Mutt, I'll answer your points of hopeful consensus from the point of view of the system we already have in place here. OK? You might be able to use it for ammunition, if you want to do some positive lobbying.
1. When you are sick you should be able to see a doctor (with no insurance, now, the only way you get to see a doctor is in the emergency room and they only have to treat you if it is a life-threatening condition)
We still have the ER option, but most people do this either because it's THAT sort of problem (injury, for example, likely to need X-rays or other hospital-basedtests) or there isn't a GP available (long weekend, or holiday period when GPs are overworked). ER visits often require a long wait, dpeending on demand. Triage is applied, based on urgency. I've been taken to the hospital by ambulance and gone straight in but still had to wait for a doctor to see me because I was assessed as not in as much urgency as, say, the suspected heart attack victim admitted at rthe same time. Our hospital system is still overloaded, we still need more money spent to keep our hospitals upgraded, currently our hospitals are administered by the state health and our new federal government has threatened to permanently take over hospital administration for all states. The state governments don't want this, but most of the population (including health care workers) do.
2. People who have insurance and are happy as clams should be able to keep what they have.
We have this option. But everybody's public insurance (our Medicare) pays for basic health care, GP visits, specialist visits etc. All the private health care covers is perhaps a higher level of hospital care as an option; some preventive medicine in terms of gym memberships and equipment; optical, dental etc. Everybody pays for the public system according to what they can afford, because it's administered trough our taxation system. If you don't pay tax, you don't pay for health care. If you pay a lot of tax, you pay even more if you choose to NOT have private health insurance as well. Past a certain income level, it's cheaper to also have private insurance. This was a deal the government struck with the private health industry, to ensure they wouldn't go broke from lack of memberships.
3. Nobody should be making huge profits from my being sick and dying.
That is always going to be a problem, because we live in a free market economy. You can still get people trying to exploit whatever system is in place. For example, we have doctors who have heavily invested in pathology firms. OK, our HIC computers are constantly watching for doctors ordering too many tests, but they don't interfere with a doctor making sure that the tests he DOES order, are always sent to the labs he owns. You can get similar arrangements with doctors having shares in private hospitals, in radiology labs or in having 'arrangements' with colleagues to cross-refer. Some of the arrangements get flagged by the HIC computer, but if the referrals check out as having been justified, then they get away with it.
4 We should rate higher than 37th in the world (if you believe some studies) in quality of care received when we pay twice as much per capita than any other country in the world.
Is the US as high as 37th?
5. Neither the insurance companies nor the government should have the right to overrule decisions by doctors about what care is appropriate for patients.
Unfortunately, someone has to do this because especially when you get a health care system like this in place, there are A LOT of doctors who will rub their hands with glee, say, "You beauty!" and start making money hand over fist. I mentioned in an earlier thread how this scrutiny works for us - it is a governemnt department which has the responsibility for scrutiny.
If private industry (ie insurance companies or a collaboration of them) is responsible for supervision, scrutiny and discipline, then you have the similar appalling cases you have told me of (which I find horrifying). We don't have these problems here. The scrutiny decisions are not based on economy, although they are driven by the need to cut costs due to fraud or unnecessary over-testing. But if a patient has serious and expensive health problems, as long as the tests and treatment are recognised as the appropriate means by conventional medicine, then it happens. A child diagnosed with leukemia, who needs expensive treatment - he will get it, through the public system. However, if the recommended treatment is one not yet available in Australia because although it's been tested in Europe or the US, the testing hasn't been completed in Australia - then it gets expensive. And in most cases, if they have private health insurance (which in our country is far less expensive because it doesn't have to cover so much) the medication will be at least partly covered. We also have the option of petitioning the appropriate governemnt body to ask for exceptions to be made. And if that fails (and what we're talking about here is really rare, as in maybe one in a million) then the family can petition a charity or welfare group for help.
But unfortunately, you must have some scrutiny, and a free health system is never free. It has to be paid for out of taxation (at some level) and to prevent the budget blowout due to opportunistic doctors, there needs to be supervision and discipline. So there will be limits. But in general, those limits should ne vastly better than what you have now.
6. Preventive care is cheaper than caring for somebody after they are seriously ill; somehow we should find a way to pay for people to see a doctor before they are half-dead.
Definitely. And this should be built in. In Australia mammograms are a cost which can be claimed back form private insurance. However, if you are female with a family history of breast cancer or if you are over 45 then you get a free mammogram annually. There are similar services available plus we are encouraged to have regular checkups. Doctors are required to check blood pressure at every appointment (although a lot don't do it when they should).
7. People who have worked all of their lives and paid their bills and tried to do the right thing should not be forced into bankruptcy by an illness.
Amen to that. Again, we have that in our system. Aged care especially is an issue for us, since in Australia the average age of the population is increasing. We already have almost half the population over 60, which leaves the oter half paying for the pensions of their parents out of their taxes. So some years ago, our governments pushed for compulsory superannuation, so people wouldn't need the government aged pension. But people over a certain age get extra health concessions, on top of our basics. For example, not all our doctors 'bulk-bill'. But people on aged pensions generally always get bulk-billed. We have choice of GP so if we need it, we can find ourselves a GP we're happy with and who bulk-bills. That way there's no cost up front. For GPs who don't bulk-bill, the majority of the cost is still paid for by the government. It's just a bit more awkward re paperwork (the government pushes towards bulk-billing because it saves them money - they only pay the doctor 75% of the schedule fee that way).
8. Just because you are young, or old, or of a different ethnic or religious group does not mean your life is worth more or less than anybody else's and you should be able to get care no matter what.
Exactly. We have laws to enforce this. I think you have too, but laws of commerce can sometimes seem to override these laws of antidiscrimination and humanity.
I really wish you all success in this. Please feel free to use any of my information to help lobby to get a better system. Just check the accuracy - I said earlier that doctors bulk-billing get paid 85% of schedule fee. It used to be the case, but it has been cut back, husband told me. The schedule fee is set by the AMA (or similar) but the government reserves the right to refuse to acknowledge an AMA rise. So there are brakes on costs in the system.
Yours is a bigger country tan ours, in terms of population. It is going to require a great deal more coordination in administration and I'm just waiting for the screams to begin from the objectors, over the associated loss of privacy and need for government supervision and controls. "George Orwell!" is going to be heard from the rooftops.
But if this is to happen, if the US is to get a good, nationalised health care system, you WILL lose some freedoms. Hopefully they will be ones you will be happy to hand over, as not being a concern unless you plan to break the law.
I'm trying to paint a realistic picture, not a rosy-hued one. We do have problems. But compared to yours at the moment, we've got it good. It's hard for me to find problems that you in your desperation would find a concern now. Just remember what can happen when you give the fox the keys to the henhouse. Just make sure that fox is a vegetarian. Or that the analogy won't hold. Analogies are generally oversimplifications anyway.
Marg
