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I'm tired of dancing around the issue here.  It's clear to everyone who doesn't have a compelling financial reason not to, that our current health care system is broken.

So, what is the major problems that we have?  Well, if you listen to those on the Right it's that we don't have enough free market freedom to choose an insurance company which will pay our bills.  If you listen to those on the center, you'll hear things about the need for some limited government programs for those who can't afford to pay full price to the insurance companies.

As a card carrying member of the Looney Left, I think we should completely abandon the concept of medical insurance, and instead go with something that actually works.  Yes, I am advocating complete, socialized medicine.

(More Socialist Ranting on the Flip.  Don't Say I didn't Warn you.)

You see, right after World War 2, The British had this idea that maybe, just MAYBE, the government should help out people that were sick.  Of course, they had just been through some of the nastiest, dirtiest fighting that the world had ever seen.  It affected everyone.  In such a time of crisis the idea of a group effort seemed reasonable, and logical.  And by gum it, it worked!  Despite the horror stories of the Right wing, Socialized medicine does not require death panels and waiting in huge lines.  Don't believe me?  Well here's some statistics updated from LAST WEEK with regards to how fast people got treated.  British Health Statistics (DATA, DULL)  

For those who don't want to pore over data the most recent statistics state that Approximately 3000 folks had to wait more than 4 hours, but less than 12 for treatment.  Compare that to the "We can see new patients in 2 months" policies which are common among Medicare providers.

So, why after WWII didn't we do the same thing?  Well, it's because there really wasn't any fighting over here.  Over here, the only people who saw that war were served by the VA.  Which was... Wait for it!  Yup, socialized medicine from a National Health Service!  Of course it only served veterans, and right there was our big mistake.

It's not insurmountable though  According to the World Bank, we're spending almost 3 times as much per capita as the UK on health care, and apparently are getting jack shit for it.   The insurance industry keeps talking about the need for reform of the system, and how our system is the best in the world, when actually we're in deep, deep shit.  Our mortality rates, life expectancy and overall health are worse than other developed countries, and keep getting worse, due to the expanding gap between rich and poor.

Oh but I hear those on the right cry, what if doctors don't WANT to enlist in the NHS?  Well, they don't have to!  The UK has private doctors for those rich people who want to pay for a personal doctor.  Honestly, I think the allure of much less paperwork and the ability to actually concentrate on the job will be a major draw for doctors.  The US Army already has a fine trained group of doctors who work quite well.  If anything it would be a fine starting point for the expansion and creation of a National Health Service.

So there's my position.  I am not going to pretend that it's all as easy as 1-2-3.  It will require hard work and effort.  There's a lot of infrastructure to set up in this scenario.  Infrastructure that needs to be paid for by higher taxes on all of us, not just the rich.  But They certainly can and do need to toss in a bit more.  And look on the bright side rich folks!  You won't have to pay for your employees health care anymore.  One more complaint right out the window!  Who knows, the health care cost might actually be quite a bit lower.  Maybe 1/3 as much.  

And maybe it won't work!  I mean, maybe we really are exceptional Americans who are unique in the history of the world, and socialized medicine WON'T work for us. Perhaps the sun won't rise tomorrow too.

But it's really not the way to bet.

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Comment Preferences

  •  Tip Jar (11+ / 0-)

    I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

    by detroitmechworks on Mon Nov 26, 2012 at 08:58:51 PM PST

  •  It's about time we got started on a NHS (6+ / 0-)

    I would like to go big right now, but I don't know how big is practical. So we leave that to the people in the field who know the particulars. What we can do as consumers is push the concept, advocate for it to our neighbors, our friends, and our political representatives.

    Eradicate magical thinking

    by Zinman on Mon Nov 26, 2012 at 09:17:38 PM PST

  •  One starting point could be the CHC network (4+ / 0-)

    Community Health Centers already have a network and an infrastructure. Perhaps, we could make them the nucleus of a new National Health Service.

    Eradicate magical thinking

    by Zinman on Mon Nov 26, 2012 at 09:26:48 PM PST

  •  YESSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS (3+ / 0-)
    Recommended by:
    radarlady, bluedust, FloridaSNMOM

    Fear is the Mind Killer...

    by boophus on Mon Nov 26, 2012 at 09:50:35 PM PST

  •  Britain doesn't subsidize high fructose corn syrup (3+ / 0-)

    Yeah, some Britons need to cut down on the bangers and mash and Newcastle Brown Ale.

    But Britain doesn't have nearly as many people bound and determined to give themselves arteriosclerosis like we do.

    And the British don't shoot each other like we do.

  •  I think one big reason that we don't (or didn't) (2+ / 0-)
    Recommended by:
    detroitmechworks, radarlady

    already have something like the NHS was the intense push-back from doctors in the 1950-90s.

    It worked great for them because they were quite successful in setting their own incomes.  So successful, in fact that eventually the insurance companies started flexing their reimbursement muscles (and around that time many insurance co.s went from non-profit to for-profit status when dividends, not health became their focus).  

    Then the relatively simple world of paying for medical care exploded in an avalanche of claims, paperwork, and coding minutia that required more and more time and back-office expenses for doctors - and daily second-guessing of their patient's care by the newly-intrusive insurance companies.  And so, finally, many physcians are seeing that there may just be a better way. (At least I hope so.) The AMA used to be a reliable (and fierce) antagonist to any expansion of public care. Don't know if they are still stuck in that position.

    Seems to me that more and more docs just want to take care of sick people, earn a good living, and leave the whole mess behind.

    OTOH, last year when my husband needed care in a Boston hospital, and had some complications, I happened to spend a lot of time waiting with his doctors for procedures and treatments to show effect. I used up my small store of small talk, and finally asked why they - all of them highly skilled cardiology specialists, and all Irish or from the UK, happened to fetch up in the US.  They weren't here on fellowships, as I imagined.  They were here because they could make two to three times as much money as they could from the NHS.  

    I think before something like the NHS can catch on here, though, the majority of US consumers are going to have to grapple with the reality that the we often get (and even demand) way more medical care than we need or is good for us (or for the source of funding of it).

    We have an overweening prepoccupation with health issues -anxiety about health is like a miasma. Our national obsession with it shows up in the popularity of info-tainment shows about health (Dr. Oz, The Doctors et al.) and countless online and print sources. It's a reliable way to get traffic to your site to offer some scintilla of health information.  And at the same time we are drowning in "health knowledge" more than half the population is overweight and in a non-specific to any particular disease, state of ill health. From mainstream care to clearly whack-adoodle theory we are adrift in a sea of medical worries.

    And then when you face a serious illness it is diificult to sort out from all the alternatives which treatment choices actually work, and why more care/ procedures/tests/medicines/ may not be the best course.  It's really, really tough to winkle out the best pathway.  It would be hard to make these kinds of decsions in a "normal" time, but when faced with life-threatening issues, it's darn near impossible to not get sucked into doing more.  

    Some people curse their health insurance companies for not approving every treatment anyone has dreamed up. Although not done with the patient's best interest in mind, some of this financial restraint may actually be beneficial. Not to say there aren't plenty of weasely insurance  companies out there whose business model is bait and switch and renege on paying for anything.

    But one side benefit of insurance restrictions may be the (entirely unintended) avoidance of over-care.  If we went to the NHS model, then it would become the focus of this anxiety, that the gov't was "rationing care", viz the absurd longevity of the Death Panel claim.

    But I'm all for the idea.  I think it would great to not have to worry about getting care if you become sick.  Think about how much that would free us up to just think about being well.

    Araguato

    •  All the things you point out... (2+ / 0-)
      Recommended by:
      radarlady, glorificus

      are to me symptoms of the problem rather than roadblocks to the problem.

      IMHO, if we didn't have an entire industry dedicated to keeping people sick in order to make a profit, our costs would come down considerably.

      If you can't make a profit selling sickness due to established standards of care which show that over half the things people are "Asking their Doctor about" are bullshit dreamed up by folks looking to push legal drugs...

      Just my optimistic opinion of course, but I recall that every time I was actually SICK in the service, the health service I dealt with wanted me better.   Three days after getting shot, I was back on the line.  "Light Duty" but still, I was back at it.

      And end of life care needs to be addressed too.  I hate the term used by Rethugs and refuse to repeat it.  I prefer the concept of Death with Dignity, which flies in the face of our obsessed with extreme measures health care industry.

      But thanks for your points, and thanks for helping develop possible consequences and pitfalls to this idea.

      I think if we think about them more, the HUGE problems become considerably smaller.

      I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

      by detroitmechworks on Mon Nov 26, 2012 at 11:17:52 PM PST

      [ Parent ]

      •  detroitmechworks - it's more likely that we (4+ / 0-)

        could move to a Canadian single payer model than a UK styled NHS model. In Canada the physicians and the facilities are privately owned, there is just a single payer. To try to move the US to a NHS model where the government owns nearly all the health facilities and the physicians are government employees is impossible at this time. Having the government buy all the hospitals and clinics would cost hundreds of billions and US physicians would aggressively resist becoming government employees.

        I think a plan that incorporates the private ownership of facilities and independence of the providers of the single payer Canadian system, but one that also allows physicians to have a private practice like the UK, is a model that has a chance in the US.

        "let's talk about that"

        by VClib on Tue Nov 27, 2012 at 12:47:50 AM PST

        [ Parent ]

        •  Also a great plan. (1+ / 0-)
          Recommended by:
          glorificus

          But I'm sticking with the ideal of a NHS, just because it's much farther than I expect us to go.

          I am well aware that it is far more expensive and harder to achieve.

          The thing is, it's my OPENING position.  I'm fully willing to negotiate from that point.  I'm not willing to negotiate down from a "single payer" to a "Public option" to a "all options are on the table"...  You get the idea.

          Nope, I'm starting at completely insane and ultra left wing socialism.  Let em moderate me from there.

          I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

          by detroitmechworks on Tue Nov 27, 2012 at 06:39:24 AM PST

          [ Parent ]

          •  The problem with that position (0+ / 0-)

            Is that it is easily dismissed because the acquisition of the facilities costs hundreds of billions that isn't allocated to the actual care of patients. Then rather than starting the conversation, it stops.

            "let's talk about that"

            by VClib on Tue Nov 27, 2012 at 07:22:00 AM PST

            [ Parent ]

            •  But we're discussing Single Payer now... (1+ / 0-)
              Recommended by:
              glorificus

              And talking about a reasonable compromise.  IMHO, the discussion has gone exactly the way I wanted it to.  A discussion of a real solution closer to the left.

              I can always bring up National Health Service again, next time the discussion starts turning to "Public Option".  ;)

              I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

              by detroitmechworks on Tue Nov 27, 2012 at 07:46:23 AM PST

              [ Parent ]

              •  You are correct, DMW. Always shoot (0+ / 0-)

                for Alpha Centauri at first, when the moon is really what you want.

                "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

                by glorificus on Tue Nov 27, 2012 at 08:02:26 AM PST

                [ Parent ]

            •  The American hospitals (1+ / 0-)
              Recommended by:
              detroitmechworks

              are building integrated care organizations.

              These integrated hospital-centric organizations could receive annual patient capitalization payments just like the very similar British NHS regional trusts.

              For example, Johns Hopkins pretty much runs the Baltimore area health care system.

              In Northern Virginia, I believe it's INOVA that runs most of the health care system.

              In Northern California, it's Sutter and Kaiser that run most of everything.

            •  In the metro Detroit area (0+ / 0-)
              Henry Ford Medical Centers, Henry Ford Macomb Health Centers and Henry Ford Wyandotte Health Centers offer the communities of southeastern Michigan a seamless array of care choices backed by excellence in research, education, and quality.

              Henry Ford Medical Centers each provide a wide range of medical services, from primary care and pediatrics to diagnostic tests as well as specialty medical services such as allergy or gastroenterology. Many Henry Ford Medical Centers offer pharmacies. The largest Medical Centers offer full-service care with Emergency Room services and select surgical services as well.

              http://www.henryford.com/...
              Medical Centers

              Ann Arbor
              Bloomfield Hills
              Canton
              Chicago Road
              Columbus (Novi)
              Commerce
              Cottage
              Detroit Northwest
              East Jefferson (St. Clair Shores)
              Fairlane (Dearborn)
              Farmington Road (West Bloomfield)
              Hamtramck
              Ford Road
              Harbortown (Detroit)
              Lakeside (Sterling Heights)
              Livonia
              New Center One (Detroit)
              Novi
              Pierson (Grosse Pointe Farms)
              Plymouth
              Royal Oak
              Southfield
              Sterling Heights
              Taylor
              Troy
              Woodhaven
              Macomb Health Centers
              Wyandotte Health Centers
              Specialized Facilities

              The regional trust has basically already been assembled. Instead of millions of patient and insurer checks annually, 26 or 52 federal checks per year could finance it.
    •  araguato, you touched on the (1+ / 0-)
      Recommended by:
      detroitmechworks

      main reasons are costs are higher and they have nothing to do with insurance.

      Those doctors who came here because they could get paid 3 times as much.

      How are you going to get doctors here to reduce their own take to one third? We will never get to British health care costs if doctors here take three times as much from the system. The same with all the other aspects of care.

      The second major reason is over treatment which includes totally ineffective treatments or poor choice of alternatives — usually the most expensive alternatives. These are frequently harmful — as we see with the meningitis outbreak. Steroid shots for lower back pain are risky in best of circumstances and are not a cure. There are better and cheaper treatments. Yet none of the medical experts discussing the problems has dared to say these treatments were not appropriate. Too many docs who get a  lot of money for automatically giving a shot or three to patients who will be right back there in about 3 months. They would be furious.

      Yes the insurers have tried to limit poor treatments but they have been excoriated for it.

      People need to educate themselves and not accept everything your doctor tells you to do or take. Sometimes they don't even know what is best — and sometimes they don't care as long as it pays them.

      A great book by a great doctor, Otis Brawley is How We Do Harm: A Doctor Breaks Ranks About Being Sick in America

      Go to the page and read about  the book and the comments there. it is worth it. And if you can get the book you will enjoy it and learn a whole lot about our system.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue Nov 27, 2012 at 05:02:16 AM PST

      [ Parent ]

      •  doctor costs (1+ / 0-)
        Recommended by:
        detroitmechworks

        In my youth I went to a clinic that was open days and evenings and I believe early Saturday.

        This clinic was a business and not a government-funded entity.

        There were five or six doctors that had two people at a desk to serve all the doctors at work. They might have had three total office staff working 40 hour weeks and 60 hours of operation.

        This would be three staffers total for five or six doctors total, or a doctor to staff ratio of 5 to 3 or 6 to 3.

        A modern office might have a doctor to staff ratio of 1 to 2 or even 1 doctor to 3 staffers.

        The modern American sole practioner is now spending about four times and sometimes as much as six times as much on office staff salaries alone than the clinic doctors did in my youth.

        Going to the multi-practioner clinic system and doing away with the American solo-practioner system would enable doctors to work for lower fees and retain the same net incomes. The multi-practitioner clinic system would also enable doctors to provide care in the evenings.

        •  Another great suggestion! (0+ / 0-)

          See, this is exactly what I'm talking about.  You throw out the concept of "Our System is fine, just needs a few tweaks" and replace it with, "Nationalize it!" and suddenly there's a million good ideas for how we can change the system to really solve the real problems with it, instead of shuffling money around without really solving the problem.

          Which of course was my entire point in calling for a NHS.  It's the ideal, but even bringing up the ideal causes us to move in that direction.

          I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

          by detroitmechworks on Tue Nov 27, 2012 at 08:21:02 AM PST

          [ Parent ]

  •  I think the most startling argument that was (3+ / 0-)
    Recommended by:
    radarlady, samddobermann, bluedust

    advanced for the NHS was the realisation that the civilian population at the end of World War 2 was healthier than the population that entered the war 6 years earlier! Like so many things British - they stumbled into this in the process of preparing a population for war that was going to come home with a vengeance.

    Nobody who had fought the Germans for four years in World War 1 was under any illusion what was ahead if Britain declared war on Germany, so the government fanned out in 1938 to see how the English countryside would handle mass evacuation from one of the largest cities in the world - London.

    What they found was the same rubbish system the US had/has - a polyglot mix of private hospitals, charity hospitals and fee for service medicine. Over the course of the war, during multiple evacuations, the government stepped into manage facilities to some minimum standard. They also began earnest efforts at primary care, and rationing had the unexpected consequence of ensuring that everyone had a decent minimum of food.

    By the end of the war the British realised they had arrived at a very good outcome - and Churchill utterly failed to understand this. He campaigned against the idea of the NHS and socialism and lost badly. The British people had fought for a lot better than a return to Tory rule.

    •  The key thing in your great (2+ / 0-)
      Recommended by:
      bluedust, detroitmechworks

      comment, islandchris, was that the British built their  system and hired the people during the war  — they basically just had to continue it. It is infinitely harder to build a system than to stop from divesting yourself of one.

      And, as you said, people getting lots of primary care — and not excess care — were a lot healthier.

      That's what Berwick who Obama appointed to head CMS — Medicare was all about. That is why the Community Health Centers are such a very important part of the ACA.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue Nov 27, 2012 at 05:14:44 AM PST

      [ Parent ]

  •  The British system is based on capitalized (1+ / 0-)
    Recommended by:
    detroitmechworks

    regional trusts (~so much money per person*number of people in a region) that run hospitals and hire doctors. There are other funding factors for the trusts to deal with older and sicker folks I believe.

    There are also a few prestigious hospital systems that might be considered roughly equivalent to Mayo and The Cleveland Clinic that are allowed to be their own trusts financially.

    What the English Conservative government wants to do (and is doing I believe) is to change all this to capitalizing doctors who are supposed to buy care, but in fact just pick a commercial company to buy the care.

    The Scots and and I believe the Welsh run their own systems along the traditional lines and don't want to run things on the Engish Conservative commercial model.

    •  Here in my Florida county (0+ / 0-)

      the Sarasota County School System provides K-12 education for the whole county, which covers an area of hundreds of square miles.

      The Sarasota County School System receives capitated payments (maybe ~$7,000/kid) from the State of Florida to provide K-12 education as well as levying taxes to what I believe is the maximum permitted by state law.

  •  It seems to me there's a good start with all (2+ / 0-)
    Recommended by:
    detroitmechworks, Utahrd

    those red states not wanting to set up exchanges. It causes them to come under one system, at least, that I would think could be more easily modified.

    The thing with Canada is waiting. They have a limited number of facilities for sophisticated procedures. Emergencies ALWAYS get immediate care.

    I have a friend who waited over a year for surgery on some gynelogical issue because it was not emergent.

    She was provided with adequate pain management and her job was held for her (she's a technical writer) as long as she was out.

    Personally, if the pain was controlled I'd wait a year rather than be impoverished for the rest of my life.

    Another big issue, though, is how much are we willing to spend to keep dying grampa on a ventilor for two weeks racking up huge bills just because.

    "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

    by glorificus on Tue Nov 27, 2012 at 08:09:34 AM PST

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