Just to put an Aussie perspective forward. By the sounds of it healthcare is a major problem all around the world. Finding a balance between a public system that covers everyone but does not drain the economy is hard, especially now with the older population.

In Australia, the health system is controlled by each individual state, which gets funding from taxes and some from the federal government. The public system is okay, it pretty much covers what most of the public systems that your hosts talked about cover. Although the waiting times here are a lot longer for things like emergency room procedures and for elective surgery. But you are covered if something bad does happen. The private health system is generally pretty expensive, but is essential if you want to get any dental work or as it was said, any preventative work done. However for most families it is hard to be able to fit private health in their budget, as most businesses here do not offer private health as part as the employment package.

Summing up, Health care seems to be a problem everywhere with overworked staff, not enough facilities, long waiting times and huge costs where ever you go.

Thanks
Gog

Seriously though, I would like to see a very basic major medical coverage with preventive care like physicals and appropriate exams based on age. Then fill in the gaps with private coverage. That way you can still pay for better care but at leas you have something and don’t go bankrupt if you’re down on your luck. I also think we need to do something about malpractice insurance. Several doctors i’ve talked to say it’s their biggest expense and can be very oppressive.

Most people in the UK don’t wait 4 months, but it does happen. If you’re ill and need immediate attention you generally can get seen right away. And of course there’s a thriving private option where you can pay for faster coverage. A lot of employers add private insurance as a perk.

Pardon me if I’m speaking gibberish. I drank a bottle of Bordeaux while listening to the podcast and decided to write a response.

Thanks Patrick for all the work you do putting out great content.

And as you said, at this point pretty much everything is better than the downward spiral that the US healthcare system is in today… :/

I want to play a bit of devil’s advocate because very few positive things about US system were mentioned and pro-private advocates were more or less thought to be idiots. I think the main reason many Americans a don’t want a public option was not touched on. It has anything to do with the government telling us we have to get coverage. Take my example for instance. Strictly in terms of care, I have very good health care. As an upper middle-class, single person with company supplied health plan, i can chose any doctor I feel like from thousands in a top 10 US health-system with minimal wait times. I can directly book appointments with elite specialists without a referral (which I admit doesn’t make sense). I’ve been able to see a Orthopedic Surgeon for an ankle injury that our fantastically rich American Football team uses. It is certainly much better than what I see people in the NHS dealing with. One of the main metrics in the NHS is the 18 weeks pathway. I could not imagine waiting 4+ months to see a specialist. I know that the UK is not the only system out there but it’s an example of what many americans fear. I have very little doubt the quality of my care and choice would go down with a national option. I think that is fundamentally the problem. It may be selfish, but many people feel that a national health system would mean less coverage and quality to pay for people who don’t want to work and support themselves.

I used to feel like that but have changed. Our system is really messed up and unsustainable as Randy pointed out. I changed my opinion due to the amount of waste, the spiral of the uninsured, not being able to get coverage due to pre-existing conditions, and being financially ruined just because you get sick while you were between jobs. A lot of Americans are beginning to feel this way as they’ve seen their health benefits decrease while costs go up. This is why we are even having the national option discussion.

But….

You know that was coming right?

there is one issue that you did not address. I love that you used the seat belt analogy, because that particular device is part of my argument. In the US we have passed seat belt laws. these laws were sold to the people as laws that are enforced on top of other laws. In fact most of them (and the ones here in Colorado) are written in a manner that you will not be pulled over for not wearing a seat belt. Fast forward 10 years and we have adds telling you, on huge billboards “click it, or ticket”. In other words you will now be pulled over and punished were you were promised you would not be.

To apply this to health care now. In the states there is a strong ideal of punishing those that cost us money. the seat belt law is an example of this. the law is needed as people who do not wear them cost us money when they get into crashes. Already we have the state of new york and other areas trying to pass “fat taxes”. These are to punish people for being overweight.

The problem I have with this is that it is the federal government trying to get in and control your behavior and your life. Which to me is not the place of the government. A national health care system will exacerbate this problem.

While I agree that the US system is in need of a great deal of reform, it is not fair to discount this very real issue of government getting into my house and trying to tell me what I can and cannot do. This is an area that I feel is not properly addressed in the debate.

And please do not pull out the red herring of “it will never happen”. It is happening already. It is just hard to get passed now as the health care is not unified. This makes it hard to for a lawmaker to claim that “you ” are paying for it. After a unified health care plan is in place they can point to the exact tax you are paying for fat people to get care. or smokers, or people who like bacon, or do not exercize or any other reasons that can be labeled.

I also realize that I am a poor writer and that my concern may be coming off, not as well I would like. But I am gonna give it a try anyway.

Also for a better examiniation of this issue and my concerns with it please listen to Dan Carlins take on it here – http://cdn2.libsyn.com/dancarlin/cswdcb57.mp3?nvb=20091023211953&nva=20091024212953&t=04ff471e0cd66328eb552 It is the second half of the show.

As an aside, Mr. Carlin here is in my opinion the best political commentator in the US at the moment.

In 2004, when I left R&D and moved on to marketing, the average cost of research on one compound, or drug, was $850 million and 12 years from concept phase to FDA approval and release. The compound I was working on was, at that time, at $1 billion and in it’s 15th year. This compound never made it to market. The accepted average was that 1 in 4 drugs would go to market.

What this lead to, a trend I could clearly see even in my relatively short number of years in the industry, was that a shift was occurring towards drugs that were known to be profitable rather than ones that could make the most impact on the general health of patients. In fact, recently, the particular company I worked for had a clear market advantage in the vaccine division and pulled funding from almost every other area, including laying off thousands of workers, in favor of pursuing a more vaccine centered market plan.

It was as simple as chasing profit.

All this is to say the current U.S. system of “capitalistic” health care management is very much a cause of the problem. Health insurance is crushingly expensive and our level of care is terrible no matter how you look at it. Doctors are being charged such high rates for their malpractice insurance that they are forced to work longer hours, seeing more patients with less time spent per patient, just to make ends meet. Pennsylvania particularly is suffering from this. The next time you visit your primary care physician, ask them how much your HMO (or POS, etc.) is paying them for the visit. You will be horrified.

Our current system does not foster a competitive market, it drives up costs and lowers accepted levels of care and production.

The reason for both of these points is that research in the U.S. is not based on innovation for the sake of bettering health care or well-being, it’s based on profit. U.S. pharmaceutical company’s pursue drugs that will make them the most amount of money – as a general rule. Smaller firms will go after major advances in medicine, but the way the system works is that those smaller firms get bought up by the larger firms, creating all of those wonderful companies with multiple initials in their names.

I worked in pharmaceutical R&D and then moved on to the sales and marketing end of the same company and the clear trend was that the spending on the R&D side was far too high with too little yield in drugs actually going to market, leading the sales and marketing end to have to scramble to sell as much volume as possible. This equated to the canceling of projects deemed unprofitable and a focus on re-purposing existing medication for other areas to extend patent life cycles and maintain profits.

Simply stated, at the very least on the pharmaceutical side, the U.S. is not truly an innovator. Point in case we are very typically behind the EU and Asia in approving treatments that had already been in practice for years.

I do not think it has anything to do with people being more or less sick. it has to do with how many different groups can buy the product.

In addition as it stands now a patient can go into a doctors office and demand a certain treatment. If they cannot get it there, then they can move a another doctor to get it. under a unified system this would not be possible as everyone would follow the same rules. This would also restrict the possible market penetration of a new product.