Heatlth care reform - cost reductions - be careful what you ask for

[russell_bynum]

How about this... do citizens in half of industrialized nations with a national health care system (inherent warts and all) wish that they had the American system instead? One quarter of these countries? How about one?

Certainly not this guy, nor any one of my group of friends. Good luck in your debate.

Sorry Mark, it's already been decided... any system other than the American one is an utter failure, with participants dreaming of the day when their employer can determine their coverage limits...

 

I usually do not participate in any debate about American health care, other than to debunk myths, or simply offer one person's perspective of how our system has performed for me, and others that I know well. From what I can see, most of the criticism of our system comes from people who have never experienced it. Same goes for the British, or French systems. There's no doubt that our system has drawbacks but, like everything in life, you have to ask yourself whether, on balance, we'd trade it for what we see down south. I've yet to meet one Canadian who would.

 

FWIW, my parents lived under the British system and that experience prompted both of them to become pretty strongly opposed to something similar here.

[smiller]

I'll note again that the British, French, or Canadian systems are not even nearly on the table in the current US debate (regardless of the 'they will be' straw man argument.)

[russell_bynum]

Count me as one of the many who are quite happy with the current medical system

 

+1

Off the top of my head I can think of 46 million Americans who would likly disagree with you!

 

I won't argue with that number. But...

 

I worry about the people like David and John...pre-existing conditions that prevent them from obtaining affordable coverage on their own. (This is generally not a problem with group insurance plans, but since not everyone has access to those....)

I worry about the people who simply can't afford coverage on their own.

 

 

I am not concerned with the folks who choose not to purchase coverage on their own. (Between college and me getting a job that offered a group-insurance plan, I purchased my own. It was very affordable like Whip said.)

 

My hunch is that most of that 46 Million (or whatever the number is) fall into the latter category rather than the former two.

 

I definitely see room for improvement in our system. We need to do something about liability/litigation concerns. We need to make it easier/faster/cheaper to bring new drugs and treatments to the market. We need to get part the idea that every little problem requires an M.D. Our medical group is pretty good about that...most of the time when we call for colds and routine stuff (even my broken ankle), they send us to the nurse practitioner or PA rather than the doctor. I don't know how much that saves, but I'm positive that a PA's billable rate is less than a doctor.

 

I'm not opposed to the electronicalization of medical records to streamline things, reduce paper, and reduce errors. I am, however, exceedingly nervous about having Uncle Sam keep the database...or be involved in that process in any way.

 

So yeah....we could improve the system. We could make it work better and more efficiently. That would reduce cost and therefore open up the option for even more people to obtain coverage.

 

I'm not sure what to do about problems like David's. It doesn't seem right to force insurance companies to ignore pre-existing conditions, since that can have a dramatic effect on the cost of providing care, but there must be a better option than what's currently available.

[Dave McReynolds]

I'm not sure what to do about problems like David's. It doesn't seem right to force insurance companies to ignore pre-existing conditions, since that can have a dramatic effect on the cost of providing care, but there must be a better option than what's currently available.

 

Actually, insurance companies have indicated that they wouldn't oppose coverage of preexisting conditions, so long as it was coupled with universal coverage. Why should they oppose it under those conditions, since it just means that they will write more policies than they did before. I suppose they believe that the increased cost of covering those with preexisting conditions will be offset by the reduced cost of covering healthy young people who otherwise might opt for no coverage at all.

 

OTOH, if insurance companies were forced to cover people with preexisting conditions with no requirement of universal coverage, policies would become more expensive for everyone, people would drop out, and fewer policies would be written.

[CoarsegoldKid]

I imagine the AMA will have some serious pressure to bear on lawmakers when decisions are made.

 

I doubt it. Not with lawmakers holding the key to how much AMA members are going to earn.

 

Want a glimpse of the future? Here's what Tom Daschle is credited by Bloomberg with saying:

 

Bloomberg: Daschle says "health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them."

 

Welcome to more taxes for less care. Welcome to fewer doctors staying doctors. Welcome to fewer students deciding on a career in medicine. Welcome to rationed care. Welcome to "you're too old for that procedure," "that condition is too rare," "that treatment is too expensive," "we've treated enough of your (race, age, gender, condition) this month and we need to spread the medical wealth around."

 

Socialized medicine has been tried in dozens of countries. And by people at least as smart as Americans (which lately may be damning with faint praise). Show me where anywhere near half of those systems provide the quantity and level of care that we currently enjoy in this country. OK, show me where one-fourth of them do. One-tenth? One?

 

It's a nice thought. Everyone gets taken care of. OCB still says that 36 million won't get the care they need. And for this we're going into debt to the tune of $3,000 per year per person? Or we're going to tax them that much? Or a combination of the two?

 

Get used to it, seniors. We're going to be left out in the cold. And, of course, if we're all sick, or arthritic, or have our driving privileges pulled because of correctible cataracts (etc. etc.), we can't get out and vote in as many numbers, can we.

 

It's already there. Trust me I'm an American Board Certified Prosthetist and Orthotist. The HMOs and Medicare and Medicade all cherry pick who gets what. It matters not what the Physician prescribes.

One other thing Medicare is the current gold standard and has been since HMOs came on board in the late 80s. So when someone says doctors aren't taking Medicare it's not because the rates are lower than the HMOs. They ain't taking the HMOs either.

 

The bottom line here is that today if you have money, and lots of it, you can have the best health care in the world. If you have no money, zero assets, you may have a chance at it. If you have Medicare you better have a secondary if you have an HMO you better be prepared to fight, lose, and take what you get in the end or have very good health in old age.

There is something wrong with the system.

It must be repaired. How, I can't say. By whom I don't care, but a nation as powerful and rich as the USA should not let its citizens and residents get second rate health care. Health care should also not be so costly that food and housing suffers. I have seen it. It can happen to all members of our society that lives check to check. Period.

[Selden]

There is something wrong with the system.

It must be repaired. How, I can't say. By whom I don't care, but a nation as powerful and rich as the USA should not let its citizens and residents get second rate health care. Health care should also not be so costly that food and housing suffers. I have seen it. It can happen to all members of our society that lives check to check. Period.

There's the rub -- How?

 

My 29-year old daughter had surgery for thyroid cancer when she was 14. In May 2008 she was laid off from a small company with fewer than 15 employees, thus ineligible for COBRA coverage. As you can imagine, she is uninsurable -- at any cost -- under our current system due to pre-existing conditions over which she has no control.

 

Around midnight in March of this year we got a telephone call from her: "Hi, I'm in the ER. The right side of my face is paralyzed and numb. Don't worry." It turned out that she "only" had Bell's Palsy, which has a very high recovery rate, but you can believe that we didn't sleep well that night. Fortunately, she completely recovered, at a cost of less than $2000. Although she landed a new job in April, she doesn't yet qualify for health insurance through employer.

 

Fortunately, she's been able to cut deals with her doctor to reduce costs of office visits, to get sample meds, and to get others at significant discounts. Despite that, we've been living one incident from financial disaster for the past year. I hope that she either qualifies for group coverage, or the present administration is able to make some progress against the current dysfunctional insurance system in this country.

 

$3000 a year would be about $9000 less than we're currently paying for her health expenses. For that matter, it's considerably less than the monthly deduction from my wife's salary to cover her and me.

 

[russell_bynum]

I hope that she either qualifies for group coverage, or the present administration is able to make some progress against the current dysfunctional insurance system in this country

 

The current system is NOT dysfunctional. There is certainly room for improvement (the situation you described is a great example), but it seems to me that for the vast majority, it works fairly well. That can hardly be called "dysfunctional".

[Ken H.]

 

 

The problem is not all those 46 million are Americans and many don't care or aren't willing to pay a penny for HC cause they don't think they need it.

 

 

 

...again

 

$200/month for the best care money can buy.

 

Less than my cell phone bill

 

Less than my cable TV bill.

 

I wonder how many of those mythical 46 million have a cell phone and watch cable every night.

 

Please don't touch our healthcare system just educate the folks.

 

 

$200 per month is not that much.....(it was $300/month)

Oh Larry, Larry, Larry, my friend... $2400 a year is a fortune to 100s of 1000s of people in the USA. People who in their wildest dreams couldn’t even image ever having, let alone giving up a cell phone, cable TV or any of the other multitude of things those of us who can sit here and type on this Internet forum enjoy.

[MikeRC]

I also try to avoid these health care debates. I like the discourse so far, but need to straighten out some misconceptions and add some facts.

 

As I understand it the OP was commenting on the bill before Senate with a short title of the "Affordable Health Choices Act". An interesting read, but after about 20 of 615 pages I had to give up. How many senators have read this whole thing? So I tried to read summaries at other government websites and newspapers and everyone had their own take on the thing. Bits and pieces here and there. Conservative reviewers one thing, liberal another. And likely to be shuffled off to Committee to die a slow death?

 

If you haven't read the article that EB refers to, go and read it now. I found it very well written and quite enlightening.

 

Anyway, I try to look up statistics where I can. And take them with a grain of salt. Some things were surprising (to me). Apparently even most uninsured Americans are happy with their health care. Between what they can get for free or work out with physicians/hospitals/employers they are just a bit less happy then Canadians with their health care. And insured Americans are quite a bit happier then Canadians. And the catastrophic illness -> bankruptcy scenario is very unusual but sells newspapers. And it does seem a bit odd to let happen in an industrialized country.

 

So if most (even the uninsured) in America are happy with the present system, what would be the driver for health care reform? What I see in the news is that Americans spend far more then anyone else on health care but aren't really ahead for that expenditure. It cuts into (rather then enhances) competitive advantage.

 

According to Fernando:

Socialized medicine has been tried in dozens of countries. And by people at least as smart as Americans (which lately may be damning with faint praise). Show me where anywhere near half of those systems provide the quantity and level of care that we currently enjoy in this country. OK, show me where one-fourth of them do. One-tenth? One?

 

Unfortunately, Fernando, you can't scrape up much objective data to support that. I went to the World Health Organization and OECD databases and found that among industrialized nations, the US leads in per-capita health expenditures by over 30% but doesn't rank in the top 1/3 for most "health" measurements including life expectancy, percentage of premature births (a measure of how effective prenatal care is), illness free years or productivity losses due to illness. France, Great Britain and Canada were all ahead. You have better access to diagnostic and treatment modalities but it doesn't seem to help you live longer or better.

 

So what are you paying that extra money for? Access. Plain and simple. Well, access and administrative costs. Larry is right about wait lists in Canada. The only problem is that those wait lists actually don't even contribute to (measurable) lost days of work. Many friends, family members and co-workers are on wait lists to see a specialist about something or other. But most are still going to work while they are waiting. One elderly relative was on a wait list for knee replacement (about 3 months) but asked to be delayed for another three months so it didn't interfere with her winter in Mexico. I guess the wait really wasn't that bad. And most serious illness is taken care of in a timely manner. Just as it is in the US.

 

I also did a little search for wait list problems in the US and found some interesting numbers for many HMOs and Managed Care groups that were similar to the Canadian wait times that Larry referred to.

 

I wish you guys luck with the problem. Fernando is right, we (Canadians) don't know the answers and are still tuning our system. But fewer then 5% of Canadians would support converting back to a for-profit medical system.

 

Now if only we could convince the politicians to look closer at the Australian model.

 

Mike Cassidy

 

[DavidEBSmith]

The current system is NOT dysfunctional. There is certainly room for improvement (the situation you described is a great example), but it seems to me that for the vast majority, it works fairly well. That can hardly be called "dysfunctional".

 

The problem is, when the system fails, it fails catastrophically. If commercial airliners occasionally and randomly exploded in mid-air because of bad maintenance, even if the vast majority of them got to their destinations safely, you would have to say that the maintenance system was dysfunctional.

[russell_bynum]

The current system is NOT dysfunctional. There is certainly room for improvement (the situation you described is a great example), but it seems to me that for the vast majority, it works fairly well. That can hardly be called "dysfunctional".

 

The problem is, when the system fails, it fails catastrophically. If commercial airliners occasionally and randomly exploded in mid-air because of bad maintenance, even if the vast majority of them got to their destinations safely, you would have to say that the maintenance system was dysfunctional.

 

Airliners DO fail from time to time. The majority of the time they work just fine, but sometimes they do fall out of the sky. We do (and should) examine those cases and see if it makes sense to make changes.

 

I haven't heard anyone on any side of this argument say that our system is perfect and that there's no room for improvement. But for the most part, for most people it works fairly well. Let's make improvements where we can, but let's not screw up what's already working in the process.

[Quinn]

Really need to factor in the cost of lawsuits in our medical system. Do the doctors and other service providers in Universal care countries have to carry as much insurance?

 

 

[EffBee]

Mike, you're a physician and Canadian, so I take your perspective seriously. But I did do some research, and it appears that the greatest reason for not wanting to revert to a free-market health-care system is fear of change. This goes a long way to confirming what many already know, that once the addictive needle of nanny government is inserted, the desire for the sense of security, real or imagined, is impossible to break. And this is why this is being fought against so hard. We can reverse the billions in new taxes that have been levied on us. We can eventually pay down our debt if we buckle down and get rid of government waste. However, the health-care shift is forever, and for many the statistics don't hold up.

 

With all due respect, you see things from the inside. If the health-care system in Canada is so good, why are so many coming across the border for treatment in the U.S.? If it's so good, and given that you have access to the same treatment modalities, why is the rate of death from cancer 16% higher in Canada than in the U.S. If the treatments are supposedly readily available, then why is the average wait time from diagnosis to radiation a stunning 8 weeks? This comes from Dick Morris who was a high-level Clinton advisor, is still very pro-Clinton, and had a lot to do with the proposed single-payer system that was developed by the then First Lady. I mention this in order to show that he's pretty bipartisan.

 

I have friends in Canada and, being of about the same age as me, they have the following situations: Age 57, approved for and awaiting a corneal transplant, two years so far. Age 60, approved for and awaiting a left-hip replacement, three years so far. Age 62, died after waiting for chemotherapy for 9 months. Yes, it's easy to take isolated instances and make sweeping generalities from them. But the constant in what my friends tell/told me is that the government rations care, and they were deemed to be too old in whom to invest. In other words, the amount of taxable productivity they had remaining wasn't enough to offset the costs. Never mind the fact that they'd been taxed and paying into the system most of their lives. In other words, either government-paid physicians, or bureaucrats have decided to NOT deliver the promised medical care and in one case the man died. And anyone who doesn't think that this is what's lying at the bottom of the plans being considered for the U.S. has no sense of finance, no understanding of the heartlessness of bureaucracy, and no appreciation for the lessons of history.

 

The facts are that you cannot legislate equality. Whether it's Little League results, or income, or motivation/drive, or wisdom, or study habits, or health habits. People are different and some are going to be able to afford care, while others are not. Can a government help those who cannot, even if it's by their own doing? Certainly. Should the government take a perfectly good system that works for more than 80% of the people and toss it out the window in order to create a new and historically questionable system that supposedly will encompass all (but even the Congressional Budget Office says will still leave 36M of the uninsured 43M without coverage)? No.

 

Finally, if we overtreat, perhaps it's because looking over the shoulder of every physician applying a band-aid, is a cadre of salivating attorneys whose concern is not for the care of the patient, but for the moneys that can be drained from any given situation. Tort Reform must come first. Once physicians are free to do what they've been trained to do in medical school and by practical medical experience, and not to cover every statistical abnormality and insignificance that might be conjured up for some courtroom, we will see dramatic cost savings. When doctors are paying $100K - $200K a year in malpractice insurance, it's pretty obvious where the keystone to overtreatment lies.

 

[David]

Without taking sides (because who in the hell knows what the plan will look like), I'm fascinated by the claim that any new plan will save billions of dollars in unneeded diagnostic procedures (xray, lab, etc.).

 

I strongly recommend this article from the New Yorker for some insight into how this might happen.

 

I followed your recommendation and read that, David. It was a good article, and really got me thinking. Especially the Mayo model portion of it.

 

I finished the article feeling like I understood the problem more than before, but a solution seemed even further away.

 

I appreciated the fact that it was very data-centric and appeared balanced.

[philbytx]

This is my (and Deb's story)....

 

We've been treated under both the U.K. and U.S. systems. In the U.S., in several different areas of the country.

 

In the U.K., if you have an accident or emergency...all well and good. Otherwise, its take two tablets and we'll schedule you in and let you know.

Oh! And don't be over 70......they really only want you to die as cheaply and as quickly as possible!

 

Here in the U.S., I experienced nothing but great care and follow-up. But I (and my company in some cases), have paid for it. We are "semi-retired", working part-time and currently paying $1200 per month for Deb and myself, with a $5000 per annum deductible. Oh! And my "pre-existing" colon cancer and hypercholestemia issues are not covered.

 

If you are poor or very rich, you have medical coverage. However, if you are in between, you have the choice to roll the dice or, HOPEFULLY, obtain coverage. Thank the Lord, we decided to obtain coverage, found a wonderful insurance guy and got our High Deductible health plan 5 years ago but with the aforementioned exclusions.

 

Deb's current fight with Breast Cancer has racked up over $300,000 dollars...so far.

 

I am 62 this year and will get Social Security......my monthly SS income just covers our monthly health insurance premiums, provided they don't increase them (again)!

 

I have first hand knowledge of the current U.K. system, as it pertains to the elderly. I have aged relatives there that are receiving less than adequate treatment.....continued cancellation and rebooking of appointments way into the future is just once tactic currently used by the "system". I am involved in getting service/treatment for them and have experienced this lack of attention and appointment shuffling first hand...it both angers and scares the crap out of me! Oh! And if you have the money, you can go "private" in the U.K. to, hopefully, obtain quicker/better service (sometimes!) but the state does not assist when you take this approach. Nice Uh?!

 

Do I have an answer...No! But I am a Libertarian, believe in less government and the idea of government bureaucrats controlling ANYTHING that affects my health is anathema to me.

 

 

 

 

 

 

 

 

[Lawman]

Phil,

Good post. I think health care now presents a real dilemma. 50 - 60 years ago no amount of money could help with treatment of many of todays health problems. People spent less money and died sooner. Today technology and successful medical research has made it possible to treat and even cure many ailments that not long ago were not treatable much less curable. But it comes at a cost. Until we recognize and deal with the fact that we cannot afford to provide each and every person in this country with the best health care money can buy we will not deal very well with this problem. I see no "solution" but I think we first need to deal realistically with this fact before we can best manage the problem..

[Whip]

IMHO there are two problwms with health insurance/health care.

 

First is the people that need it the most don't have it, can't afford, or do afford it and it's so expensive it changes their life.

 

Second is the folks that don't think they need it, don't have it, most of the time are very healthy and really don't need it. Of course sh&t happens and they wish they did, but for the most part they never need it and don't want to waste/spend their money on somethin they may never need. I've been there

 

Car insurance was the same way at one time. The only folks that had it wrecked all the time. The others "safe drivers" didn't feel the need for it. Car insurance was very expensive in those days.

 

Once everyone was forced to get liability insurance, pay for it themselves, it became very competitive. The prices came down.

 

I hate the idea of Big Brother forcing us to do anything, but maybe the answer is in there somewhere. Take away the employee deduction for health insurance and leave the deduction for the individual.

 

In order to drive a car and get a license you must have some form of health insurance. (I don't know what kind...I'm sure we can find somethin)

 

This would bring the price down dramatically. I'm sure we can come up with somethin for the utes and non drivers.

 

Make the requirements the same for all fifty states.....so you can buy your policies across state lines.

 

 

I bet we would be surprised at how cheap it would be.

 

 

 

Class dismissed

 

 

 

 

 

 

 

[marcopolo]

Perhaps people should focus as much, if not more, on results/outcomes. Here's a few interesting facts: The average Canadian lives to the age of 81.23 years (eighth in the world), longer than people in every other major North American and European country (to save you looking it up, U.S. life expectancy is 78.11). Source: The CIA's World Fact Book 2009. When it comes to healthy life expectancy (number of disability-free years a person enjoys), Canada is fourth highest in the world at 73 years. We do better than most of our neighbours in terms of health and life expectancy. I'm not going to pretend to understand all the reasons why, but it does suggest to me that our health care system must be having a positive effect. I read an article recently (Macleans magazine) that stated that nations with universally accessible health care always have longer average life expectancies.

 

Canadian "system" is a bit of a misnomer too. We do not have a single national plan, we have interlocking provincial health insurance plans, all of which share certain common features and basic standards of coverage. Federal legislation spells out criteria and conditions that must be satisfied by provinces in order for them to qualify for federal cash (a very large hammer). In essence federal law demands that provincial health insurance plans be:

 

1) publicly administered (operated on a non-profit basis by a public authority);

2) comprehensive (province must cover all insured health services provided by hospitals, physicians or dentists (surgical-dental services which require a hospital setting);

3) universal (all insured residents of a province must be entitled to the insured health services provided by the provincial health care insurance plan on uniform terms and conditions);

4) portable (you can move from one province to another and maintain coverage and you're covered if you travel); and,

5) accessible (reasonable access to insured hospital, medical and surgical-dental services on uniform terms and conditions, unimpeded by charges (user charges or extra-billing) or other means (e.g., discrimination on the basis of age, health status or financial circumstances).

 

And as Fernando has pointed out, if you're wealthy and want to pay for it yourself, you can go anywhere in the world you want to and buy medical services. For those that do (I don't know any personally), the obvious choice is the U.S. -- it's close, we speak the same language (sort of) and the service is first rate. Obviously this is an option for only a very very small percentage of Canadians.

 

Any individual's views of their health care coverage are very strongly influenced by their own personal experience. My experience has been nothing but positive, so for me, my family and my friends, the system works well. We have no worries about pre-existing conditions, or facing financial ruin because of ill health. My son (still in his twenties) has had two kidney transplants. Total out-of-pocket expense to him was zero (they even covered his parking at the hospital). Any wonder I think we're well served? We know we're paying for it (in our taxes), but any person I've talked to values the principle that every Canadian has access to health care regardless of their means. Call me altruistic, socialist, or apply any other label, but to me that's important and well worth paying for.

[Boffin]

Phil,

the service you get from the UK's NHS varies by region and condition. My mother who is in her 80's and lives in Devon has had none of the issues you describe. She has several health issues in addition to the simple ravages of age.

 

My mother-in-law, also an octogenarian, lives in Warwickshire. She has type 2 diabetes - no problem with treatment or appointments there either.

 

I have had a few recent health issues myself, two of which were dealt with by the NHS, one by my company's private heath insurance.

The first issue was a cat bite. When the bite was obviously infected I saw my GP - phone at 08:15, appointment 09:20. She prescribed antibiotics and told me that if the redness did not subside to come back. The next day, a Friday, the redness had increased. I went back and she said that as the next day was a Saturday, she would get me admitted to the local hospital for an overnight observation, so off to hospital I went (That day).

Saturday AM the doctor looked at my hand and scheduled me for emergency surgery! One week and three operations to clean out the infected finger joint later (all under a general anaesthetic (SP?) I went home. There I received daily visits from the district nurse to give me intravenous antibiotics.

 

The second issue is my OSA. I saw my GP - same deal, phone at 08:15, see GP later that morning. She gave me a few tests and referred me to the hospital. Two weeks later I am talking to an ENT consultant. Another two weeks I am on a sleep study. Then came Christmas, so it was three weeks before I saw the consultant, got my diagnosis and the APAP machine on the same day. I know people in Kent however, for whom the process took the best part of a year.

 

The final issue is my hearing - I suffer from Otosclerosis. I have had NHS digital hearing aids for a few years now but decided in May that it was time to get it sorted. I saw my GP (same deal etc), asked for a private referral, which I got and the next week I was speaking to a different ENT consultant - a leading specialist in this area but also the one I would have seen via my local NHS hospital for this condition. I have the operation on the 30th July - it could have been earlier (yesterday was the earliest date) but the dates were not convenient for me. I asked the consultant what the wait would have been had I gone via the NHS and he said in this area about two to three months for the consultation, then a further three for the op.

 

Under the NHS scheme, I can also asked to be referred to another health authority area with lower waiting times for any specific condition - these wait times are published.

 

I like having the choice, I relish having the lack of worry that a major condition would bankrupt me. Of course, if I did not have the NHS there to cover me, I would have taken out private cover.

 

BTW, the NHS is not free, it is free at the point of delivery. I pay 11% of my wages as 'National insurance' - people on low earnings do not pay, those on high earnings pay 12%. Employers also have to pay about 12-13% for each employee with varying profits/employee number thresholds. Then I have to pay a fixed fee for each medicine prescribed (about £6 from memory). Those on benefits, pregnant or under 16 (or both!)do not pay.

 

How does this fit into the debate, I am not sure, but I do not accept that the NHS is a total crock of manure. It does have shortcomings but then it costs the UK less to run per capita than the US government spends per capita on its health provision.

BTW, the only time people have to wait for extended periods is for non-life-threatening issues.

 

Perhaps the answer for the USA is to adopt our system but to keep paying the current per-capita amount. That should allow the 'waiting time issue' to be dealt with.

 

Oh, and I do not know of anybody in the UK who fears that a major illness will throw their family into destitution. In fact, the one topic that never gets mentioned in conversation here is the cost of health cover.

 

Andy

 

 

[JohnnyJ]

In the U.S. there is a significant number of people that already have universal health -- Government employees; The rest of the population pays for it through taxes. Also, employees of large corporations have similar privileges... paid for by the consumer.

Much of the funds that pay for this comes from those that have no insurance. How is this fair?

 

If you are not one of the privileged, you're screwed.

 

I personally have excellent insurance because I work for a large utility, but I'd be willing to start from scratch with a government plan because I feel no one segment of the population is more deserving than another.

 

 

JohnnyJ

 

 

 

[russell_bynum]

Also, employees of large corporations have similar privileges... paid for by the consumer.

 

Huh?

 

 

[Ken H.]

Also, employees of large corporations have similar privileges... paid for by the consumer.

 

Huh?

 

Cost of the products/services.

[JohnnyJ]

Also, employees of large corporations have similar privileges... paid for by the consumer.

 

Huh?

 

 

When you buy electricity you are also paying for someone elses medical insurance.

 

When you buy a new car, part of the expence is the employees medical.

 

How can this be argued?

 

JohnnyJ

[Lets_Play_Two]

"Much of the funds that pay for this comes from those that have no insurance."

 

You were doing okay until you got here. Many of those without insurance do not pay taxes, so they are not subsidizing the government and corporate sponsored plans. Tax payers pay for this and we all know who pays 80%+ of the taxes in the country.

 

Like everyone else, I have no answer but I do believe if we are going to start with the premise that health care is important for everyone and required for everyone, it must be universal and paid for by everyone. I agree with the idea of taxing the value of the health care benefits paid for by employers (without the exemption for union plans). This would include government employees (a definition I would set to include congresspersons and senators). Also establish the plans with a reasonable deductible amount so people don't run to emergency rooms or doctors for sore throats and 99.5' temperatures. The conversation here seems to focus on people not having to worry about life-destroying medical bills. Make the deductible $3000 a year for a family. One day in intensive care with eat that up.

 

I pay about $500 a month for basically catastrophic coverage for myself and an 18 year old and a 22 year old. The deductible is $3000. We are fortunate to be healthy except for my daughter's allergy shots. As soon as I go on your nickle (medicare) my kids insurance will be about $200 per month. Speaking of medicare...that will cost me almost the same as I am paying now with very little change except I will have drug coverage. I am not worried about today or tomorrow, but about what happens when I need medical care at 80 years old. I forget the number but a high percentage of medical costs are the money spent in the last days of life in an effort to keep you alive!!! And in spite of what you hear, it is very difficult for you to make a decision to forego heroic lifesaving efforts. When they can't ask you someone else will butt in and decide not to pull the plug. But that is a different conversation.

 

 

[Lets_Play_Two]

 

When you buy electricity you are also paying for someone elses medical insurance.

 

When you buy a new car, part of the expence is the employees medical.

 

How can this be argued?

 

JohnnyJ

 

That can't be argued but why stop there. You are paying for someone's time off to go on vacation (you willing to give up your vacation time to cut electric rates? What about those people who can't afford vacations?), time to stay home with the flu...my God!! you are also paying them money to make their mortgage payment and even pay their electric bill!! If they bought a gun to defend themselves you paid for that too.

[VinnyR11]

 

...again

 

$200/month for the best care money can buy.

 

Less than my cell phone bill

 

Less than my cable TV bill.

 

I wonder how many of those mythical 46 million have a cell phone and watch cable every night.

 

Please don't touch our healthcare system just educate the folks.

 

 

$200 per month is not that much.....(it was $300/month)

 

 

Your quote is a little misleading. It should read "$200 per month, which is what I pay living in San Antonio and with my history." The prices vary wildly depending on where you live, and your health history.

 

There is no way you get anywhere close to that number living in the Metro NY area or Florida, for top of the line Blue Cross Blue Shield, especially if you're not working for a company with a number of employees. Even within a large company you're paying multiples of that (adding the costs to you and your employer).

 

While in NY my wife and I paid over $1500/month (combined) for catastrophic coverage only, and I shopped everywhere. My friend, living on Long Island, who recovered from cancer 5 years ago is paying $25 THOUSAND per year for the full boat Blue Cross Blue Shield.

 

To your reference, that's a heck of a lot more than our cell pone, cable bills, and dining out combined.

[russell_bynum]

 

When you buy electricity you are also paying for someone elses medical insurance.

 

When you buy a new car, part of the expence is the employees medical.

 

How can this be argued?

 

JohnnyJ

 

That can't be argued but why stop there. You are paying for someone's time off to go on vacation (you willing to give up your vacation time to cut electric rates? What about those people who can't afford vacations?), time to stay home with the flu...my God!! you are also paying them money to make their mortgage payment and even pay their electric bill!! If they bought a gun to defend themselves you paid for that too.

 

[SeanC]

How can this be argued?

 

We can extend your argument to just about anything.... I mean, if consumers are paying for the health care of corporate employees, they're also paying the salaries.... they're paying for the vacations.... they're picking up the tab for Christmas parties.... and office supplies.... and, well, anything and everything else.

 

So?

 

Should taxpayers provide everyone's salaries? How 'bout Christmas parties, vacations, cell phone bills, car allowances and fitness programs? Consumers pay for those benefits, ergo everyone should have them in the name of fairness, right?

 

C'mon now.

 

If it can't be argued, then none of the other stuff consumers pay for can't be argued either. Why is health care different?

 

 

Edit: Ooops. I was typing the same reply as Bill at the same time.

[JohnnyJ]

 

 

"Much of the funds that pay for this comes from those that have no insurance."

 

 

This point is arguable but not that relevant. That statement could have read " Much of the funds that pay for this comes from those that pay for insurance THEMSELVES"

 

Why should you pay for your own insurance AND the insurance for the cop that's giving you a ticket.

 

 

JohnnyJ

 

 

[Lets_Play_Two]

Maybe we should all just live in the same two/three bedroom apartments as doled out by our great benefactor and go to benefactor-approved locations for a 3 day respite from working in our steel grey cubicle. If we exceed our electricity allowance it is just turned off until the next allowance cycle. Hopefully our benefactor-approved doctor will be able to keep his electricity on, or maybe he is only open three hours a day two days a week!!

 

Of course there will be exceptions to these rules to include the chosen people by the great benefactor, most of whom will wear uniforms and carry BIG guns.

[Lets_Play_Two]

 

"Much of the funds that pay for this comes from those that have no insurance."

 

 

This point is arguable but not that relevant. That statement could have read " Much of the funds that pay for this comes from those that pay for insurance THEMSELVES"

 

Why should you pay for your own insurance AND the insurance for the cop that's giving you a ticket.

 

 

JohnnyJ

 

 

You don't think cops pay taxes? And where did you get the money to pay for your insurance and that ticket? Why should I pay electric rates that pay for your traffic tickets?

[philbytx]

Hi Andy

 

I grew up with the NHS (I was born in 1947!) until I left the U.K. in 1979 and I believe I certainly got my monies worth !!

 

I also understand that changes wrought over the past 15 or so years have improved service levels and, please note, I never said it was a crock of manure. I only spoke of my dealings with the NHS in the London area relative to my mother, stepfather, aunts and uncles, all in their 70's and 80's. I also didn't include other cases that I am aware of, especially concerning my sister and cousins (in their 60's), and older relatives of friends living in the U.K.

 

I am fortunate that I have CHOICE and, more importantly, a VOICE here! As I said in my earlier post, I prefer it that way and am still happy to pay DIRECTLY for it.

 

And in the case of BOTH our cancers, early detection and speedy diagnostics followed by super-prompt surgeries and treatments certainly saved and extended our lives.

 

Your point about a family spending health care dollars into destitution is a fair one. Although I do not know anyone that has experienced that particular tragedy!

 

I don't want a Nanny state, I don't want a state pension scheme, I don't want anything that a politician can wrap his greedy little hands around. More importantly, I want to retain the choice and a voice when it comes to my own care and treatment!

 

 

 

[JohnnyJ]

How can this be argued?

 

We can extend your argument to just about anything.... I mean, if consumers are paying for the health care of corporate employees, they're also paying the salaries.... they're paying for the vacations.... they're picking up the tab for Christmas parties.... and office supplies.... and, well, anything and everything else.

 

So?

 

Should taxpayers provide everyone's salaries? How 'bout Christmas parties, vacations, cell phone bills, car allowances and fitness programs? Consumers pay for those benefits, ergo everyone should have them in the name of fairness, right?

 

C'mon now.

 

If it can't be argued, then none of the other stuff consumers pay for can't be argued either. Why is health care different?

 

 

Edit: Ooops. I was typing the same reply as Bill at the same time.

 

The difference is everything mentioned can easily be purchased by almost everyone. Or easily done without.

 

Medical insurance is different.

 

If someone has a preexisting condition and cannot get it... they should not have to pay for yours.

[Ken H.]

Perhaps people should focus as much, if not more, on results/outcomes.

Some more numbers to banter about...

 

United States

 

Abortions per capita - 2nd highest in the world

Breast cancer incidences - 17th

Deaths from cancer - 9th

Heart disease deaths - 13th

Hospital beds per 1,000 - 27th

Infant mortality rate - 35th

Life expectancy at birth - 48th

Maternal mortality - 121st

Percentage Obese – 1st

Physicians per 1,000 - 31st

Plastic surgery procedures - 1st

Spending - 1st

Suicide rate - 40th

Teen birth rate - 1st

 

Not exactly my personal opinion of what constitutes, "the best health care in the world", but then that's just me.

 

Here's Canada's numbers for comparison:

 

Abortions per capita - 11th highest in the world

Breast cancer incidences - 10th

Deaths from cancer - 17th

Heart disease deaths - 16th

Hospital beds per 1000 - 25th

Infant mortality rate - 162nd

Life expectancy at birth - 8th

Maternal mortality – 162nd

Percentage Obese - 11th

Physicians per 1000 - 37th

Plastic surgery procedures - 13th

Spending - 5th

Suicide rate - 33rd

Teen birth rate - 21st

 

Not the best in the world either, but beats the US in all categories but: breast cancer incidences (but Canada’s cancer death rate is lower), # of hospital beds per 1000, and suicides.

 

Overall Switzerland, Norway and Denmark hold the top distinctionS. With Germany and France close behind. All of which have some form of UHC.

 

[Lets_Play_Two]

 

The difference is everything mentioned can easily be purchased by almost everyone. Or easily done without.

 

Medical insurance is different.

 

If someone has a preexisting condition and cannot get it... they should not have to pay for yours.

 

So we are entitled to health insurance but not sick time? What about the person who can't take a vacation, should they have to pay so that others can? You are trying to create a difference when there is simply not one to make an argument for a socialized way of life. People with preexisting medical conditions can get insurance, and in fact that has been made easier in the recent past, it certainly does cost more, but so does life insurance for a 60 year old cost more than that for a 25 year old. You can see from the comments here that the argument gets to be more and more about the "right" to things rather than cost. People with more money have more stuff...some simply don't like that and use whatever wedge is available to promote a different idea.

[Lets_Play_Two]

Perhaps people should focus as much, if not more, on results/outcomes.

Some more numbers to banter about...

 

United States

 

Abortions per capita - 2nd highest in the world

Breast cancer incidences - 17th

Deaths from cancer - 9th

Heart disease deaths - 13th

Hospital beds per 1,000 - 27th

Infant mortality rate - 35th

Life expectancy at birth - 48th

Maternal mortality - 121st

Percentage Obese – 1st

Physicians per 1,000 - 31st

Plastic surgery procedures - 1st

Spending - 1st

Suicide rate - 40th

Teen birth rate - 1st

 

Not exactly my personal opinion of what constitutes, "the best health care in the world", but then that's just me.

 

Here's Canada's numbers for comparison:

 

Abortions per capita - 11th highest in the world

Breast cancer incidences - 10th

Deaths from cancer - 17th

Heart disease deaths - 16th

Hospital beds per 1000 - 25th

Infant mortality rate - 162nd

Life expectancy at birth - 8th

Maternal mortality – 162nd

Percentage Obese - 11th

Physicians per 1000 - 37th

Plastic surgery procedures - 13th

Spending - 5th

Suicide rate - 33rd

Teen birth rate - 21st

 

Not the best in the world either, but beats the US in all categories but: breast cancer incidences (but Canada’s cancer death rate is lower), # of hospital beds per 1000, and suicides.

 

Overall Switzerland, Norway and Denmark hold the top distinctionS. With Germany and France close behind. All of which have some form of UHC.

 

I am not sure how these prove your point since we have different policies and different life styles that affect all of these. Leading the world in abortions is a political result and infant mortality can also be argued to be greatky affected by political policies. Percent obese has nothing to so with the health care unless you believe that we should mandate calories or Big Macs consumed. Teen birth rate? What does medical care have to do with this. Another statistic that is probably more impacted by political decisions than health decisions. Plastic surgery...I guess this is your way of taking another poke at life styles you don't like but has nothing to do with health care. So now we are down to heart disease where it is 13th to 16th (you didn't indicate if this is absolute or per capita), Breast cancer 17th to 10th, and deaths from cancer 9th to 17th, hardly improvements that will force a change of venue.

[SeanC]

Why is health care different?

 

The difference is everything mentioned can easily be purchased by almost everyone. Or easily done without.

 

Medical insurance is different.

 

If someone has a preexisting condition and cannot get it... they should not have to pay for yours.

You're saying it's different, but you're relying on an argument that can be used for anything else. Homes, for instance. Houses can't be easily purchased and can't be easily done without. My preexisting condition is that I live in San Diego, where home prices are very high. Should your taxes be used to help pay my mortgage?

 

Auto liability insurance is also very high. Like health insurance, it is very important to have. In fact, the government requires you to have it. Should taxpayers pick up the tab for drivers who can't afford the insurance? How about for those drivers with preexisting conditions, i.e., bad driving records? My auto insurance is paid for with money from my salary, which consumers of my company's products pay for, and some of those consumers probably can't afford their own liability insurance, so it must be unfair that they're paying for mine....

 

So again, why is health insurance somehow different?

[MikeRC]

Fernando:

 

Thanks for the well thought out reply. You make some good points, but I'm still not fully "on side".

 

In most polls, Canadians list their Health Care system as a source of pride and one of the nations greatest achievements. But we would also like to see it improved. I'll accept your argument about the "fear of change", but by the same token that also applies to Americans accepting change in their Health Care system.

 

We can all find "exceptions to the rules" and horror stories. People fall through the cracks in all countries, and I hope we are all trying to improve that.

 

Regarding the issues you mentioned inside information does help:

• Going to the reference that Larry used above and other Federal health documents nearly 90% of cancer patients receive treatment within national and international guidelines. But that also means 10% don't. One very large international study (the CONCORD study) showed that cancer survival rates are the highest in the US, but not by as much as you might think. Canada ranked second in patient survival for breast cancer, third for prostate cancer in men and for colorectal cancer in women, sixth for colorectal cancer in men. And in all cases survival was only 2-5% different between most industrialized nations.
  
• Corneal transplants are emergency procedures and depend on corneal availability and patient need. There is no difference between the US and Canada because we are both short donors and that is the limiting step. And all countries use the same priority system for transplants. Unless you are a Hollywood celeb.
  
• I'm very surprised about the wait for joint replacement, as there have been some real strong initiatives to improve that and most provinces are down to 6 months from first referral to surgery. Age isn't included in the wait list priority, BTW. I just did a fairly healthy 90 year old last week.
  
• I'm sorry about your friend who died awaiting chemotherapy and would have look at the details. It certainly could be a screw - up. Or one of those unusual cases where that province doesn't cover that chemotherapy or has a limited number of patients funded for "last resort" type treatments. But that happens in your system as well because your "plan" doesn't cover the "recommended" treatment.
  

 

If you go back to some other references you will find that tort reform is part of the puzzle, but not too much. It is hard to know how much money is spent with CYA tests and referrals (in either country). I think most of those extra tests are actually ordered to minimise the chance that something is missed.

 

In Canada, we look at Universal Health Care more like a public education system. It provides a basis for helping the public to be productive by maintaining a certain level of stability. It certainly isn't perfect (I would sign up for extended coverage tomorrow if it was available) but it works for the majority.

 

Mike Cassidy

 

 

[Boone60]

When Wendy was dying from breast cancer, it was the insurance company that decided what medications that they approved for the doctor to use, and they told the doctor how long she could remain on the hospital floor before sending her home (but didn't stop me from bringing her back to the ER for readmittance in a worse condition.)

[DavidEBSmith]

If you go back to some other references you will find that tort reform is part of the puzzle, but not too much. It is hard to know how much money is spent with CYA tests and referrals (in either country). I think most of those extra tests are actually ordered to minimise the chance that something is missed.

 

A couple of points here:

 

- A huge portion of the claims for malpractice is for medical expenses arising out of the malpractice. With universal coverage, those costs get shifted out of the tort system into the health care system. It will reduce the number of malpractice lawsuits (and arguably the number of personal injury lawsuits in general) if the fighting over who pays the medical bills (and the lawyers' fees) is eliminated.

 

- There is a currently a disconnect between malpractice liability and medical care quality. All but the very worst doctors can still get liability insurance and insulate themselves from catastrophic liability for the results of their mistakes. Even then, they don't get priced out of the market - malpractice insurance rates tend to top out at an upper limit and then insurers just cancel. I would hope and expect that a necessary part of any universal system would be results-based quality control - that doctors who are doing a consistently bad job and costing the health care system a lot of money will be required to do a better job or get out of the business. To work, a universal system has to do better than the current system that lacks adequate controls, but with proper controls in place, improvements in the quality of care provided can eliminate much malpractice litigation.

 

- Many tests are done as CYA, but many tests are also done because the doctor receives a direct or indirect financial benefit from making the referral. Quality control can help eliminate unnecessary tests done for either reason. On the flip side, standards or referrals and universal coverage for appropriate tests can mean that we can catch more problems earlier while they're cheaper to fix.

[John Ranalletta]

Many tests are done as CYA

The term "CYA" is almost always used pejoratively by the unknowing.

 

"CYA" is any action wherein a person attempts to guarantee an outcome; or at least increase the odds of a specified outcome.

 

"CYA" as practiced by physicians can occur because:

• S/he is trying to minimize his/her liability;
• S/he is trying to minimize his/her personal liability and is trying to insure a good outcome for the patient; or,
• S/he is trying to insure a good outcome for the patient.

So, how does "quality control" sort out one motive from the other two?

 

What happens when, through an application of a yet undefined "quality control" process, the physician who is only concerned about a good outcome for the patient is denied the diagnostics s/he believes s/he needs?

 

If the level of diagnostics are restricted based upon the diagnostic codes but the physician would prefer more diagnostic data would the physician tell the patient, "I don't think this is enough diagnostic information, but it's all I am authorized to order. Your treatment is prescribed based upon statistical studies of outcomes for all patients presenting with your symptoms. Those studies say the authorized treatment is 77% effective. If it turns out badly, I just want you to know that I'm not to blame."

 

That, too, is "CYA", appropriately deployed. We hear it every day in every workplace, "I did what you told me to do. If it didn't work out the way you desired, it's not my fault."

 

So, tort reform will not be an issue since a government-run system will truly be a "no fault" system where everyone involved can say, "It's not my fault because I did what I was told."

[Dave McReynolds]

The term "CYA" is almost always used pejoratively by the unknowing.

 

And also by the knowing, since CYA is a pejorative term.

 

To extract from the Wikipedia definition:

 

"Defensive medicine used by physicians; i.e., ordering tests that may not be necessary or helpful to the patient solely to insulate from future medical malpractice suits if the patient fails to recover, or if an illness is misdiagnosed."

 

There are no doubt physicians who will order more tests than other physicians may think necessary because of their personality types, just as certain personality types will require more data before making decisions than other personality types in any endeavor. This personality difference (which may beneficial or may be a personality disorder in the extreme) is not the same thing as CYA, unless you want to distort the meaning of the acronym.

 

Either way, if any scarce resource is going to be allocated according to rules, there will be some needs that will go unfulfilled. If the rule is that the scarce resource will be allocated based on who has the most money, the needs of the poor will go unfulfilled. If the rule is that the scarce resource will be allocated based on the probability of the best outcome for the most people, then people who would otherwise be able to buy more of this resource with their money will go unfulfilled.

 

Regardless of the rule, CYA, under my more limited definition, creates waste, and should be eliminated.

[John Ranalletta]

Here's a hypothetical and I'd like your response.

 

You take your bike into your dealer for service. You agree with the service manager

as to the work to be done and the cost before leaving. Later, the tech spots a condition

that needs attention that, if fixed, will incur both parts and labor costs.

 

If you're the owner, you want the tech to make any repair he deems necessary, regardless

of final cost. Yes ___ No ___

 

If you're the service manager, you want your tech make the repair without checking with

him or you, incurring costs to which you, the customer, might object. Yes ___ No ___

 

If both answers are "no", you want the tech to CYA by calling before fixing. How can

that be a bad thing?

 

In your world, you tell a client a job will take 10 hours and quote a fee based on those

hours. You find the job will take 20.

 

Do you call the client before expending the hours? Yes ___ No ___

 

If "yes", aren't you just covering your ass?

 

Commercial pilots are in a steady-state of CYA. The entirety of the job is to make sure

nothing goes wrong; or conversely, to make sure everything goes correctly. It's the reason

pilots echo the controller's instruction; and, it's the reason why some employees leave

meetings and immediately send emails to meeting attendees trying to clarify exactly what

they are to do.

 

Thank God (or god for the atheists and agnostics) for CYA. Cherish it for it keeps us

safe in more ways than we can count.

 

 

[Selden]

My god -- Whip and I agree on something!

 

The whole premise of insurance is to spread the risk among as large a group as possible. Part of my auto, motorcycle, and property insurance rates undoubtedly "subsidize" those who have had losses, but that's OK, because some day I may be one of those people, whether through my own actions or the roll of the dice.

[ghaverkamp]

Thank God (or god for the atheists and agnostics) for CYA. Cherish it for it keeps us safe in more ways than we can count.

 

If what you were describing was CYA, then it would indeed be a good thing. I don't think those scenarios describe what most people consider to be CYA.

 

In the first scenario, the mechanic would be covering his ass if, after finding and reporting the problem, he was told not to do the work, and, as a result, wrote a memo to the service manager and/or owner describing the problem and how he was rebuffed in his efforts to fix it, in an effort to insulate himself from liability.

 

Take affirmative steps to directly address changed circumstances or to clarify orders isn't CYA. CYA is taking indirect measures to defend one's own hide in the event it all hits the fan.

[John Ranalletta]

The whole premise of insurance is to spread the risk among as large a group as possible

No, no, Nannette. Private health insurance as practiced in the US is a combination of:

• Excluding applicants who are likely to make claims; and,
• Denying or procrastinating the payment of claims.

Which, of course, is why we're having this discussion. IMO, it's also an argument for letting any citizen buy the same insurance any federal employee can buy and then creating a government-paid program for those who truly cannot afford insurance.

 

The 15% overhead that insurance companies add to the cost of care is there to minimize/eliminate risk and payouts.

[Ken H.]

I am not sure how these prove your point since we have different policies and different life styles that affect all of these. Leading the world in abortions is a political result and infant mortality can also be argued to be greatky affected by political policies. Percent obese has nothing to so with the health care unless you believe that we should mandate calories or Big Macs consumed. Teen birth rate? What does medical care have to do with this.

These things and more have everything to do with healthcare. “Healthcare” is not just about fixing people once they are ‘broken’, it’s about preventing people from ‘breaking’ in the first place.

 

[Ken H.]

When Wendy was dying from breast cancer, it was the insurance company that decided what medications that they approved for the doctor to use, and they told the doctor how long she could remain on the hospital floor before sending her home (but didn't stop me from bringing her back to the ER for readmittance in a worse condition.)

Yup. Anyone in the USA (with insurance) that thinks there isn’t already someone already ‘rationing’ healthcare for them has never had to navigate a major health catastrophe I suspect.

[Ken H.]

What I find quite amazing, astonishing even, is that the USA has the most expensive by far, but yet sub-standard just about any way you can measure it healthcare system in the world. Yet some (many even) US Americans tolerate it, defend it even, to their last breath.

 

If we were talking about any other product or service you would be total up in arms. And what single thing could be more important than your health?

 

What is it? Is it lack of vison about what could be? lack of knowledge about what works in the rest of the world? Stubborn US American pride?

 

Ignoring for a second the 46 million there without healthcare coverage, even those of you who can afford it are getting totally ripped off. But yet you resist every effort decade after decade to improve the situation. I just don’t get it...

[Ken H.]

In Canada, we look at Universal Health Care more like a public education system. It provides a basis for helping the public to be productive by maintaining a certain level of stability.

You know, and I think that’s a key point right there Mike. A healthy populous is a productive, growing, vibrant one. A less healthy population is a declining, struggling, lacking/lagging one. A core principle of long-term sucess that seems lost on some societies.