Dems agree to drop full-blown public option

[Admiral Yi]

Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.

A couple questions about the Canadian system.  Are all health workers public employees?  Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")

[MadBurgerMaker]

I fly Southwest and do that and somehow still pay less for my flight.  Other Airlines = fail.

Southwest pays a bunch less for fuel, or at least they used to.  I haven't looked to see if that's still going on or not recently.

[Caliga]

Hopefully whatever reforms they do pass will have an overall positive impact.

Agree, and I agree that we are in dire need of reform.  I don't think that nationalizing the health care industry is the solution though.  Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.

[Iormlund]

In Spain there is staff overseeing expenditures. Basically watching if this or that physician been giving prescriptions for brand instead of generic when available, ordering tests out of protocol, etc. I have never had a test, procedure or hospital stay revoked - I have no idea if it is common or rarely happens.

[Sheilbh]

A couple questions about the Canadian system.  Are all health workers public employees?  Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")

In the UK, which I think is different, then doctors are employees of the NHS but consultants are allowed to divide their time between NHS commitments and private practice (which many do) and I believe GPs have financial autonomy so can set their own wages.  There's an HMO style gatekeeper system I suppose, in that if you request a test and the doctor already thinks you've been diagnosed he'll probably say that you don't need it.  Though you can always get a second opinion.

Agree, and I agree that we are in dire need of reform.  I don't think that nationalizing the health care industry is the solution though.  Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.

The UK is, to the best of my knowledge the only country that's nationalised healthcare.  Absolutely no proposal that's been offered by anyone in the US has been to institute an American NHS.  Nationalisation is a giant strawman.

[Grey Fox]

Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.

A couple questions about the Canadian system.  Are all health workers public employees?  Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")

Surprisingly, and even tho there's Federal legislation about it, Health care is a provincial matter, so it will differ in each provinces.

In Québec, we have so called "private clinics". There staff are privately employed. Not sure about the physicians themselves tho.

Usually Specialized test have to be "prescribe" by the doctors. Takes forever to get one in the free parts, couple of days in the paying parts. Altho, that might have changed. I don't go to the doctors regularly.

[Iormlund]

Hopefully whatever reforms they do pass will have an overall positive impact.

Agree, and I agree that we are in dire need of reform.  I don't think that nationalizing the health care industry is the solution though.  Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.

You don't need to nationalize everything. In reality there isn't such a thing as a European model. It's a whole array of different systems.

[Valmy]

Agree, and I agree that we are in dire need of reform.  I don't think that nationalizing the health care industry is the solution though.  Maybe we are just incompetent compared to Europeans, but we seem to suck horribly at nationalizing shit and still making it affordable and high quality.

Oh I agree I was just figuring if we are going to pay money as if we had nationalized it we might as well get the paltry benefits that go with it.  That was mostly tongue in cheek though.  I have no idea why we pay so much for health care and not only get mediocre results but look to be sitting on a health care public time bomb that is eventually supposedly to overwhelm our ability to fund it.

But it is simply ignorant to think that all other Western health systems consist of a socialist nationalizing solution.  They also balance private and public and so forth.

[Iormlund]

A combination of factors most likely. From higher medication prices to admin and regulatory costs, lack of leverage (it is not the same to buy 1 MRI machine than 50), higher doctor salaries, defensive medicine, higher ER costs if problems are left untreated long enough and so on.

Also, behavioral patters. I've never been to the US but if it is true that there's a higher percentage of obese that could also explain things. Not to mention long work hours.

[grumbler]

Oh I agree I was just figuring if we are going to pay money as if we had nationalized it we might as well get the paltry benefits that go with it.  That was mostly tongue in cheek though.  I have no idea why we pay so much for health care and not only get mediocre results but look to be sitting on a health care public time bomb that is eventually supposedly to overwhelm our ability to fund it.

We get so little for so much because there is no one with the incentive and power to control costs.  Drugs are so much cheaper in Canada, for instance, because the provinces negotiate prices, and if the drug companies want to much, the provinces just don't buy.

But it is simply ignorant to think that all other Western health systems consist of a socialist nationalizing solution.  They also balance private and public and so forth.

But it is simply ignorant to say that "socialized medicine does not work, and all we need to do is tweak the free market US system and miracles will occur" (not that you are saying this, of course).  A rational look at health care from the top down would reveal those areas where the market could help control costs and allocate resources efficiently, and where it won't (and we need to look at countries where health care is a success to do this).  Where the invisible hand doesn't work, the visible hand must be employed.  Germany, for instance, has a system in which 77% of the money is paid by the government-run system (and covers about 87% of the population), but self-employed people can go for the more expensive (23% of the total expenditures divided amongst only about 13% of the population) private system.  The private system allows for the accumulation of benefits (and is thus an actual insurance system), so the additional costs are not all spent on immediate care.  The government-run system is single-payer but service providers are not government employees.

This is just as valid a starting point as any other.

[Admiral Yi]

Does Spain have a single payer or multiple payer system?

[Fate]

You guys are still afraid of progress socialism, eh.

That's a load of shit. We're fine with a socialist single payer system as long as we call it medicare. But call it a Public Option and all hell breaks lose.

[Sheilbh]

Does Spain have a single payer or multiple payer system?

Single payer.

Edit: Here's the wiki map.  Single payer's pretty rare and I think most European insurance systems differ from country to country:
http://upload.wikimedia.org/wikipedia/en/e/e7/Universal_Health_Care_World_Map.svg

[DGuller]

Health insurance companies at present don't charge premiums; they commit usury.

Do you know what usury is?

As it stands, the insurance I have through the college is worthless.  The caps would kick in before the end of the first day of treatment if something were to happen to me, yet that doesn't stop them from charging me $100 per semester for the privilege of "having insurance."

Well, $100 per semester is like 10% of the average US premium, and probably more like 5% of the average NJ premium.  How much can you really expect from such a policy?  I really don't get why some people expect insurance companies to operate at a loss.

[Barrister]

Why not? Why would it be more expensive in the US? Usually it's Canada that is 7% more expensive then the US.

A couple questions about the Canadian system.  Are all health workers public employees?  Does the patient get whatever tests and procedures he asks for, or is there an HMO style gatekeeper system (i.e. the primary care doctor says "no Grey Fox, you don't need a CAT scan, STFU.")

Not public employees, at least like I am (where I get a big "Government of Canada" check every payday).  Health care workers work for a variety of clinics or hospitals, some of which are for-profit, some of which are run by non-profits or by arms length government agencies.  That being said the principal source of revenue for all these clinics and hospitals is the government.

Any test r procedure needs to be approved by the primary care doctor.  You can not just walk in and demand a blood test - you need a referral from a doctor.  That being said there is essentially no incentive for a doctor to not recommend a test or procedure.