Public Option Defeated?

[Monroe]

However the test to detect said tumor is the sort of thing you can get done in the US the same day your doctor suspects something, and that you have to wait a couple months for in the UK/Canda and hope that things haven't progressed by then to the point where you die.

Riddle me this, what if you DON'T HAVE A DOCTOR because you can't afford it?! Rochey to answer your question. In the US if you're poor and you have a brain tumor you die. End of story. Happened to a bitch of a boss at my old job. She actually had health care but her insurance wouldn't cover the scans.

As for bankruptcy, as an FYI it isn't nearly so bad. Or at least wasn't, it might be getting worse with the banks failing. Last I knew of things you only needed a decent credit rating for the sort of jobs that, if you qualified for them, you should have health insurance. And generally the same for Apartments. And getting your credit rating back up simply required getting a loan on a crappy car (which they'd give to anybody at least somewhat recently), or get a credit card with horrible terms. If you actually make the payments your rating heals to decent levels fast.

You need credit for a job, a car, a place to live, hell student loans. If you're bankrupted none of that matters. It takes, in Missouri, 7 years for a credit hit to fall off your record. Other states it never falls off. In those 7 years you can't get a decent job (to get that health insurance that would have saved someone from bankruptcy), you can't get a car, you can't get a loan. Hell you can't even go to college.

Surviving an injury or a disease ruins your life. How ironic is that?

[Tsukiyumi]

...Some people are just trying to make it in the world then get stuck with a $20k bill. How is that right to treat our citizens like that?

My mom and I caught some sort of unidentified pneumonia about three years ago; she was in the hospital for a week, and I could barely manage to take a shower (I did power through a mile walk to go see her in the hospital though - doctors told me they weren't sure she'd live, and I should go see her while I had the chance).

For some antibiotics, a breathing machine, oxygen, and the isolated room, she owes $60,000. Her credit is toast, and I'm the one who has to sign for anything now.

getting your credit rating back up simply required getting a loan on a crappy car

I have a car. Why would I "get a loan" for something I don't need?

...or get a credit card with horrible terms.

That's an excellent idea: I'm being robbed by healthcare, so in order to fix my credit, I need to get robbed by a credit card company? What a great system. Best in the world.

[Mikey]

You can get all the credit cards you want - it's definitely a starting point, but what the lenders say is "no loan of comparable size since re-establishing."

[Tsukiyumi]

..."no loan of comparable size since re-establishing."

Odd.

I know that's in English, yet I have no idea what the hell that means.

[Mikey]

Lately, especially, lenders (at least for auto loans) look at prior history in both size and quality. That is, if you have a few credit cards and pay them all like a champion, they'll still turn you down for not having had a debt of comparable size to an auto loan.

Hell, lately we've had people with what would be considered perfect scores get turndowns because of things like the amount of current outstanding debt, percentage of debt on revolving terms, or total debt-to-income ratio.

[Tsukiyumi]

Lately, especially, lenders (at least for auto loans) look at prior history in both size and quality. That is, if you have a few credit cards and pay them all like a champion, they'll still turn you down for not having had a debt of comparable size to an auto loan.

Hell, lately we've had people with what would be considered perfect scores get turndowns because of things like the amount of current outstanding debt, percentage of debt on revolving terms, or total debt-to-income ratio.

No comment.

[Aaron]

Lately, especially, lenders (at least for auto loans) look at prior history in both size and quality. That is, if you have a few credit cards and pay them all like a champion, they'll still turn you down for not having had a debt of comparable size to an auto loan.

Hell, lately we've had people with what would be considered perfect scores get turndowns because of things like the amount of current outstanding debt, percentage of debt on revolving terms, or total debt-to-income ratio.

My bank of over a decade (not that it matters) turned me down for less then 5000$ even though I "have excellent credit" because as the dude put it "we've got no money to lend". Figures that I finally repair my credit and I can't get anything cause the bank is hanging onto it's cash like a two dollar hooker visiting her pimp.

[Monroe]

"we've got no money to lend".

Maybe they had a trip to the emergency room?

[sunnyside]

In theory at least the banks being tightwads thing should return to, perhaps not the insane hieghts of the housing bubble where a five year old could probably get a million dollar house, but at least a more "normal" situation.

@Monroe. I'm getting the feeling that while you perceive hard times ahead you might have grown up accustomed to more money than me. While some fancy apartment building with an office full of young attractive secretaries will run your credit, if you're renting a room in the basement from some guy (or even a house in some cases I've seen), they often don't bother. Same with jobs. Many job oportunities where I come from don't care if you're legally allowed to work in the US, or speak english, much less if your credit rating is bad.

Where you can get into trouble is possibly where you are at. You've got a degree and the potential for a solid job that would provide health insurance. But if you have something bad happen while uninsured it could wreck your credit when you declare bankruptcy to get out of debt and thus hurt your chances of that sort of employment in an already bad economy, especially for your majors. That's why I suggest you get some short term insurance even if you couldn't afford it indefinitly. The idea being to get a decent job before you run out of cash (or get more part time hours).

Remember there may not be any help for you no matter what bill passes. Especially since I've heard that even if passed they wouldn't come into effect for some time (I heard 2013, conveniently after Obama would be done running for his second term).

Gotta run, I may reply to more later

[Sionnach Glic]

I'm not sure, but I bet it involves a lot of paperwork and phone calls. However the test to detect said tumor is the sort of thing you can get done in the US the same day your doctor suspects something, and that you have to wait a couple months for in the UK/Canda and hope that things haven't progressed by then to the point where you die.

Okay, and do you have a source for the claim that, if your doctor suspects you have a brain tumor or such, you have to wait weeks/months to get it checked out?

See, this is where the term "emergency procedure" from your earlier link becomes important. What does it define as an emergency? Personaly, I'd say having your doctor agree that you may have a brain tumor counts as an emergency.

Also, as Monroe points out, what do you do in the US if you can't afford to see a doctor?

And again I stress that with MRIs and Angiograms calling their use "elective" is a bit of an abuse of the english language, even if in some sense it is technically true. Botox is elective. Getting your insides checked out is something you always want if your doctor thinks it can help keep you alive, it's just a matter of whether you can get it.

Indeed. And if you're poor in the US, you don't get it at all. Whereas if you're poor in the UK or Canada, you (worst case scenario) wait a month or so before getting it checked out.

Let's see, one is pretty much certain death, one is a possibility of death if the tumor is serious. I think I know which option I'd choose.

[Aaron]

Also, as Monroe points out, what do you do in the US if you can't afford to see a doctor?

You die.

A number of years ago Alberta passes a law allowing private clinics (private as in the American sense) and IIRC within a year they were begging for money to stay afloat, cause as it turns out most people would rather wait then shell out thousands.

Quebec has private MRI/Radiology clinics where you can pay if you want. VA suggested I go there and plunk down 3000$ so I don't have to wait my turn for a non-emergency MRI. I told them to "fuck off".

[Monroe]

In theory at least the banks being tightwads thing should return to, perhaps not the insane hieghts of the housing bubble where a five year old could probably get a million dollar house, but at least a more "normal" situation.

Agreed there.

@Monroe. I'm getting the feeling that while you perceive hard times ahead you might have grown up accustomed to more money than me. While some fancy apartment building with an office full of young attractive secretaries will run your credit, if you're renting a room in the basement from some guy (or even a house in some cases I've seen), they often don't bother. Same with jobs. Many job oportunities where I come from don't care if you're legally allowed to work in the US, or speak english, much less if your credit rating is bad.

Yes if I wanted to wash dishes all my life. Boy that would be great wouldn't it? I went to school to edit film for $50 an hour but why bother hunting down a job that pays 100 grand a year when I can wash dishes at El Generico Taco all my life. Gee golly that makes everything seem a-okay.

Where you can get into trouble is possibly where you are at. You've got a degree and the potential for a solid job that would provide health insurance. But if you have something bad happen while uninsured it could wreck your credit when you declare bankruptcy to get out of debt and thus hurt your chances of that sort of employment in an already bad economy, especially for your majors. That's why I suggest you get some short term insurance even if you couldn't afford it indefinitly. The idea being to get a decent job before you run out of cash (or get more part time hours).

That's not a bad idea except for one thing- why go into the red with no end in sight? You're arguing going into debt (maybe not in the economic sense of no money but going into the red in cost compared to money coming in) when there's no end in sight. Sure I'll get a job eventually but that might be a few years from now And I might decide to go to grad school. Do I just don't figure out how to feed myself until I'm through?

Remember there may not be any help for you no matter what bill passes. Especially since I've heard that even if passed they wouldn't come into effect for some time (I heard 2013, conveniently after Obama would be done running for his second term).

Meh it would still be relief. If it passed in the 90s I would have it now. If it passes now I might have it when I need it.


So I was thinking of examples on how it works in the US and I was thinking about the public health clinic here in town. So I had a UTI and was paranoid I had something so I went to get my STD screening is one of the few things I do because I just lie and say I don't have insurance. I waited about a week for my appointment, they tested me, and two weeks later I got my negatives. If the tests were positive I would have gotten free counseling and free care. The paper work I had to fill out? Besides the survey on my sexual past I had to tell them my address. Gosh.

How does that compare to what happens if I went to a private insurer? Make an appointment least a week in advance? check. Wait two weeks for the blood tests? Check. Its was exactly the same care. Only difference is the public health clinic was a bit dirty inside. But not being able to afford janitors helps.


In America you need a few things to go from rags to riches. Smarts, motivation, a will to succeed, and never ever EVER get sick.

[sunnyside]

That's not a bad idea except for one thing- why go into the red with no end in sight? You're arguing going into debt (maybe not in the economic sense of no money but going into the red in cost compared to money coming in) when there's no end in sight.

Because if you do have something bad happen than the El Generic Taco problem starts looming large. Up to you, but you're taking a risk.

Remember there may not be any help for you no matter what bill passes. Especially since I've heard that even if passed they wouldn't come into effect for some time (I heard 2013, conveniently after Obama would be done running for his second term).

Meh it would still be relief. If it passed in the 90s I would have it now. If it passes now I might have it when I need it.


@Rochey. No, they don't break MRI usage down by condition. Though I htink the cardiogram paper is pretty clear cut. And I really doubt the problem is a bunch of Brits and Canadians that have MRIs done just for the laughs.


Anyway I do want to make it clear that I do support the idea of health care for all, given the right conditions and requirements.

But I get the feeling a lot of people don't care what the plan is like. So long as "universal health care" or "public option" are in there than forget the details.

Now I know there are something like a half dozen plans floating around. But as I understand it part of the public option in at least some if not all of them is an ability to, like with some of the other government health programs, dictate to hospitals how much they can charge for things. And they're taking some similar shots at what drug companies can charge.

Imagine if there was, I dunno, nationalized food plans. Everybody gets to eat at any resturant they want to, and order anything on the menu, but the resturants can only charge $2 per meal. Think of what the menus will look like. Same basic idea here.

I also don't like the idea of turning the screws more on businesses with the proposed penalties if their health options aren't good enough during a recession. Sneak that in there when we're starting to climb another bubble.

And there are some other things. But honestly I'm not an expert on the plan. However I think part of the problem is that few if any people are. Granted that's in part because of its changing nature.

[Lazar]

Now I know there are something like a half dozen plans floating around. But as I understand it part of the public option in at least some if not all of them is an ability to, like with some of the other government health programs, dictate to hospitals how much they can charge for things. And they're taking some similar shots at what drug companies can charge.

That's a good thing - as it is, many people are subject to exorbitant and variable prices. Another problem is that Medicare is uniquely prohibited from negotiating prescription drug prices.

Imagine if there was, I dunno, nationalized food plans. Everybody gets to eat at any resturant they want to, and order anything on the menu, but the resturants can only charge $2 per meal. Think of what the menus will look like. Same basic idea here.

The difference is that food is a regular, predictable, low cost need. People don't buy food insurance, and they don't have to worry about suffering a catastrophic craving where they need to buy tens of thousands of dollars worth of food to stay alive. And your example is hyperbolic because no one is proposing making all medical procedures anywhere near the same cost. Reduce crazily inflated medical prices, yes.

[IanKennedy]

Does this take into account the number of available machines in each case? It would make a massive difference in these figures.

But the fact remains that the US has the most expensive health care system of any developed country and doesn't get the results to justify it.

Alright, so everyone seems to be talking about this. Republican talking heads have been acting like it'll kill us all, Democrats act like so long as it's nationalized health care it's just as good as the US system even in some backwoods African/South Asia country with a life expectancy in the 30s.

So I poked around for some info. Little hard to find stuff. But I did find numbers for MRI wait times.

Uk wait time 7.5 weeks average
http://www.privatehealth.co.uk/news/jul ... -ct-scans/

Canada 10.1 weeks 2007
http://www.cbc.ca/health/story/2007/10/ ... raser.html

United States 0 wait. That's how it had been in the limited instances it's come up with family members. But, while the US doesn't do studies (because there isn't much to study I guess) I found info on New York. It wasn't a question of wait times for an MRI machine, it was a question of how long the hospitals bothered to staff them and how utilized they were. So if you need an MRI done there is likely a machine around not in use.
http://www.myhealthfinder.com/hcac/MRIreport03.pdf

While at that I also found a good study (from Sweden it seems) comparing wait times for US Veterans hospitals, regular US hospitals, Candadian, UK, and Sweedish hospitals.
http://dx.doi.org/10.1016/0735-1097(94)00442-S

(you can click on the pdf option for full text, scrolling down it's pretty well spelled out in the figures)

Suffice it to say I hope I'm inside the US if I ever need a coronary angiography, electivly OR urgently.

One interesting thing there is the VA hospitals are notably worse. Also it seems hospitals with larger percentages of HMO business are worse on MRIs.
http://content.healthaffairs.org/cgi/reprint/17/5/195

I wanted to find something about a newer procedure, but I'm not a doctor and don't know what is really cutting edge. Any of you are welcome to look around yourselves, but I think we all know what the general trend will be. I started looking into minimally invasive aortic aneurysm surgery, looks like Canada might be a bit backwards there.
http://www.biomedcentral.com/1472-6963/7/182
And the US certainly has a lot of places that do it. But maybe everyplace actually picked it up last year, I really don't have the time to look right now.

Point is. The US system IS significantly better * Though I don't know about outcomes. We're also the fattest nation. So maybe having a long wait time is balanced out by a few dozen Wendy's Baconators


*when you have decent insurance handled by a private company.

If we had a single-payer system, it would cut out profits and marketing,

That, by the way, would be solved by the Co-op concept that is floating around now if you''ve seen it. As a non-profit member owned enterprise (which there are a number of in the US already which should make the Liberal Socialists happy) it wouldn't need profit margin beyond padding for hard times. And possibly wouldn't need marketing. Though again we're only talking about a couple percentages. Still, I'd consider joining something like that.

it would reduce needless duplication of equipment and personnel, and it would make the claims process much simpler because everyone would be covered for all necessary care, with no consideration of pre-existing conditions. And it would let us eliminate fragmented government health programs like Medicaid and SCHIP,

This stuff is possibly true, depending on exicution.

and it would take a tremendous burden off of American businesses because they wouldn't have to provide health care as a benefit.

Actually I believe the proposed laws all tighten the screws on business. Though conceivably you could create a plan that shifts all the burden onto taxpayers.

And last time I checked, public universities haven't put private ones out of business, and the Post Office hasn't put UPS and FedEx out of business.

Well, if someone decided that tax payers would subsidize the post office such that it always costs a buck to ship anything anywhere it would.

The primary difference in the comparison is that if you join up with a public university you can't just waltz into a class at a private university. If you created a system where, there are signficant differences in the standard of care between public option and private option people, than yes, you could probably create a system where you don't degrade the overall quality of care in America while providing reasonably priced care for all.

But nobody is really talking about that at this point in the US. Though I thought that things were more like that in the UK. I wonder why their wait times are so bad. Is it that a lot of people are on the state system and that's really bad while non state is actually good so on average they're just bad?