A question

Why is it that when people propose US government health care it’s always Medicare for everyone and not Medicaid for everyone?

Might we have an admission here that government health care isn’t always lovely?

44 comments on “A question

  1. Give that the UK delivers healthcare for everybody at half the cost of the US healthcare system isn`t it time to admit the public sector is rather good at some things ?
    The NHS may not be perfect but the US system is astonishingly wasteful and think of the stress….I`ve seen Breaking Bad ..I know what its like

  2. I think so, John. They simply don’t know what currently exists.

    A few months ago, there was a report that 14 government (US) agencies supported some climate change nonsense. I asked why 14 agencies were involved. Many of the US’ 615 alphabet agencies are duplicates. I’ve heard of as many as a dozen agencies with the same remit.

    That something already exists is no barrier to Congress in creating it again. Got ’em votes before; it’ll get ’em votes again.

  3. Speaking as someone uses either the French or Spanish health systems, depending, are you completely stupid Newmania?

  4. are you completely stupid Newmania?
    Of course xe is. “Envy of the world”, innit? That must be why no country on earth has copied the NHS, not even the colonies.

  5. My God, BiS, are you suggesting that there are better systems than the NHS? Burn the heretic!

    Come to think of it, various people I have met have preferred the following systems over the NHS: Canada, Australia, France, Spain, Singapore, Iceland. Perhaps if I’d quizzed my German, Dutch, and Italian friends I could have added three more countries to the list.

    As for the Yanks, I shouldn’t dream of recommending how they should change things, although naturally I think it would be very interesting if they were to try free markets. They might work far better than their current nexus of corporatism, cartels, corrupt politicos, monopolist trade unions, and plain gangsterism.

  6. The amusement of breaking bad is of course that he wouldn’t have got that special treatment on the NHS either. He’d have been told to go home and die.

  7. That must be why no country on earth has copied the NHS, not even the colonies.

    Sadly, one is about to.

    The Cyprus NHS service starts this year. It is already a complete omnishambles even before the off (in March I think but nobody is sure)…

  8. I notice y’all keep using all the medical innovations we ‘Mericans keep coming up with with our awful healthcare system.

    I could cut U.S. healthcare costs in half . . . overnight.

    “In this present crisis, government is not the solution to our problem; government is the problem.” – Ronald Reagan

  9. The NHS probably is better than the US system on average (of a mean type).

    But it’s the wrong comparator. The US is uniquely expensive and exclusionary – it’s actually more of an outlier than the NHS itself is in terms of cost/benefit.

    There are dozens of other private and semi-private systems that are much better.

    I’ve found it a useful barometer of judging propagandists vs. real pundits in the health debate actually – if anyone is promoting the NHS based on simple comparisons with the US system then you can generally write them off as uninformed or untrustworthy.

    Personally when it comes to the NHS it’s not so much the public funding I have an issue with – I think there should be some redistribution when it comes to health. But rather the public provision, which can be absolutely woeful.

    I had a medical complaint requiring a routine operation a couple of years ago. Left despising the NHS. Why?

    – nil by mouth from the night before. Asked to come in at 7am. When I turned up, they said they were surprised. Turns out I wasn’t scheduled until the afternoon. After 19hrs with no water, I was not a well person.

    – about a dozen of us were clustered around locked doors to ‘envyoftheworld ward’ at 7am. By 7.15 no sign of activity, apart from the odd nurse walking past. Then some passing porter, only when asked, said that we were all supposed to be in ‘envyoftheworld ward floor 4’, which was in a totally different place and not noted on anyone’s paperwork or signage. This must happen every damn morning.

    – Matron turned up only at 9am. Said people would be called, and that a nurse would visit every hour to provide updates. That was the last time a nurse actually turned up.

    – Witnessed a ~90yr old woman dropped off by ambulance staff in the utterly boiling waiting area (they had clearly never heard of radiator valves) at 9am. She was abandoned until 3pm, despite being immobile. And I do mean abandoned – no water, no contact with a nurse. When I went down the corridor to find a staff member to inform, some nurse shouted at me for leaving the waiting area. Wasn’t even ashamed after I told her why I was there, told me someone would be over. They never were.

    – about 2pm I was told I might not even be operated on that day, but they would do a quick assessment to see if I was a simple case or not. No joke, my assessment took place in the janitor’s cupboard. The surgeon said he could get me on the table but wouldn’t have time to sew me up with any care.

    – I left, with no operation, as they ran out of time. Went private the next day.

    And the fucking posters drove me nuts – who pays and has time for all that crap festooned on every available surface? If they could solve the problems of the world with posters we’d be sorted.

    None of this shambles was due to austerity, except perhaps a slot or two missed due to bed blocking (which is a whole other topic- they are so stupid the way they deal with it). The nursing staff in particular were incompetent and hateful. God knows where the the managers were and what they were doing.

  10. When folk propose ‘Medicare for all’ it is never clear whether they think that this means everybody would pay what retirees pay, or what Medicare thinks it costs.

    If you’re a properly retired person eligible for Medicare and have paid in the requisite sums during your working career, you’ll pay about $100 a month for basic Medicare. If you’ve not paid anything in, you can still get basic Medicare, but it’s at the rate they think it should cost. Which is $500+ Which is essentially the same as ordinary health insurance…

    So it’s unclear how this is a Big Win for anybody.

  11. Come to think of it, various people I have met have preferred the following systems over the NHS: Canada…

    One of the most interesting features of the US-Canada border is the hundreds (literally) of private clinics on the US side… all within very easy driving distance from Canukistan.

    Canadians will boast of their medical system out of one side of their mouths and ask you to recommend a clinic near the border in Minnesota out of the other side.

  12. Give that the UK delivers healthcare for everybody at half the cost of the US healthcare system isn`t it time to admit the public sector is rather good at some things ?
    The NHS may not be perfect but the US system is astonishingly wasteful and think of the stress….I`ve seen Breaking Bad ..I know what its like

    One day this cunt mocks us for being so ignorant as to not know who Shakespeare and Elgar are, and the next he defends governmental health care by comparing it to the private health care delivered to a fictional character on a fictional TV show that had nothing to do with health care in the first place. Holy plot device, Batman!

    An ataxic mouse if ever there was one… And a cultured, edjamacated one at that!

  13. Why is it that when people propose US government health care it’s always Medicare for everyone and not Medicaid for everyone?

    Basically, because Medicaid was never meant to be for everyone. It was meant to help those who are genuinely poor and lack the resources to cover the medical costs Medicare doesn’t pick up. There’s a bit more to Medicaid than that, but essentially it’s a means tested expansion of Medicare.

    Another reason it isn’t mentioned is that most Americans don’t understand the difference between the two… They usually have contact with Medicare, not Medicaid.

  14. My experience is nowhere near as bad as Oblong’s but the last time I saw my GP I mentioned that I was still waiting for the appointment that he had requested during my previous visit just over two months earlier and he was *not* happy, commenting that the delay would almost certainly mean some damage was permanent. Three days later (Friday) I got a ‘phone call from the GP’s secretary to say I had an appointment on Wednesday at 10.30 and that the hospital (in the next town but one and over an hour away by public transport) had written to me: I said I hadn’t received it and she said they probably had only just written it. On Tuesday I got a letter a bit after 9.30 detailing the appointment – I didn’t immediately notice that the date expressed only in numbers meant Tuesday. When I did I ‘phoned and the department had closed for the day, Wednesday morning I ‘phoned when they opened and the young lady seemed totally unsurprised that I had been told the wrong day for my appointment and made me another one.

  15. @ Chris Miller

    It is mental, the private health system is awesome here.

    I live in a village of ~2,000 people. There are two clinics each with doctors, nurses and all facilities competing for my illness. We have a Phlebologist, two dentists and a physiotherapist.

    30 minutes drive away I have access to at least 10 state-of-the-art private hospitals, all competing for my business.

    But no, even though the state health system can’t even provide an ambulance service they are going to force everybody to pay into the new ‘NHS’…

    …and one of the features will be that it will cost an additional €1 to see a doctor but you can choose to see a doctor in one of the shitty state run hospitals OR one of the private hospitals – for the same price!!!

    I despair…

  16. The NHS execution is woeful, anyone with half a brain, who spends more than 5 minutes watching how it is run could come up with a number of improvements.

    Things like not booking everyone to arrive for a 9am appointment, then seeing them in whatever order they like.

    Or from my latest trip, how about seeing people in A&E and assessing/treating them in a room, without needing to use a bed if possible. Then they won’t need to wait for a bed they don’t need. What an idea!

    Or how about doctors actually get their hands dirty (I know this is heresy, wanting them to do some actual f*ing work) and do quick things like take IV needles out. Last time we had one, the doctor said he’d get a nurse to take the IV out and we could go home. We then had to sit there waiting for over an hour! Then they complain they’re too busy with not enough beds.

    Idiots, the lot of them.

  17. I have a completely crap GP surgery who treated what turned out to be heart failure as maturity-onset asthma. after 9 months of deterioration I went to A&E when the receiving nurse took about 2 minutes to admit me to the cardiac ward, where my feet literally did not touch the ground for 2 weeks while they sorted out. It turned out that if ECG’s had been properly interpreted, my condition would have been picked up 6 years earlier. Cardiac staff were magnificent, wonderful care and compassion for a bunch of grumpy old men. Similarly, when my kidneys finally packed up and I needed dialysis 3 times a week, the care was excellent. I think the superior staff get put on the life-critical wards and the rest get pot-luck.

  18. @Gamecock January 30, 2019 at 5:27 pm

    You didn’t invent MRI scanners; however you saw it’s benefits and bought them from us long before NHS did. Glad you did otherwise it would have been abandoned.

  19. Dearieme, you can add Germany to the list.

    Tim, I don’t recall the special treatment in breaking bad. Neoadjivant/palliative chemo (May be including some more expensive targeted therapies, most of which are NHS funded now), lobectomy. Standard and generally inexpensive stuff. The special treatment was administering it to himself while on the run. What am I missing that the NHS would have refused to pay for?

  20. Oblong, I was in hospital for a week in 2017 due to a heart attack.
    Local hospital admitted me, decided I had a heart attack and started administering drugs. The consultant decided to send me for angiogram and fitting the bits as needed in arteries.
    But not at my local hospital as it doesn’t do it. So a few days treatment at local hospital while slowly starving.

    Then transported by ambulance to nearby city on Friday evening where they started the same treatment I’d been on all over again. A few days of blood thinners, starvation diet and when consultant saw me Monday he arranged the angiogram and fitment of any artery stuff. With heated blanket and padding as operating theatre is lethal to me.

    So spent a week in hospital where realistically I could have spent 3 days. Lost considerable weight in a week and picked up a couple of bugs while in there.

    Not a fan of the NHS. I can recover considerably faster at home in a heated environment rather than keeping below multiple blankets in a bed and a couple of years worth of allergic reactions in a week.

  21. DtP

    “Canadians will boast of their medical system out of one side of their mouths and ask you to recommend a clinic near the border in Minnesota out of the other side.”

    For some reason, I think it would be hilarious to watch a Canadian talking out both sides of his mouth at once. You don’t know if there’s a video on the net?

  22. Mr Drakon, courts are often the same: they’ll book three to six trials in the same courtroom in one morning. They do it on the reasonable assumption that some trials will collapse and in others people won’t turn up (so the trial collapses).

    But it doesn’t always happen that way. Sometimes all six trials are good to go. But there’s space for only one or two of them. Parties in all other cases have to biff off, their costs most likely irrecoverable.

  23. Newmania

    Sorry mate, you jumped the shark with the Shakespeare Elgar Gilbert and Sullivan nonsense.

    I’m now treating your posts as being on a par with the ramblings of a morose drunken horse.

  24. My little bit of anecdata. The local hospital is a 60s abomination which gives every impression of not having been cleaned since Geoff Hurst’s hat-trick. Womaning reception is a morose lardbucket who, on being asked a simple question (such as directions to a particular specialty), makes it very clear that you’re interfering with her important reading of Hello.

    But the scanning (MRI, ultrasound, etc) is outsourced to a ‘privatised’ centre half a mile away. This is clean, modern and cheery and has a couple of receptionists who will dash round the other side of their desks to assist an elderly patient (not me, your honour), I don’t know if the treatment is any better than you would receive from the NHS, but the experience is poles apart.

  25. Come to think of it, various people I have met have preferred the following systems over the NHS: Canada, Australia, France, Spain, Singapore, Iceland. Perhaps if I’d quizzed my German, Dutch, and Italian friends I could have added three more countries to the list.

    dearieme – if it helps the New Zealand public system is a bit of a shambles and not the most efficient. Although it is significantly better than the NHS (from both my point of view as a patient and those of a couple of mates of mine as doctors)

  26. Gamecock –

    Expensive – the US system is an outlier on various expense metrics, things like healthcare spending/GDP or cost/benefit analyses. There are many arguments about why this is (anything from corporate corruption to costs of innovation), but not much argument about the fact that it’s expensive.

    Exclusionary – I was just looking for a neat word to express unequal, basically. But because I don’t agree with equality as an objective per se (for example Mali is equal but awful) I just wanted a word to express how much benefit the poorest receive.

  27. There was a cartoon going around about it in the US. He goes in, needs treatment, doctor says it’s all on the NHS, end of series. But wasn’t he asking for some experimental treatment? I recall that I did try looking it up and came to the conclusion that he wouldn’t have got that…..

  28. It is mental, the private health system is awesome here.

    Having spent time in Paphos hospital some twenty years ago, I can attest to this. I agree – it’s insane. It ain’t broke, don’t fix it.

  29. Is the Cyprus thing a lefty government on a dogma kick? It would explain the ‘If it ain’t broke, break it’ mentality.

  30. Facepainter –bashing brainless traitorous dross like you is getting too easy–as you get ever more mental–so just this: The US has more than three times the population of the UK. So if US Health care costs only twice as much then it is considerably cheaper than the National Death Service.

  31. Mr Ecks: you’ve got the wrong end of the stick I’m afraid – when people compare healthcare system costs they do so on a per capita basis (or % of GDP which is the same thing). And the US system is by far the most expensive healthcare system in the world, costing (IIRC) some 16% of US GDP. Whereas the NHS is in fact cheap – less than half that, under 8% of GDP.

    The problem with the NHS is not the amount we spend on it, its how that money is spent. Any system of nationalised industry will always become a system where the customer takes a back seat to the producers interests. If the UK spent 8% of GDP on privately provided healthcare we’d all get a far better service. Its the shit hole State providers that are the bit that needs razing to the ground, or at least provided with some effective competition.

  32. In fact I was wrong, its actually 18% of US GDP. The US system is so far off the chart its as much an outlier as the NHS is in the other direction. The US system is insane, at the rate things are going healthcare will consume the entire economy inside a decade or two. Karl Denninger keeps banging on about it. Anyone who defends the NHS by saying reformers want the US system is a lying sack of shite. No one in their right mind would want the US system, its utterly broken and will collapse in a heap in the not too distant future.

    Why the UK can’t have a socialised healthcare system such as exists on the continent where the State acts as insurer (ie collecting taxes and paying for care) while the actual healthcare is privately provided (or at least a proper mix of private and State provision) I do not know. Its blatantly obvious such systems are far superior to both the US and UK systems.

  33. ISTR a discussion at someother place wherein the extreme cost of the American medical system was laid largely at the feet of the legal profession and the american public’s enthusiasm for litigation… Meaning IIRC that an average GP (or whatever the equivalent is in the USA) has to carry negligence / malpractice insurance that costs thousands of dollars a week and that huge amounts of unnecessary testing and treatment is done as part of an endemic CYA system.

    Stop the legal shenanigans and costs would probably drop by 25 – 30%.

    Mind you, looking at the amount reserved by the NHS for litigation we’re getting as bad here in the UK.

  34. “ISTR a discussion at someother place wherein the extreme cost of the American medical system was laid largely at the feet of the legal profession and the american public’s enthusiasm for litigation… Meaning IIRC that an average GP (or whatever the equivalent is in the USA) has to carry negligence / malpractice insurance that costs thousands of dollars a week and that huge amounts of unnecessary testing and treatment is done as part of an endemic CYA system.”

    Its not just the litigation costs (which undoubtedly are high) its the utter lack of competition (ironically in the so called Land of the Free) in the US medical system. Its just a load of cartels, hospitals, insurers and drug companies.

    Read Karl Denninger on it (https://market-ticker.org/) – he reckons if the existing laws on monopolies and free trade were enforced on the US healthcare sector, costs would collapse by over 50%. Making most healthcare something that could be afforded in cash out of incomes with a small insurance premium for catastrophic health issues.

  35. The media narrative on the US healthcare system is dishonest – it’s not the poor that don’t get healthcare, it’s the lower-middle-class that don’t qualify for Medicaid and can’t afford insurance premiums.

    Some basic facts:
    1. ~75% of the average US hospital revenue comes from CMS reimbursement – so the elderly (all 65+, regardless of working history) Medicare and the poor (Medicaid) consume three-quarters of all US healthcare.
    2. Hospitals have merged into massive systems/groups to form cartels and regulatory capture.
    3. Americans demand/expect every treatment, drug, and procedure available, and they expect it immediately.
    4. Population density – continental US is big and people are disbursed, but they still demand/expect full service local medical facilities, even though the volume does not justify.
    5. No-one is refused treatment ever (that is the biggest lie). Hospitals are still reimbursed for ‘charity’ care via a modifier called Case Mix Index – hospitals that provide non-reimbursed care receive a higher CMI and get paid more for all the reimbursed care they provide to paying patients (CMS).
    6. Americans live a pretty unhealthy lifestyle (freedom), so the performance of US healthcare is pretty good given how unhealthy the average patients are.
    7. As someone else mentions, if the Canadian system was better, why are there hospitals/clinics dotted along the northern US border – 80% of patients to US border medical facilities are Canadian citizens who either (a) don’t want to wait for their great NHS, or (b) the treatment they need isn’t offered/covered.

  36. @Jim January 31, 2019 at 12:29 pm

    Its the shit hole State providers that are the bit that needs razing to the ground, or at least provided with some effective competition.

    We tried with GP Contracting Out – worked well with faster, more convenient and better treatment.

    Then Blair & Brown won in 1997 and abolished it.

    .
    @Henry Dunne January 31, 2019 at 3:18 pm

    Informative. Thank you

  37. Henry, I had a golfing buddy who was CFO of an American hospital. He said 16% of their cost was uncompensated, government mandated treatment of the indigent.

    So I don’t buy your #5.

    Government mandates should be funded by . . . the government.

  38. This is over a month too late Tim, but hoping you see this, no health system I am aware of pays for experimental treatments. The people doing the experiments do the paying. And you only get it if they are doing the experiment where they are seeing you.

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