Alison, yes, I do. It's not that many years ago that mammograms were not covered by insurance. Insurance companies are not benevolent organizations. They are in business to make money and their policies include only what they are required to include. It's nice to think that cancer screening is something you wouldn't want them to leave out, but all cancers? Or just the more common ones? How about birth control pills? I'm sure Viagra will be covered? The fact that there are no noises being made by health insurance companies in opposition to this bill immediately raises a huge red flag.

Insurance companies exist to make a profit. Healthcare delivery is, in the 21st century, considered a basic necessity of life. Therefore, it should not be left to the vagaries of the free-enterprise system.

What would happen if police forces were privatized, and each person or household had to pay individually for protection?

julies, you mentioned smueller's reference to the Fraser Institute. Just a cautionary note: the Fraser Institute assembles and publishes facts that support their view of how Canada should be organized.

While it is true that there are unreasonable wait times for some procedures in some provinces in Canada, do not rely on the Fraser Institute to provide anyone with complete or unbiased information about anything.

Anselm

kswl -- Are you then advocating that we transfer all provision of health care to the government? How will that make the situation better? In Canada it is a crime for a person to seek medical treatment outside of the government's medical system by paying out of their own pocket, even if the person has the means to pay. It is looking more and more like Canada will go to a two-tier system in the future because of all of the obvious problems (including lawsuits) caused by their current system. Who wants to wait a year for a hip replacement?

Of course insurance companies want to make a profit. Allowing people to buy health insurance across state lines will require the industry as a whole to become more competitive in order to survive. So we should see less profit for profit's sake.

Barbara -- Again, I don't buy the doom and gloom scenario that you talk about. I just want to have access to the insurance that people in Iowa and Wyoming currently have access to.

Allison: No, I do not advocate the transfer of healthcare <i>provision</i> to the government, but rather that the government, in the form of a Medicare type system, be the single payor. Medicare does a pretty good job of keeping costs down--or would, if Congress would stop voting huge increases in coverage. The prescription bill is going to astound everyone.

The Medicare-type system would provide basic services. Others could be added on by paying a tariff or by purchasing them from a private doctor.

You said, <i>So we should see less profit for profit's sake.</i> I think you are terribly naive, or have some ties to the insurance HMO industry.

kwsl -- I am neither naiive nor do I have ties to the insurance industry, and I would prefer for you to not insult me.

Ok, Allison. I ask you---for what other reason is profit, if not for &quot;profit's sake&quot;? Would there be an insurance company in existence if it were not making a profit &quot;for profit's sake?&quot; The whole notion is absurd. If you think insurance companies, or food companies, or any other type of business is in business for any reason other than profit, you misunderstand our free enterprise system. I am not knocking capitalism. However, as a nation we have agreed that access to some services is a basic necessity (police, education, armed forces) and therefore should operate outside of the free enterprise system. This prevents higher costs due to a corporate mandate to make a profit and the consequent restricted access by ability to pay.

Sorry, I don't mean to be insulting. I believe your statement is naive.

kswl, I don't agree either.

Police, Education, and Armed Forces all have sectors outside of the government run entities that are better run and more efficient. There are private out-sourced police, private schools, and out-sourced military. My brother is one right now in Iraq, as a police advisor training Iraqi police.

Right now the government controlled hospital in Chicago has a 6 to 7 hour wait for one perscription to be filled. They have a line that stretches for almost 2 blocks without chairs. It was featured on our news last night. You have a whole lot more faith in government than I do. We can't even get our Motor Vehicle Dept. to run in a manner that gives service to the citizen.

&quot;all have sectors outside of the government run entities that are better run and more efficient. &quot;

Sure they are better run and more efficient---they have weeded out the high-cost problem cases and situations. Most private schools in our area have an entrance exam that must be passed for admission. Insuring that they have students of a minimum competency means they can do &quot;more&quot; with those students, sometimes with less money spent per child than the local public schools. It isn't a fair comparison of efficiency, obviously, between the two systems. And the government system is designed to provide a basic threshold of services. Of course a person can hire a bodyguard if he or she feels threatened. And people can send their children to private schools. But there must be some basic level of service that is available regardless of the individual's ability to pay.

It's interesting how married many people are to the idea of free enterprise, especially in health care, but wonder why the &quot;rat race&quot; seems to be run so much faster here than in Europe. (Not personally directed at Allison or JJ5, by the way.)

I agree with kwsl. Part of the reason for high cost in insurance coverage is the layers of bureaucracy, with each layer making its own profit. One central payor removes all that. Medicare is run very efficiently. The prescription thing is the exception,and that is because it was designed to make profits for pharmaceutical companies, rather than make the meds easily available to the people who need them.

As far as I know, there is no privately run military in the US. We are not talking about Iraq, which is a whole other debacle. And I suppose you could call private security firms the same as private police, but do you really think they're better than regular police? Not all public schools are badly run. You really cannot compare public and private schools until all private schools are required to admit all the same kids, and parents, the public schools have to take.

kswl, I was writing my post while yours posted. I had to stop and do something else in the middle!

Anyone who believes that the British and American gene pool are essentially identical knows little about America. This is a commonly encountered European stereotype of the US. America is far more racially and ethnically diverse than any European nation. Britain is typical of Europe in that most of its ethnic diversity is derived from a relatively limited part of the world (mostly former sub-Asian colonies).

In any event, life expectancy in the UK is only marginally greater than that in the US. The difference is small enough that a wide variety of factors could tip the balance. Homocide rates, for example, which predominantly affect young males and therefore disproportionately skew life expectancy statistics.

This discussion also ignores an important point - longevity is not the sole objective of contemporary healthcare. Quality of life is also important. Whether it's waiting three months versus two years for a knee replacement, or access to the MRI that reassures that a persistent vision problem is not the onset of Multiple Sclerosis, quality of life is dramatically influenced by readily available diagnosis and treatment. In addition, many US healthcare plans cover (at least partially) non-life-threatening issues that significantly impact the quality of life, such as fertility and impotence treatments, cosmetic procedures, mental health counseling, etc.

Since the earliest days of Blue Cross and Blue Shield, when Americans and their employers bought health insurance directly from local hospitals and doctors, US healthcare has been fragmented. This pattern persists. Today, some Americans are covered by their employer, some purchase their own insurance, some fall under federal coverage, some are covered by the Veterans Administration, some (mostly young adults) voluntarily gamble on the likelihood that they will not need coverage in the immediate future, and some desperately seek coverage but simply can't obtain it.

Depending on the precise definition of &quot;uncovered,&quot; 10 to 35 million Americans fall through the healthcare cracks. All Americans over the age of 65 are covered by Medicare, but unfortunately there is no blanket coverage for children. The only politically viable solution is to fill the cracks, rather than force everyone onto a one-size-fits-all plan, which the majority of Americans would reject because it would represent a step down.

Finally, the simple fact that Canada has criminalized those that seek, at their own expense, better healthcare alternatives than those offered by the state speaks volumes about the dark side of socialized medicine.

I don't believe that Medicare holds down costs. My mother lived with us through her terminal illness, and I had to handle to bills as she was no longer capable. Midicare nominally limits payments, but the health providers have learned that by hiring a lot of claims facilitators, they can grow fat off Medicare. My mother had a virtual free ride, but for prescriptions, for which there was a copayment. She was subjected to far more procedures than she would have undergone had she been able to express herself, much less had she been paying for any part of them.

I read an article a while ago about some physicians, in rural areas, who dealt only with their patients; they wouldn't hire the staff necessary to deal with insurers or government payors, and as a consequence were able to make a living while charging very nominal fees. Granted, the article ignored situations where high tech procedures would be used, and one of our problems is that high tech procedures are becoming more and more routine, as we try to prolong our lives.

As to whether some people would opt for insurance that doesn't cover certain items, such as cancer screening, the answer is absolutely yes. When I worked, my employer offered a wide assortment of policies, some of which were very bare-bone, but were also very inexpensive. It was common that new employees would select the lowest cost option, or even forego coverage, then later, as they aged and became less confident of their invulnerability, they would switch to one of the full coverage options, and pay the higher price. When the universal coverage advocates wail about 45 million people having no coverage, they don't tell you who all those people are. I think many of them are young people in part-time jobs who don't want to pay for coverage. In fact, I'm pretty certain my daughter as a student was one of those, as her vacation job at a bank didn't offer coverage; that she was still covered on my policy would just be an inconvenience to the universal coverage advocates, as they need big numbers to support their claims.

clevelandrown, while agree with some of your statements, I disagree with your opinion about the number of uninsured. &quot;They&quot; do tell you that most of those people are employed in low-paying jobs which do not provide health insurance, such as at Walmart. Rents are high, food is getting more and more expensive - I just noticed a couple of days ago that prices for many items have gone up dramatically, which must be a direct result of the cost of gas going up- and there is no money left over for health insurance. It's just not even an option.

Yes, I am totally married to the idea of free enterprise doing a better job. I have personally seen the other up close and personal, both in Italy and in Germany where I have relatives.

You don't have to be a member of the rat race if you don't want to. There are persons in my small Michigan town who opted out and get county health care and affordable minimal hospitalization insurance.

There are mercenaries, and many countries use them.

As I have aged the tests &quot;required&quot; for my preventive health profile have increased to the point where I need a vacation to take tests. Some here would consider all these tests to be absolutely essential. I do not. I would much rather pick both the insurance and the doctors I want and be in control of my own health care. I will never join an HMO, as I want to develop a doctor/patient relationship. AND IMHO, everyone I know who goes to an HMO tends to use the system way too much because they are not charged by time or visit. And if needing specialist, their wait is always MUCH longer than mine. And that is here, in the USA right now.

MANY Americans feel just like I do.

In actuality the uninsured in USA
do get health care, and sometimes better than what I can pay for. And sometimes not. And sometimes it is slightly deferred. And sometimes they do NOT lose any of their assets at all.
I know one family with tons of insurance that have still had to spend most of their assets on a child's chronic illness. And a person who is paying off a $300,000 hospital bill for an uninsured car accident- leg (numerous orthopedic surgeries)that occurred when he was 20 at $5 a month for his lifetime. That's affordable to me. All kinds of options are available after the fact.

What you do and when is most of the medical assessment/process- and it is totally dumbed down to minimums and delayed even then, in the governmental systems I observe. And instead of excellence, you get a lower common denominator practice across the board.

Yes, there are mercenaries and until recently the countries that used them were third world-type countries. Now the US is using them and this is not good.

As none of us know what tests you take, and don't really care to, why would we have an opinion about the necessity of taking them?

I think you really don't understand HMOs as you've apparently never used one. I do not have an HMO, but my kids do. They can see the same primary care physician, or, if I choose, one of his partners. There is no wait for specialist care because of the HMO. My daughter, unfortunately, sees a whole range of specialists regularly and all of them are very busy. Also, anyone using an HMO pays a co-pay for each visit. These vary a lot, my kids' is $25. The co-pay for the ER is $100 if they are not admitted. Generally, the premium for HMOs is higher than for PPOs.

Yes, the uninsured in the US do get health care and the cost of that is borne by everyone, in higher insurance costs. Hospitals charge the uninsured at a much higher rate. It would be much better if there was a basic level of coverage available to everyone, paid through taxes, then you would be free to add on whatever superior (though they're probably not)services you choose? As somebody further up said, this is how it is in the UK, and I have personal knowledge of that system. I know that my family in the UK does not think their system is &quot;dumbed down&quot; and in fact think it's much superior to ours.

No, I'm not in an HMO, and I have the choice to be, if I'd prefer that. But I have seen enough with my sister's family and especially one BIL to not be at all tempted.

He was &quot;disallowed&quot; a doctor/specialist not in his system and now has neuropathy from the herniated discs that resulted from no proper treatment in the proper time frame. He is on disability for the rest of his life, WHICH ended up being MORE expensive for all of us who pay into that system.

And 2 of her three kids have developed a &quot;doctor&quot; habit of running to the office every time they have a bump or scratch. They take antibiotics at the first sign of colds etc. These HMO's pump out antibiotics to people like a fountain. That's why most no longer work for the germs they were produced to eliminate. In fact, all American MD's give out antiobiotics way too much, because it is a pro-active billable response.

Historically many, many countries fought with mercenaries, Great Britain and the Dutch especially. Even Rome did when their own recruits did not seem up to snuff. They were not 3rd World countries. I'm not saying it was a good tthing or a bad thing- but it was and it was the most efficient response for that time. Not all armies are or ever have been just governmental. What government is al qaeda's army part of? Looks like they may have cut out the middleman, as well.

Governmental bureacracy increases cost at every level of service. The costs incurred by the non-insured are large, but not as large as the costs incurred to the entire entity by disability, malpractice suit payoffs, and the costs of malpractice insurances by the doctors themselves. Do you think that the meager $50 a month a poorer worker could afford would actually be a drop in the bucket of what he/she would ultimately use? Hardly. The numbers and economics just don't work, especially when you consider all the non-citizens using the system and numbers of frivilous and exhorbidant lawsuit wins that the doctors have to ever escalate themselves against.

If anyone should want &quot;free&quot; universal health insurance it should be me, because that is the primary reason I will have to work the next 5 years. But I know enough economics to know that it will not work to most Americans' satisfaction or standards.

RufusTFirely,
I have to disagree with you about expensive treatments not being covered by socialized medicine. My mother-in-law received dialysis 3 times a week for over nine years and never paid penny one for it. This on Ontario's medical system. Also, organ transplants are performed here, also covered by our medical system.

Plus for seniors (over 65), most prescriptions are covered by a flat cost of $2 per prescription. Out of the 6 medications my mother takes, only 1 is not covered.

What DOES irritate me are people going to emerg pr a doctor for colds, sniffles, bruises, what I think of as stupid things. That's where a user-fee for hypchondriacs would be a good thing!

I'm really impressed with the calm tone of this discussion (and frankly thought Fodors would have pulled it long before now).

I do want to correct one statement that's been made a couple of times......Canada has not criminalized the private provision of various health care services - that's a very misleading statement which leads to images of people being carted to jail for buying an MRI.

In actual fact there's a dance happening between the federal and provincial governments regarding provision of services under the Canada Health Act (if I kept describing it you'd all fall asleep).