Healthcare Debate Thread

I just realized we don't have a dedicated Healthcare thread and if we do I missed it.

I started this thread because all of the nomination threads seem to end up on this.

I want to actually talk about Universal Healthcare pros and cons because most Bernie supporters seem to think M4A means everybody will have better service and healthcare.

I actually want Universal healthcare or single payer but It will not be the same and some people myself included it will not be as good.

So let's have a good debate and use facts and figures to drill down on the topic.

 

I will start with an interesting op ed about Canada.

https://www.investors.com/politics/columnists/canadians-high-price-health-care/

I don't take this at face value but there are some interesting figures in here.

Last year, Canadians faced a median wait of more than 21 weeks to receive treatment from specialists after obtaining referrals from their general practitioners. That's double the median wait time of 25 years ago.

Patients in some parts of the country had it far worse. The typical patient from New Brunswick had to confront a median wait of nearly 42 weeks — about ten months. Nationwide, for the first time, more than 1 million Canadians are waiting for treatment.

A recent analysis of health systems in 11 wealthy nations found that Canadians faced the longest wait times — and not just for specialist care. Delays for family care and emergency room treatment were also the longest among peer nations.

These treatment delays can injure or even kill patients. Long wait times were a factor in 44,000 Canadian women's deaths from 1993 to 2009.

Patients waiting for surgeries and other procedures often can't work. They may be in pain or have limited mobility.

 

Here is something else talking about the actual cost that Canadians pay for Healthcare annually.

https://nationalpost.com/health/how-much-does-the-average-canadian-pay-for-public-health


How much does the 'average' Canadian pay in a year for public health care?
About $5,789 — but it depends on what you think 'average' means. What you’ll have more trouble doing is deciding whether that spending represents a good value

Health care is perhaps Canada’s defining obsession. As a nation, we crow about it and complain about it. We deify Tommy Douglas, rage about wait times, fret over private clinics and fight campaigns on minute points of privatization.

But for all the endless studies, Royal Commissions and political bloviating, it can be hard to know how much Canadians actually pay for health care, not as a nation, but as individuals.

The Canadian Institute for Health Information (CIHI) believes Canada spent approximately $228 billion on health care in 2016. That’s 11.1 per cent of Canada’s entire GDP and $6,299 for every Canadian resident.

That per capita rate would put Canada near the high end of what other advanced economies pay. According to the CIHI, in 2014, the last year for which comparable data was available, Canada spent $5,543 per resident, more than the United Kingdom ($4,986) and Australia ($5,187) but less than Sweden ($6,245) and far less than the United States ($11,126).

Assuming roughly similar rates of growth, Canada will remain near the top of the tightly clustered group of wealthy countries that have strong public or mixed public/private systems in terms of per capita spending this year. (The primarily private system in the United States remains an outlier.)


But per capita is just an average. Not everyone pays the same. And figuring out what any individual Canadian, or even a representative sample of Canadian demographics, pays turns out to be a lot harder than it seems.

This week, the Fraser Institute, a Vancouver think-tank dedicated to small government thinking, took a thwack at the problem. Researchers at the institute used a proprietary system —the same one used to calculate the institute’s controversial Tax Freedom Day — to break Canadians into a host of economic tranches.

They then used their own calculations for the tax burden faced by each of those groups to figure out roughly what an “average” family pays for public health every year.

Their conclusion? The “average” Canadian family, consisting of two adults and two children, earning about $127,000, will pay about $12,000 a year for public health care.

Is that a lot? The Fraser Institute researchers think so. In their study, they paint a picture of out control health care costs growing at break neck speed (173 per cent over the last 20 years) compared to things like food (54.6 per cent) and shelter (93.4 per cent).

But not everyone agrees with their analysis. For one thing, the new study uses an old Fraser Institute system that critics have long charged vastly overestimates the tax burden faced by Canadians. For another, their definition of an “average” Canadian by income earned or income tax paid is not actually what a “typical” Canadian makes and pays, according to economist Richard Shillington.

A better measure than the average, Shillington believes, is the median. The average — the total taxes paid divided by the number of people in Canada — is pulled upward by a small number of individuals with a very high-income, he said. The median, the taxpayer in the exact middle of the sample, is a better, and considerably lower, estimation of what’s normal.

(Bacchus Barua, one of the authors of the study, points out that data for median earners is included, although it’s not broken down by family type. They calculate that an individual in the fifth decile of Canadian earners will pay approximately $5,789 in public health costs.)

 

You need to tell Bernie that because thats not what he is campaigning on.

The majority does not want the Bernie bill and a Bernie type president if they he would not have a problem cracking 35% nationally.

Let's debate the actual numbers and issues about healthcare instead of claiming what the majority wants or what you think is actually going to happen.

 

I thought this was a fair article on the difference between Canada and the U.S.


O Canada: What our neighbors to the north can teach us about health care reform

The stunning implosion on Friday of the American Health Care Act, the Republican Party’s replacement for the Affordable Care Act (Obamacare), may have been a defeat for President Trump and his party, but it certainly isn’t the end of the push to reform health care in the United States.

The repeal and replace drama has understandably captivated the American media for weeks. But it isn’t just Americans who are fascinated by the unfolding story. International media outlets have also been covering each moment, as the world watches mostly with what seems to be incredulity. For people living in just about every country making up the Organization for Economic Co-operation and Development, in which universal health insurance is seen as both a mundane fact of life and practically a right of citizenship, the AHCA proposal is downright odd.

Nowhere is the incredulity more pronounced than among our neighbors to the north in Canada. As two physicians who have practiced medicine in Canada, now working respectively in Toronto and Boston, we ask this question: Are there lessons that Canada can teach America about healthcare , particularly in this time of change?
There seem to be two answers to this question: absolutely yes and absolutely no. Some describe the Canadian health care system as an example of health care at its best, the pinnacle of equity and excellence. Others portray it as a failed socialist experiment, a disaster so unmitigated that people die waiting for care.

Neither characterization is correct. The Canadian system for health care is complex, just as is the US system. There’s no question that Canadians have achieved undeniable success, accomplishing the double feat of providing universal health coverage for medically necessary services at low administrative cost. It is not without problems, including the often-overstated but real issue of long wait times for non-urgent care. But it has by and large contributed to better health outcomes than the US system at lower cost — Canada spends 11.2 percent of its gross domestic product on health care, the US spends 17.6 percent. This success makes the Canadian example worth considering for the US, or at least learning from.

How has Canada been effective at providing care and containing costs? We suggest two main reasons for its success, both of which offer lessons for the US.

First, to Canadians, health care is more than a matter of money and medicine: It is an expression of core national values. It’s no coincidence that the late Tommy Douglas, the former premier of Saskatchewan who introduced universal public health care to Canada, was chosen by Canadians from across the country to be “The Greatest Canadian of All Time” in 2004. Simply put, universal health care has become central to how Canadians think about their identity. It reflects a national determination to take care of each other at moments of vulnerability, and to place well-being over wealth.

To Canadians, health care is more than a matter of money and medicine: It is an expression of core national values.

This national aspiration has helped Canada weather discussion and debate for decades about the right way to reform the system because there is broad agreement on the fundamental goals and values that underpin it. In other words, when there is national agreement on the fundamental importance of health care for all, the remaining debate is around matters of fine-tuning and making the system better. Such agreement has eluded Americans for decades, leading to the enormous national debates around the ACA, and now the AHCA.

We suggest that a broader national conversation among Americans about our collective responsibility for health as a public good is essential if we are to find a solution that transcends this political moment.

Second, the feature that has likely been at the core of the Canadian health care system’s success is a federal requirement to provide insurance to cover all necessary doctor and hospital services, which has been part of the plan since its inception. Although actually providing health care is decentralized to 13 provinces and territories, each of these regions is required to provide free point-of-care treatment to all citizens through one central payer that guarantees coverage for an agreed-upon package of essential services.

The health care plan for each province and territory is shaped from that core guarantee of universal public coverage, bound together by national legislation. That has buffered Canadian health care from multiple challenges. This central, long-established, and legislated imperative also encourages the organization of the provision of medical services, the elevation of primary care to a central role in care coordination, and the rational allocation of resources to ensure that everyone has access to the care they need at all levels, from primary care to advanced and highly specialized “quaternary” care.

The US is challenged on both of these fronts. There is no national agreement on the core principles that inform American health care, and no attempt has been made to create a single legislative linchpin around which all other elaborations revolve. Since the ACA was first proposed, little of the debate was focused on the core building blocks needed to create a high-performing health care system. Rather than tackle the existential question of why Americans need universal health care in the first place, the conversation centered around patches that have been stitched together to create the flawed but critical coverage network that the ACA provides. This led to legislative compromises and deals struck between interest groups, all administered by a range of disparate stakeholders.

To make progress on providing sensible health care, the US needs to decide what having a health care “system” means to Americans. Is it simply a way to coordinate the exchange of dollars for care? Or is it an expression of our highest aspirations, an investment in the well-being of our communities?

If it is the latter, America would make an historic mistake by dismantling the ACA. Instead, its citizens and lawmakers should be clamoring to take the next step toward structuring our health care system in a way that will allow for organized delivery of care.

Single-payer systems, like the Canadian version, or a single provider system, as seen in the United Kingdom and other countries, provides the means of bringing care under the umbrella of a single, accountable authority. This is neither socialism nor an attack on individual liberty. It is simply making a promise: to protect each other from disease and preventable harm, recognizing that our capacity to do so is perhaps the most meaningful measure we have of our society’s worth.

It is heartening that recent national opinion polls suggest that Americans are beginning to agree with that promise. It is also becoming clearer that Americans care more about health care for all than previously thought. We could certainly look to our northern neighbors for a workable example of how this feeling can be translated into healthier populations, and a system that is geared towards well-being.

 

And it seems Canada is having a debate about private clinics.

https://business.financialpost.com/...uld-benefit-canadians-and-be-boon-for-economy

 

I posted this in another thread but it should also be here.

https://www.vox.com/health-care/201...payer-private-health-insurance-harris-sanders

Private health insurance exists in Europe and Canada. Here’s how it works.
The debate over eliminating health insurance is actually offering a false choice.

By Sarah Kliffsarah@vox.com Feb 12, 2019, 7:30am ESShare this on Facebook (opens in new window)

An international perspective is helpful here. When you look out at the rest of the world — at the dozens of countries that run universal health care systems — you find that every universal health plan relies, in some form or another, on private insurance.

“Basically, every single country with universal coverage also has private insurance,” says Gerard Anderson, a professor at Johns Hopkins University who studies international health systems. “I don’t think there is a model in the world that allows you to go without it.”

Other developed countries routinely use private insurance to fill in the gaps of their public plans or to offer patients a way to get to see a doctor a bit faster. Some countries, like Australia, even take aggressive steps like offering tax benefits to encourage citizens to enroll in private coverage alongside their public plan.

“Each country has figured out its own role for private insurance,” says Robin Osborn, a vice president at the nonprofit Commonwealth Fund who studies international health systems. “In almost every system, it tends to not be controversial because the commitment to basic universal coverage is there.”

How other countries use private health insurance, it turns out, can actually tell you a lot about what countries value in a health care system — and how they think access to care ought to be organized.

The three ways other countries use private health insurance
When you look out at our peer countries, you essentially see them using private health coverage in three distinctive ways.

First, there are some countries that require all citizens to enroll in health coverage run by private insurers. These insurers typically compete in a market with strict rules about what they must cover and how much different medical services cost.

The Netherlands and Israel are good examples of this type of system. In both countries, citizens are required to purchase coverage from a private plan. Somewhat coincidentally, the Netherlands and Israel both have four dominant health plans in their private markets.

In each case, the insurers are required to cover the same set of benefits and cannot charge higher premiums for the sick. But they can compete along other dimensions.

“They compete on what other benefits do they offer, and the price of the premium too,” Osborn says. “Generally, though, people don’t switch insurance very much. They tend to stick with their plans for a long time, even though they have the option to switch each year.”

The benefit these systems offer is primarily about choice: In Israel and the Netherlands, patients have multiple options for where they want to seek health coverage.
Second, there are some countries where private insurance supplements public insurance. It’s quite common for Canadians and Europeans to purchase supplemental insurance that covers things that the public plan won’t.

Sometimes this takes the form of supplemental insurance to pay for non-covered benefits. In Canada, for example, two-thirds of the population takes out private plans to cover vision, dental, and prescription drug benefits — none of which are included in the public plan. Thirty-nine percent of Danish citizens carry private coverage for non-covered benefits including physical therapy.

In other places, this takes the form of supplemental insurance to cover the cost sharing included in the public plan. If you look at France, you see that 95 percent of the population takes out (or receives public subsidies for) private insurance to cover their copayments and deductibles.

Third, there are some countries where private insurance complements public insurance. In these places, residents buy private coverage to gain better, faster access to benefits that are covered in the public system.

Osborn points to England as an especially good example of this type of coverage. About 11 percent of the British population purchases complementary coverage that can get them faster access to specialty doctors or elective procedures.

“The UK is very committed to solidarity and equity in its health system, but at the same time, they are still very comfortable with this private insurance role,” she says. “I think it operates as a safety valve. People use it for elective surgery, for something like a hip replacement where there might be a long waitlist.”

Australia is another example of a country that has really embraced complementary coverage, to the point that 47 percent of the country’s residents carry private coverage alongside their public plans. The government actually encourages citizens to buy a private plan, offering tax rebates to those who enroll — and a lower lifetime premium for those who sign up before they’re 30.

Graphic: Javier Zarracina/Vox
Many countries combine these different types of private insurance too. In the Netherlands, for example, private plans run the basic benefit package — and 84 percent of Dutch residents purchase a supplementary plan to cover more benefits. Denmark has strong markets for both supplementary and complementary coverage, as do New Zealand and Australia.

Why we’re having a debate about eliminating private coverage in the United States
The debate we’re having around universal coverage in the United States right now often centers on the health care plan offered by Sen. Bernie Sanders (I-VT). His plan — which you can read a longer explainer of here — envisions government-run health insurance that covers a wide array of benefits including vision, dental, and prescription drugs. His plan has no cost sharing for patients — meaning you don’t pay a copayment when you go to the doctor, nor do you have a deductible to hit before your benefits kick in.

The Sanders plan permits supplemental private insurance, the type that covers things that the public system doesn’t. But because the public insurance plan pretty much covers everything, it’s difficult to see what role it would play.

Here’s the thing: None of our peer countries have built a health care system like this. Canada, France, England, Australia, and the Netherlands all run health care systems that have gaps in coverage.

Not one of our peer countries has found a way to provide health care that covers all benefits at no cost to patients — the price is just prohibitive. Instead, most provide free or low-cost access to core medical services while asking patients to kick in something for the parts the government can’t afford.

When you look at America’s peers, the key question doesn’t seem to be whether there will be private health insurance. Instead, the key question seems to be what role private health insurance will play. The answer to that question can often reflect a health system’s core values.

Take Canada, for example. That country outlaws complementary insurance. Any benefit covered in the public system — things like doctor visits and hospital stays — cannot be covered by a private provider there.

This reflects the Canadian system’s commitment to equality and fairness. As one scholar there memorably told the journalist T.R. Reid, “Canadians don’t mind waiting in lines, as long as the rich Canadian and the poor Canadian have to wait about the same amount of time.”

This is really different from the Australian system, where the government expressly encourages citizens to enroll in private coverage with various tax rebates and penalties. There, officials think they can alleviate burdens on the public system by building a robust private system in parallel.

It’s true that Australians like their health care system more than Canadians like theirs — but it’s also true that wealthier Australians are more likely to enroll in private insurance than lower-income Australians, introducing an element of inequality that doesn’t exist in Canada. The health system you prefer turns on the values you hold.

“I think there are some basic policy issues that countries have to face,” says Anderson. “Should private insurance allow you to jump the queue? Should it allow you to get a private room? These are big policy debates in other countries.”

 

My bad I guess I did misunderstand.

You know what would also be great?

For people to stop saying if you don't agree with M4A or Bernie that you are ok with the status quo or corporate control of the government or the MSM narrative.

Ok can we agree on that?
I could give you a myriad of examples of Bernie supporters doing Trumper things but I am not gonna go there in this thread.

 

Yeah thats gonna be a huge issue with him but let's just discuss actual healthcare instead of the candidates.