay into it. And in that 40+ years, the taxes kept going up - because the government doesn't care what your faith is, and would quite probably be happier if you had none, as long as they get paid their first fruits. Sound like anything you've heard before? Thank goodness there was no church involved, with people giving out of the goodness of their hearts. So, as taxes go up-up-up, effective take-home pay goes down-down-down. This leaves less money for the faithful to give to churches and charities - so the churches and charities become more and more burdened with less and less resources. And even the faithful end up turning to the government instead of God, or even each other.
So, yeah, there was a little preaching going on there - and I think it's a good thing. It keeps people from trying to play the "If you were a good Christian" card. (Most of them aren't Christians, anyway.) God did not create socialist governments, men did. And God did not create insurance companies, men did. God did create doctors and apothecaries (pharmacists), who could charge a lot less and do quite fine if they didn't have so much government regulation and bureaucratic BS at insurance companies to deal with. Most of the doctors I know have less business management budget than they need, because they have to have a corps of insurance billing staff to make sure everything gets filed with the right codes and on the right schedule or they don't get paid. Consequently, the business side of a private practice gets run by someone who has been educated and trained as a healer, not a good business manager. And that is even more expensive.
And again, it comes down to an inefficient way of paying those who provide the best service in the world. No, it's not perfect. And it's expensive. And there are bad doctors, bad hospitals and bad administrators. And people die, unnecessarily. Some of this comes from overworked employees (do you think that will change with this new system?). Some of it comes from 5-o'clock-Charlie (no, not the biplane bomber from M*A*S*H, but the employee who produces just enough to not get fired and is the first to the parking lot at the end of the shift). Some of it comes from greedy people in the system. These things won't change. And I'm fairly certain they'll be even worse when it all comes down to a fixed-rate system. I'm still waiting to hear the stories of people leaving the US for Canada, Mexico or Europe for general health care.
Uh, under the proposed system, I could keep my current insurance until I lost it, and then it's onto the "public option" (which, like "pro-choice", doesn't leave any other "options" on the table). At that point, I'm off to see the "public option" doc or seek non-covered (illegal?) care.
And, as has been seen, there is a strong incentive for my employer (generically speaking) to drop my insurance and FORCE me onto the "public option" - as it costs my employer less for me to be on that system. I have heard the reports of a good number of small and mid-sized companies notifying their employess that employer-subsidized health insurance will not be renewed after this year. Where is the "option" for those folks?
And, if docs get paid to treat disease A and don't get paid to treat disease B, God help you if you get disease B - because you're still coming out-of-pocket to pay for it. IF that's even legal. So much for this great reform. It helps out people who don't have money, but really screws those with the money who (1) don't have health care issues or (2) have health care issues that aren't covered.
And don't worry about making up words when refering to O'Reilly with me. I can't see it mattering much. --grin--
There's a lot to chew on here. (I appreciate getting other perspectives, too - my polisci degree is indicative of my unhealthy interest in these things! Incidentally, I'm not party aligned - I tend to think both the Dems and the GOP are equally corrupt),
Our current "good" insurance plan costs around $400/month, but that includes an eyecare and dental option (the last two actually make financial sense, the former - not yet, anyway). It's deducted pre-tax, which helps hide it on pay-stubs (it's University insurance, Mel works for them so we're on that). For most people right now, I think a health-savings-account plus catastrophic coverage is the way to go - less expensive, you get to keep money you don't use (other than the small premium), and you even get a tax break. On the other hand, I do sleep better at night knowing that if Mel or I were to get really sick, we'd be cared for.
Both my heart-attack friend and grandma will have paid for their coverage, as will other UK taxpayers - through "national insurance". It's a complicated formula to figure out exactly how much you owe, but the online calculator indicates (with our current combined income) we'd be paying about $410/month - so about the same. (Only no deductibles except for prescriptions, and all care is free when you need it).
I also checked, and Lyme disease is covered in the UK. The worst case would be $100 out-of-pocket, for a long-term prescription setup. (There's actually a law stating that the NHS has to treat you, even if they've never heard of what you have. If you come down with something rare/new, you'll be poked/prodded by specialists all over the place trying to figure out what it is - although if its something new, that may not help since it can take a while to figure out how to treat something!)
The big thing we agree on seems to be that the insurance system is the problem. (I think both sides of the last election even agreed on this). The difficult question is how to resolve it - and that's probably where we disagree. I prefer a "public option" for baseline insurance, with the option of buying more (this works pretty well in the UK, and BUPA - one private option over there - is doing fine) - simply because I want as many people to get care as possible.
I also think insurance needs to go back to its roots. Originally, insurance was based on pooled risk - that is, premiums have to cover all likely payouts, a small profit, and not much else (in fact, early insurance programs date from the industrial revolution, an extension of community-run credit unions).
Currently, when you go through a procedure: your claim is processed by a medical billing company (who take a cut), by the insurance claims department (who take a cut), by the insurance payables department (who take a cut), and then a small portion of your money goes to the doctor.
I like doctors. I'd much rather that my money goes to a semi-non-profit* insurance company, who keeps it in the pool - and writes a check to the doctor when I make a visit, without taking a large cut!
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