Universal health care

This is the International Symbol of the World Conspiracy for Universal Health Care.

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This is the new spokesman for universal health care, according to one blog.

Universal health care describes any system whereby all residents of a given jurisdiction, often a country, are covered by plans to pay for their medical needs as they arise.

This can arise in several ways:

• The free market creates conditions under which, between employer-provided plans, individually purchased plans, and charity, everyone is covered (neo-con ideal).
• As above, except the gaps in the free market system are covered by government sponsored programs (current US system, except for the "universal" part — or the coverage of gaps part, or the level of "need" addressed, part...).
• A "single payer" system where one organization, whether private or public, pays for all care, theoretically at a regulated and affordable cost to the covered.
• A tax-supported government program is set in place to pay for medical care for all who partake of it. This is what people usually mean by "single payer".

The first two do not succeed in providing health coverage for all, in practice. The third example is provided just to acknowledge the concept that single payer universal health care could arise in the free market private sector somehow.

The fourth is what we see in many countries of the world, with varying results and popularity.

Advantages of tax supported single payer universal health care

• Health care for all!
• No direct health insurance costs for businesses or individuals.
• Efficiency of scale and simplicity.
• Health care continuity not affected by employment status changes.
• Doctors' main goal is to get you healthy/save your life. The current system can encourage unnecessary, expensive testing and extended care.
• The citizens of the USA were the tallest in the developed world, up to the Second World War. This has plateaued, whilst the Europeans have increased and now the Dutch are tallest. This is correlated with Universal Health Care and better health.

Disadvantages of tax supported single payer universal health care

• The government cannot do anything as efficiently as the private sector.
• Higher taxes, which may be levied unfairly (i.e. taxing the rich people more).
• Creeping socialism.
• Lazy poor people don't deserve free health care.
• Adding millions of new insured patients might overload the current system, leading to rationing.
• If doctors are not compensated appropriately, there will be shortages in health care availability, like in Canada and the UK .

Budget concerns

The costs of maintaining universal healthcare, or financial limitations in its implementation, tend to increase substantially over time.

For example, the United Kingdom's National Health Service (NHS) was founded way back in the 1940s. There have been huge advances in pretty much every branch of medical treatment during the decades that followed, including, for example, the development of effective cancer treatments, intensive care and life support technology, and vastly improved pharmacology. With these improvements in medicine comes the ability to treat more conditions and keep people alive for longer, and with universal healthcare comes the obligation to do so. Many of these treatments are highly expensive, and some rely on corporations such as those of the pharmaceutical industry, resulting in NHS money being routed back into the private sector.

Hence the national cost of universal healthcare has gradually become more expensive. This, along with measures taken in response to the rising costs, has resulted in restrictive budgeting and performance pressure at every level of the NHS, an unnecessarily competitive culture (including hospital league tables), marginalisation of some services, and lengthy waiting lists for surgery and other treatments. Regardless of the positive advances which have caused them, these negative effects have been a major target for criticism, with short-sighted commentators regarding them as a sign that the quality of service offered by the NHS has declined.

This link between improved medical possibilities and rising healthcare costs also leads some to believe that universal healthcare has become — or will become — unsustainable. Arguably, it may also lead to increasing ethical (and financial) dilemmas of the "when do we pull the plug?" kind. Obviously, this problem never occurs without universal health care, because the complete lack of taxes under such a system implies all patients are breathtakingly wealthy.

Examples of systems in use today

Australia

Residents with a Medicare card can receive subsidised treatment from medical practitioners who have been issued a Medicare provider number, and fully subsidised treatment in public hospitals. Visitors from countries which have reciprocal arrangements with Australia have limited access to Medicare.

The Pharmaceutical Benefits Scheme (PBS) subsidises certain prescribed pharmaceuticals.

Au! Canada

Free leeches back bacon for the asking, eh?

In practice, healthcare is generally funded by a combination of sales tax and federal transfer payments, although in the western provinces they've had good results in using casino revenues. While long wait times are often pointed at as a weakness of the system, they are more likely caused by the system's underfunding by a series of Liberal (centrist) and Conservative (right, recently hard right) governments, who didn't necessarily have a commitment to the system, and only hesitate due to the massive public supports for socialized medicine. Hard to win an election when you give the source of national pride a kick to the 'nads, eh?

There's some good background here on the history of Canada's healthcare system.

China

Since the dismantling of much of the communist health care system public health in china has deteriorated substantially. Citizens now find they need to save substantial sums to cover potential medical bills.

Cuba

All the slaves have free health care, and it is reputedly rather good according to Michael Moore.

After Moore's film Sicko, which depicted Cuba's healthcare system as incredibly good, the Republicans were quick to point to a hospital in Cuba with absolutely despicable conditions, that make 18th century medicine look like miracles. The Republicans pointed to this hospital to show that health care in Cuba is not as good as people present it to be. The hospital in question is actually a volunteer hospital providing care to people who are against the Communist Regime. It would honestly surprise us if a totalitarian government did provide adequate health care for dissidents. The USA (which arguably isn't totalitarian) certainly doesn't provide adequate healthcare for its poor or even all its freaking veterans! It's no wonder criminals in America want to stay in jail, or commit a crime to go to jail, just so they can get their cancer treated.

Denmark

All Danish citizens have the right to free treatment from general practitioners, specialists and public hospitals. Depending on personal income, it may also be possible to get financial support from the municipality for other health-related costs.

About 1.8 million Danish citizens are also members of Sygeforsikringen danmark (Health Insurance denmark), a private mutual insurance company, which offers refunds of up to 85% on expenses not generally covered by the public health insurance, such as certain types of medicine, eyeglasses and dental care.

Government expenses for the public health care system amounts to ca. 14 billion, or about 2500 USD per citizen, per year. The system as a whole generally functions well, but is however plagued by certain serious structural problems that lead to inefficiency and dissatisfaction in certain sectors. Many people also believe that the system does not receive enough funding to live up to expectations from the political level.

Japan

Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business (not exactly what you can call socialism). In Japan, waiting times are so short that most patients don't bother to make an appointment. The only problem is the prices are to cheap.

France

They pay less money for their healthcare, and get better treatment than most non-millionaire Americans. The disadvantage is that many hospitals need serious renovation, and getting extraordinary medical care, or routine care on weekends, is unlikely (despite the utopia presented in Michael Moore's film). However, "additional coverage" insurance, which provides for private doctors, more advanced technology (think "MRI" vs. "X-Ray" for a broken bone), and shorter wait times for routine care can be purchased at a fairly minimal cost.

Germany

Very little tax money goes into the system. Germans can sign up for any of the nation's 200 private health insurance plans — a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

India

None of the slaves have free health care.

Netherlands

Citizens may choose between private and public health care, where public health care consists of special programs provided by the same companies that offer private health care.

The maximum fees of these public programs are restricted by the government, a typical public health insurance including dental care costs around 80 euros a month.

Health care for all minors (less than 18 years old) is free.

New Zealand

The Accident Compensation Corporation is an insurance fund paid into by all employed citizens, which then funds treatment for accidents and provides a percentage of salary lost due to accidents. Public hospitals provide care to a large portion of the population with means-tested fees and long waiting lists in some cases, while private hospitals cater to the wealthy and the privately insured.

Spain

National health system paid for by taxes. Quite centralized system but it works quite well. Hospital care covered but patients sometimes have to wait for non-urgent treatment. Standard charge for prescription medicines with reductions for pensioners. People have the option of taking out private health insurance if they don't want to wait for their non-urgent operations.

Apart from the central system there is also a system of General Practitioners (AKA Family Doctors) who provide localised care. The quality of this service varies from the really outstanding to the quite poor.

As far as dental treatment is concerned, urgent extractions are covered by the state system, but all other treatment is private.

In general Spanish people seem quite satisfied with their system, especially when compared with what they understand the American system to be.

United Kingdom

Britain's National Health Service is similar in principle to Spain's, i.e. a centralized system paid for by taxes. Hospital care is covered but patients sometimes have to wait for non-urgent treatment. There is a standard charge for prescription medicines but there are exemptions for the elderly, the very young, the poor, expectant mothers, and people living in Wales. People have the option of taking out private health insurance if they don't want to wait for their non-urgent operations.

Until recently the British NHS was the envy of most other countries but there is a determined effort by the Government to edge it closer to the American model by privatisation in various guises. This effort is opposed by the majority of the British populace.

Michael Moore's 2007 film Sicko, made for the American market, paints an excessively rosy picture of the NHS and condemns US healthcare.

It is certainly true that the British in general have much better health care than Americans, except for millionaires.

Dental care is not fully covered by the NHS, but the repercussions of this are not obvious, particularly to Americans who would never base a stereotype on such a shortfall.

There even a twitter page of real British people expressing support for the NHS. This led to twitter crashing when millions of Britons turned up to defend the NHS. The NHS supporters included Steven Hawking, who said "I wouldn't be here today if it were not for the NHS."

United States of America

15% of U.S. residents have no health care plan, nearly two-thirds of bankruptcy filings in 2007 were linked to overwhelming medical bills, and 18,000 unnecessary deaths every year in the United States simply because they're uninsured.Despite campaigns by politicians on the center and left, no national health care service seems likely to be enacted any time soon, due to the perceived association of "socialized medicine" with Communism. The state of Massachusetts, as of July 2007, has a rudimentary universal health care system based on providing state-funded subsidies to commercial health insurance providers, but it's too early to decide how well it works.

In that same month in a speech in Cleveland, President Bush asserted that America already had universal health care when he said, "People have access to health care in America. After all, you just go to an emergency room."

In 2000 a World Health Organisation report noted that the USA ranked 37th out of 191 member states for the quality of health care available to its citizens (France was top, the UK 18th, Colombia 22nd).

The Southern Baptists officially opposed expanding public child health insurance on the strawman that fetuses will not be covered. However, the Democrats were idiots for allowing this strawman to become an issue, considering that public health insurance for pregnant women would be a good thing. In 2009, the Democrats wised up and added a section for covering pregnant women; the godless Southern Baptists still found a way to oppose this under the motto of "Love the fetus, hate the child".

Michael Moore made a documentary, Sicko, in his inimitable style, about the current "system" in the United States, comparing people's experiences with it to those in Canada, France and Great Britain. He also pointed out that detainees at Guantanamo Bay receive free health services on par with, or better than, that which the average American must work or pay for. He then pulled an illegal stunt by bringing several ill first responders from the 9/11 cleanup to Cuba and obtaining free care for them (see above, Cuba). Which isn't so unusual since more than 5000 foreign patients traveled to Cuba in 2006 for a wide range of treatments including eye-surgery, neurological disorders such as multiple sclerosis and Parkinson's' disease, and orthopedics. Sean Hannity thinks the film is a pack of lies and misrepresentations even through there's a site that gives backup information and cites sources.

As of the summer autumn of 2009, some sort of "health care reform" law is likely to be written and passed. No one knows how much Change it will entail, but there is much Hope. On September 9, 2009, a frustrated President Obama gave a speech before a joint assembly of both houses of Congress, outlining what he insists be included in such a bill and castigating people promoting what he termed "lies" about what such a bill might entail. Joe Wilson (R-SC) at one point heckled him, calling him a liar.

2009-2010 Health care legislation

An $848 billion Health care plan will be debated in the U.S. Senate after Thanksgiving, 2009. Its goal is to get 31 million Americans who don't have health insurance to get health insurance. Some senators strongly oppose the Medicare reform part of the bill because it would lower Medicare, increase bureaucrats, and increase taxes. Senator Reid wrote the first draft of the legislation, which the senators will be trying to improve, putting forth their various opinions. Some of the Republican Senators said the bill would not only increase taxes, it would increase medical costs and insurance premiums people would pay. The Senate bill came two weeks after the House passed its own version of the legislation to be sent to the White House. After Senate achieves a consensus, it will try to reconcile the two bills, to create a version for the President to consider. The bills create insurance exchanges for comparing coverage plans, including the lower Medicaid plan. They require medium and large employers pay for employee health insurance, either directly or by way of a tax. There also might be a tax on insurance or more taxes on the rich. The lowering of Medicare coverage would be a decrease of $400 billion. An easier way to bail out nearly bankrupt insurance companies could be grants via the Internal Revenue Service. The money could come from coining it rather than taxes, to keep business owners from raising prices, but for some reason the legislation doesn’t include that idea.

Countries with universal health care

Map of countries with universal health care

External links

• A Conservative Convert To Socialized Medicine.
• The Health of Nations, an interesting essay comparing several health care systems.
• Single Payer FAQ - Physicians for a National Health Program