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Sober@#!@! look at how single-payer healthcare systems are actually fairing

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Where ObamaCare Is Going - Scott Atlas

 

Came across this because a former CA lawmaker (termed out) posted this on FB. ...They're not all crazy. Good read.

 

The liberal attraction to making government the sole source of health-care insurance has not abated even as the deficiencies in ObamaCare, a halfway move toward the single-payer model, have become increasingly evident. The question is whether growing signs of single-payer trouble overseas will be enough to discourage this country's flirtation with socialized medicine.

 

The Obama administration showed its hand long ago with the nomination of Tom Daschle, an advocate for Britain's socialized National Health Service, as secretary of Health and Human Services in 2009. (Mr. Daschle withdrew amid criticism for nonpayment of taxes.) The White House installed another outspoken NHS fan, Donald Berwick, as an interim appointee (2010-11) to run the Centers for Medicare and Medicaid Services.

 

This summer, the Commonwealth Fund—a private foundation focused on health care that is a favorite of progressive policy types—issued a report ranking the NHS as the best medical system among those in 11 of the world's most advanced nations, including Canada, France, Germany, Switzerland and Sweden. Coming in last: U.S. health care.

 

Yet the Commonwealth rankings are contradicted by objective data about access and medical-care quality in peer-reviewed academic journals. For instance, Americans diagnosed with heart disease receive treatment with medications significantly more frequently than patients in Western Europe, according to Kenneth Thorpe in Health Affairs in 2007. In Lancet Oncology in that same year, Arduino Verdecchia published data demonstrating that American cancer patients have survival rates for all major cancers better than those in Western Europe and far better than in the U.K.

 

Similar examples concerning the deadliest and most significant diseases abound in medical journals. One may ask why the Commonwealth Fund's health-care rankings published in June don't reflect that reality. The answer lies in the report's methodology, which relied heavily on subjective surveys about "perceptions and experiences of patients and physicians."

 

Yet even as the single-payer system remains the ideal for many on the left, it's worth examining how Britain's NHS, established in 1948, is faring. The answer: badly. NHS England—a government body that receives about £100 billion a year from the Department of Health to run England's health-care system—reported this month that its hospital waiting lists soared to their highest point since 2006, with 3.2 million patients waiting for treatment after diagnosis. NHS England figures for July 2013 show that 508,555 people in London alone were waiting for operations or other treatments—the highest total for at least five years.

 

Even cancer patients have to wait: According to a June report by NHS England, more than 15% of patients referred by their general practitioner for "urgent" treatment after being diagnosed with suspected cancer waited more than 62 days—two full months—to begin their first definitive treatment.

 

In response the British government has enlisted private care for help, including most recently through the Health and Social Care Act 2012. In May last year, the Nuffield Trust, an independent research and policy institute, along with the Institute for Fiscal Studies, the U.K.'s leading independent microeconomic research institute, issued a report on NHS-funded private care. The report showed that over the past decade the NHS, desperate to reduce its ever-expanding rolls, has increasingly sent patients to private care. The share of NHS-funded hip and knee replacements by private doctors increased to 19% in 2011-12, from a negligible amount in 2003-04.

 

In 2006-07, according to the report, the NHS spent £5.6 billion on private care outside its system. This increased by 55% to £8.7 billion in 2011-12, including a 76% rise in spending on nonprimary care, going to £8.3 billion from £4.7 billion, despite significant reductions in spending on private care attributed to the financial crisis.

 

Britons who can afford to avoid the NHS are eager to do so. Even with a slight decrease due to the 2008 financial crisis and its aftermath, about six million British citizens buy private health insurance and about 250,000 choose to pay for private treatment out-of-pocket each year—though NHS insurance costs $3,500 annually for every British man, woman and child.

 

The socialized-medicine model is struggling elsewhere in Europe as well. Even in Sweden, often heralded as the paradigm of a successful welfare state, months-long wait times for treatment routinely available in the U.S. have been widely documented.

 

To fix the problem, the Swedish government has aggressively introduced private-market forces into health care to improve access, quality and choices. Municipal governments have increased spending on private-care contracts by 50% in the past decade, according to Näringslivets Ekonomifakta, part of the Confederation of Swedish Enterprise, a Swedish employers' association.

 

Swedish primary-care clinics and nursing facilities are increasingly run by the private sector or receive substantial public funding. Widespread private competition has also been introduced into pharmacies to tear down the previous government monopoly over all prescription and non-prescription drugs. Though Swedish economist Per Bylund calculates that the average Swedish family already pays nearly $20,000 annually in taxes toward health care, about 12% of working adults bought private insurance in 2013, a number that has increased by 67% in five years, according to the trade organization Insurance Sweden. Almost 600,000 Swedes now use private insurance, though they are "guaranteed" public health care.

 

The recent Veterans Affairs scandal, following the disastrous ObamaCare rollout, was a red flag about problems of nationalized health. Now concrete evidence is coming in from other countries that have tried it for decades. The reality is that the key goals for health-care reform—reducing spending, expanding access to affordable coverage, preserving personal choice and portability of coverage, promoting competition in insurance markets, and maintaining excellence in medicine—do not require government to directly provide insurance or health care.

 

Dr. Atlas is a physician and a senior fellow at Stanford University's Hoover Institution.

 

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Anyone who examined that Commonwealth ranking (I think there is s a thread around here) learned that the US ranked near the top in every category related to actually treating patients. The 2 single paying outlets here (VA and Medicare) are completely dysfunctional, to the point that the VA decided their hospital system simply does not work, and has allowed patients to go outside the system. A reminder to some that there is no "outside the system" in a single pay system, meaning the VA has admitted failure. All of these trillions spent in order to get 10% of the population health care that they did not have. It would have been far cheaper for the US to simply have a single payer for them alone.

 

As an aside my health care plan, which was excellent, will cease to exist on 12/31/2014. It had to, the monthly premiums I was paying were not going to support those who had no health care, and the government needs my money in that pool. It always did. That is why Obama is a complete fraud and liar on this issue, and went to any length to push it.

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The merits of Obamacare or a single payer system aside, this is a really poorly written article.

I would love for you to outline all the 'merits' of Obamacare..........well written, of course.

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I would love for you to outline all the 'merits' of Obamacare..........well written, of course.

He can't outline how the article is poorly written, other than being an obvious attack on the messiah

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I stopped reading at "socialized medicine" because at that point it's just a right-wing political rant.

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I stopped reading at "socialized medicine" because at that point it's just a right-wing political rant.

:doh:

 

What do you call single payer if not socialist?

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but obamacare isn't a single payer system.

i have aetna as i always have-it is not a government controlled health plan.

there are a lot of options and choices with obamacare.

not sure how britian and swedish models have anything to do with our current system?

naomi, is that really you??

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Stupid article. I'm all for a real analytical look at the costs and benefits of various healthcare systems, but the author doesn't even feign impartiality and also does not seem very bright

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I stopped reading at "socialized medicine" because at that point it's just a right-wing political rant.

It is socialized medicine - but that doesn't mean it's bad thing either. There are certain aspects of Socialism and Communism for that matter that are good - but we are trained to think whenever we hear those words it's evil. I'm as capitalistic as the next American but IMO it's ignorant to just say all aspects of socialism and communism must flawed simply becasue of the name. I happen to agree with single payer health care if it's done the right way - I think France is a good model to use. On the same token only a fool would think going to a single payer plan isn't going to have it's own problems as well like maybe having to wait longer and a slight dip in quality. For everyone to have health care soem things have to be at least partially sacrificed.

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but obamacare isn't a single payer system.

i have aetna as i always have-it is not a government controlled health plan.

there are a lot of options and choices with obamacare.

not sure how britian and swedish models have anything to do with our current system?

naomi, is that really you??

 

Advocates of the current public option system would eventually like to have a single-payer system. The author recognized it isn't currently one...

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Stupid article. I'm all for a real analytical look at the costs and benefits of various healthcare systems, but the author doesn't even feign impartiality and also does not seem very bright

 

He's not interested in feigning impartiality...has a pretty solid view. What isn't bright about it to you?

 

I will concede that throwing stats and polling conclusions around can be spurious. The financial fallout and choices governments and citizens are making are more compelling.

 

Like 12% of working adults buying private insurance in Sweden when they're already paying a ton in taxes toward healthcare.

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He's not interested in feigning impartiality...has a pretty solid view. What isn't bright about it to you?

 

I will concede that throwing stats and polling conclusions around can be spurious. The financial fallout and choices governments and citizens are making are more compelling.

 

Like 12% of working adults buying private insurance in Sweden when they're already paying a ton in taxes toward healthcare.

Why does that seem weird to you at all? People often spring for better protection than the baseline when they can afford it.

 

Take automobile insurance, for example. Many states you're just required to have basic collision insurance. Yet people purchase additional protection like full coverage, underinsured/uninsured motorist protection, higher payouts for single occurrence injuries, etc., etc. Does that mean our automobile insurance system sucks, since some people opt for more than the baseline?

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The merits of Obamacare or a single payer system aside, this is a really poorly written article.

as poorly written as the bill?

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Why does that seem weird to you at all? People often spring for better protection than the baseline when they can afford it.

 

Take automobile insurance, for example. Many states you're just required to have basic collision insurance. Yet people purchase additional protection like full coverage, underinsured/uninsured motorist protection, higher payouts for single occurrence injuries, etc., etc. Does that mean our automobile insurance system sucks, since some people opt for more than the baseline?

 

The insurance they're already paying taxes for...

 

A limit on health-care fees per year exists; 150-300 SEK for each visit to a doctor, regardless if they are a private doctor or work at a local health-care center or a hospital. When visiting a hospital, the entrance fee covers all specialist visits the doctor deems necessary, like x-ray, rheumatism specialist, heart surgery operations and so on. The same fee is levied for ambulance services. After 1100 SEK have been paid, health-care for the rest of the year will be provided free of charge.

 

To compare this to your auto insurance example, it's paying (A LOT) for the public all inclusive coverage while at the same time opting to pay more for higher quality private care of whatever elements you're needing. It's not about baseline versus enriched coverage. It's about "we pay a ###### load of taxes but don't have that much faith in the quality of what we're getting in return."

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Stupid article. I'm all for a real analytical look at the costs and benefits of various healthcare systems, but the author doesn't even feign impartiality and also does not seem very bright

 

Why does that seem weird to you at all? People often spring for better protection than the baseline when they can afford it.

 

Take automobile insurance, for example. Many states you're just required to have basic collision insurance. Yet people purchase additional protection like full coverage, underinsured/uninsured motorist protection, higher payouts for single occurrence injuries, etc., etc. Does that mean our automobile insurance system sucks, since some people opt for more than the baseline?

 

 

Speaking of stupid.

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The insurance they're already paying taxes for...

 

 

To compare this to your auto-insurance example, it's paying (A LOT) for the public all inclusive coverage while at the same time opting to pay more for higher quality private coverage of whatever elements you're needing. It's not about baseline versus enriched.

I'm not seeing much of a distinction there at all. Ok auto insurance isn't done through taxes, but you're required to get it if you drive. The only real difference is you pay an insurance company instead of the government. Just like Obamacare, coincidentally.

 

So when people opt to get extra auto coverage, does that mean that the government-mandated coverage is lacking? Or could it just be that some people prefer greater coverage than the required minimum?

 

And let's be careful throwing the term "need" around here. I guarantee you that some of this extra insurance is for elective procedures.

 

This would all be very apparent to you if you weren't starting your analysis from the position of a very heavy and obvious bias. I'm a little surprised too as you usually are pretty thoughtful about the issues. There's plenty of real downsides to Obamacare (as well as upsides); a few Swedes opting for Cadillac insurance plans ain't one of them.

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Is it possible that the private insurance is gap coverage? That's not a totally unheard of thing to do. Plenty of people on Medicare purchase gap insurance, too.

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Speaking of stupid.

How about adding a little something more to the discussion? Are you capable of that?

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I'm not seeing much of a distinction there at all. Ok auto insurance isn't done through taxes, but you're required to get it if you drive. The only real difference is you pay an insurance company instead of the government. Just like Obamacare, coincidentally.

 

So when people opt to get extra auto coverage, does that mean that the government-mandated coverage is lacking? Or could it just be that some people prefer greater coverage than the required minimum?

 

And let's be careful throwing the term "need" around here. I guarantee you that some of this extra insurance is for elective procedures.

 

Again, it's not about access to baseline coverage versus enriched coverage. The way it works in Sweden is that after you pay so much, you don't pay more beyond that, regardless of what you'll need in totality. So these are people where desire to 'up' coverage they're getting, like in the automobile insurance analogy, is moot, but they still seek the private care for the quality.

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How about adding a little something more to the discussion? Are you capable of that?

 

What, like bad analogies? I didn't call the original content stupid and follow it up with absurd analogies..

 

HTH

 

 

Again, it's not about access to baseline coverage versus enriched coverage. The way it works in Sweden is that after you pay so much, you don't pay more beyond that, regardless of what you'll need in totality. So these are people where desire to 'up' coverage they're getting, like in the automobile insurance analogy, is moot, but they still seek the private care for the quality.

 

This.

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Again, it's not about access to baseline coverage versus enriched coverage. The way it works in Sweden is that after you pay so much, you don't pay more beyond that, regardless of what you'll need in totality. So these are people where desire to 'up' coverage they're getting, like in the automobile insurance analogy, is moot, but they still seek the private care for the quality.

What? That doesn't even make sense.

 

I think you don't understand how insurance works. There will ALWAYS be perceived gaps and shortcomings for any plan. So if some swedes think they need additional procedures covered or they want to have a private doctor who caters only to the elite, that is hardly an indictment of the whole damn system.

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What, like bad analogies? I didn't call the original content stupid and follow it up with absurd analogies..

 

HTH

 

 

 

This.

Yeah I figured you wouldn't add anything. You just don't have the capability

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Yeah I figured you wouldn't add anything. You just don't have the capability

 

Christ you are an idiot, it's not "gap" coverage, they are buying private insurance to replace their Government provided healthcare.

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Let me give you another example. I have pretty good dental coverage - don't pay a dime for checkups and if there's an issue requiring a filling or root canal or whatever, I hardly pay anything for that either.

 

But it doesn't cover cosmetic orthodontia. Not really an issue for me but could be an issue for my kids someday. The rationale is essentially that cosmetic orthodontia is not "necessary" and they want to keep the cost of the plan (relatively) low so they only cover necessary procedures.

 

Does that mean my dental coverage is lacking? If I went ahead and bought a plan that covered braces, teeth whitening, etc., would that mean that my dental plan must have been crap since I decided to supplement it?

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Christ you are an idiot, it's not "gap" coverage, they are buying private insurance to replace their Government provided healthcare.

No they're not. They're buying extra coverage of some variety. Like I said maybe it's for elective procedures or because they want to have an on call doctor who doesn't dirty his hands with the masses. Which is fine, but it doesn't mean the basic health coverage is crap

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Let me give you another example. I have pretty good dental coverage - don't pay a dime for checkups and if there's an issue requiring a filling or root canal or whatever, I hardly pay anything for that either.

 

But it doesn't cover cosmetic orthodontia. Not really an issue for me but could be an issue for my kids someday. The rationale is essentially that cosmetic orthodontia is not "necessary" and they want to keep the cost of the plan (relatively) low so they only cover necessary procedures.

 

Does that mean my dental coverage is lacking? If I went ahead and bought a plan that covered braces, teeth whitening, etc., would that mean that my dental plan must have been crap since I decided to supplement it?

dude not too long ago you defended obamacare on the merits of it improving the crap insurance we all had, now you're trying to use the argument in reverse:lol:

Hackopottumus

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dude not too long ago you defended obamacare on the merits of it improving the crap insurance we all had, now you're trying to use the argument in reverse:lol:

Hackopottumus

Link?

 

Truth is, if you had good insurance before, then it changes very little for you. Except that you can change jobs without fear of getting frozen out of new insurance thanks to preexisting conditions, and your kids can stay on your plan longer.

 

Who the law was aimed at were the uninsured and underinsured. For them things should improve dramatically :thumbsup:

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No they're not. They're buying extra coverage of some variety. Like I said maybe it's for elective procedures or because they want to have an on call doctor who doesn't dirty his hands with the masses. Which is fine, but it doesn't mean the basic health coverage is crap

 

Wrong, they are buying private insurance to receive the same procedures offered by the public healthcare system faster.

 

More than half a million Swedes now have private health insurance, showed a new review from industry organization Swedish Insurance (Svensk Försäkring). In eight out of ten cases, the person's employer had offered them the private insurance deal.

"It's quicker to get a colleague back to work if you have an operation in two weeks' time rather than having to wait for a year," privately insured Anna Norlander told Sveriges Radio on Friday. "It's terrible that I, as a young person, don't feel I can trust the health care system to take care of me."

The insurance plan guarantees that she can see a specialist within four working days, and get a time for surgery, if needed, within 15.

In December, the queues in the Swedish health care system pushed the country down a European ranking of healthcare.

 

"Why can Albania operate its healthcare services with practically zero waiting times, and Sweden cannot?" the report authors from the Health Consumer Powerhouse (HCP) organization in Brussels asked, albeit acknowledging modest improvements. "The Swedish queue-shortening project, on which the state has spent approximately €5 billion, has achieved some shortening of waiting times."

 

Sweden aims to make sure people can see their general practitioner within one week, which the organization said was a modest goal in and of itself.

 

"The target for maximum wait in Sweden to see your primary care doctor (no more than seven days) is underachieved only by Portugal, where the corresponding figure is 15 days," the report stated.

 

Health system wait times in Sweden were deemed so lengthy that they pulled Sweden down the European ranking despite the country having technically advanced healthcare at its disposal.

 

"The Swedish score for technically excellent healthcare services is, as ever, dragged down by the seemingly never-ending story of access/waiting time problems," the reported noted, underlining that the national efforts to guarantee patient care had not helped to cut the delays significantly.

 

In its year-ahead report, industry organization Swedish Insurance said many people now felt they did not know what they could expect from their health care providers.

 

"There is a lack of certainty about what the individual can expect from public welfare and which needs have to be taken care of in another manner," the report authors noted.

http://www.thelocal.se/20140117/hospital-queues-tied-to-insurance-trend

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A little clarity about what's going on in Sweden: http://www.cmaj.ca/content/179/2/129.full

 

It looks like they're adopting a hybrid system, but the government is also funding some of the private healthcare and forcing them to compete for the funding.

 

Looks like they've found a way to make private and national healthcare work at the same time.

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What? That doesn't even make sense.

 

I think you don't understand how insurance works. There will ALWAYS be perceived gaps and shortcomings for any plan. So if some swedes think they need additional procedures covered or they want to have a private doctor who caters only to the elite, that is hardly an indictment of the whole damn system.

 

When 12% of workers who are paying a lot in taxes already (enough so that you would feel like you should have great care) are responding to the shortcomings of the government plan, it's compelling.

 

Here's what Sweden has been up to in order to improve things.

 

The ultimate goal for ObamaCare's biggest advocates is the ideology Sweden is moving on from.

 

And what didn't make sense? It should be an indictment of a system when it's intended to cover you completely, costs you a lot of money, and you want to augment it or pay extra for another version of what you already have access to.

 

The way I would argue that it's not truly all inclusive coverage is with those who want to be given what the government sees as unproven treatments. That would fit your coverage upping explanation. And that just highlights another problem, you have to respect the government as your health overseer, literally. Another indictment.

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Worms took it on the chin in this one.

Maybe I should change my name, try to start fresh with a clean slate? :(

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A little clarity about what's going on in Sweden: http://www.cmaj.ca/content/179/2/129.full

 

It looks like they're adopting a hybrid system, but the government is also funding some of the private healthcare and forcing them to compete for the funding.

 

Looks like they've found a way to make private and national healthcare work at the same time.

Too bad their quality care is one of the worst of developed nations according to the Commonwealth report.

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Too bad their quality care is one of the worst of developed nations according to the Commonwealth report.

Natural result of a socialist healthcare system.

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