The Winning Numbers are 14, 46, 23, 49, and 22.

March 30, 2008 6:14 PM

The state of Oregon is holding a health insurance lottery where 91,000 hopeful enrollees will be competing for a couple thousand spots under the Oregon Health Plan, the state's Medicaid program. OHP was created to cover those who made too much to enroll in traditional Medicaid but too little to afford market healthcare, and this development comes as a result of budget cuts and a subsequent enrollment closure in July of 2004. It's a far cry from the universal health care coverage that the plan was suppose to lead to, and marks a dramatic turn for the state's once-ambitious health care reforms.

(Previously in dystopic health care developments)
posted by Weebot (64 comments total)

Paging Shirley Jackson. . . . Ms. Jackson, please report to the Oregon healthcare lottery thread.
posted by FelliniBlank at 6:17 PM on March 30, 2008 [6 favorites]

Uh, why don't they open the other 85,000 slots and balance out the risk pool a bit more?
posted by crapmatic at 6:22 PM on March 30, 2008

The winners get to go to Carousel!
posted by computech_apolloniajames at 6:32 PM on March 30, 2008 [12 favorites]

What's the most you ever saw lost on a coin toss?
Sir?
I said what's the most you ever saw lost on a coin toss?
Coin toss?
Coin toss.
posted by StickyCarpet at 6:36 PM on March 30, 2008 [1 favorite]

Oh my how this can be an uncivilized country.
posted by aerotive at 6:51 PM on March 30, 2008

Quote from the story:

“They said they’re going to draw names, and if I’m on that list, then I’ll get health care,” said Mr. Tsosies, 58, a handyman here in booming Deschutes County. “So I’m just waiting right now.”

posted by Brandon Blatcher at 6:58 PM on March 30, 2008

WTF, richest nation in the world?
posted by pompomtom at 7:03 PM on March 30, 2008

Why succumb to Communist Russian ideas like UNIVERSAL health care when we can fob off the poor with a LOTTERY to determine who gets health care at random? It's better than a regular lottery because you don't even have to pay a dollar to participate! The downside is that if you don't win, you lose a lot more than a dollar.
posted by grouse at 7:13 PM on March 30, 2008 [3 favorites]

It's like that scene from Idiocracy, where the guy missing an eyeball is slowly pulling the arm of a slot machine in the ER waiting room.
posted by Blazecock Pileon at 7:13 PM on March 30, 2008 [2 favorites]

Blazecock is dead-on; Idiocracy becomes life once again.

I watched Idiocracy in HD this afternoon (courtesy of Usenet). Look closely on those slot machine reels and you'll see pills and prescriptions.
posted by porn in the woods at 7:16 PM on March 30, 2008

A lottery for health insurance is only a step away from "the lottery"
posted by HuronBob at 7:17 PM on March 30, 2008

Wow. So close and yet so far away.

I'm confused by the stat in the article that only 16% of the US population is uninsured... it seems like every day (or more) that people post medical or mental-health AskMe questions predicated on not being able to afford health or psychiatric care. Is it just that MeFi is a weird demographic?
posted by loiseau at 7:29 PM on March 30, 2008

A trade-off for Pacific Northwestern states like Oregon and Washington seems to be that, with lower taxation (Washington has no state income tax; Oregon has no state sales tax), these states cannot afford to provide services at the same level as in the rest of the country. What looks like a dramatic turn may simply be fiscal reality, with politicians tightening budgetary belts as the country's economy tanks and health care costs rise.
posted by Blazecock Pileon at 7:42 PM on March 30, 2008

Jesus christ, people! We're trapped in a fucking Terry Gilliam movie.
posted by Avenger at 7:46 PM on March 30, 2008

I'm confused by the stat in the article that only 16% of the US population is uninsured... it seems like every day (or more) that people post medical or mental-health AskMe questions predicated on not being able to afford health or psychiatric care. Is it just that MeFi is a weird demographic?

Just a hunch...but MeFi leans way left, and generally speaking, lefties are not employed by Large Corporations that offer health insurance. They tend more towards the arts and creative professions, which are not as well-known as Big Business for providing health coverage.

Please note that I am NOT attacking MeFi, or the political bent of the majority of the users. I am generalizing and positing ONE possible explanation for the above question.
posted by davidmsc at 8:01 PM on March 30, 2008

Next up: game shows where you win a paying job.
posted by The Card Cheat at 8:01 PM on March 30, 2008

Wow. Tell me how this isn't the dystopian future of Running Man?
posted by five fresh fish at 8:12 PM on March 30, 2008 [3 favorites]

Man, with great opportunities like this (win a lottery or die slowly!) how could that Negro radical Pastor Wright have ever even thought of saying God Bless Damn America!?!?
posted by orthogonality at 8:14 PM on March 30, 2008

lefties are not employed by Large Corporations that offer health insurance.

Is that Large Corporations like Walmart and McDonalds with their $1000 a year cap in cover? Because I'll be betting they've got plenty of lefties working for them.

If they weren't lefties when they were hired, they surely will be by the time they leave.
posted by PeterMcDermott at 8:15 PM on March 30, 2008 [4 favorites]

A trade-off for Pacific Northwestern states like Oregon and Washington seems to be that, with lower taxation (Washington has no state income tax; Oregon has no state sales tax), these states cannot afford to provide services at the same level as in the rest of the country.

Well then maybe it's about fucking time they instituted a state tax. Or increased taxes on high tech. Or someway or other made it necessary for those who have so benefited by the State and its pepole give back to the State and its peoples. There's one helluva lot of wealth up there: there's no excuse for not having excellent public health services.
posted by five fresh fish at 8:16 PM on March 30, 2008

Blazecock Pileon: A trade-off for Pacific Northwestern states like Oregon and Washington seems to be that, with lower taxation (Washington has no state income tax; Oregon has no state sales tax), these states cannot afford to provide services at the same level as in the rest of the country. What looks like a dramatic turn may simply be fiscal reality, with politicians tightening budgetary belts as the country's economy tanks and health care costs rise.

Wow. Okay, I don't get this. If the people desire universal health care, where do they expect it to come from? If Oregon instituted a state sales tax, would people be up in arms?

Disclaimer: I'm Canadian. I take for granted that health care for all is a societal responsibility. I don't think paying taxes that go toward other people's health care is an infringement on my rights.
posted by loiseau at 8:17 PM on March 30, 2008 [1 favorite]

And MeFi only leans "way left" if you are using the unusual United States of America understanding of left and right. By the standards of actual civilized nations, ie. those that do not imprison 1% of their population, who provide universal health care, who have a functional electoral system, MeFi is decidedly centrist. It's not very "left" at all.
posted by five fresh fish at 8:19 PM on March 30, 2008 [22 favorites]

If the people desire universal health care, where do they expect it to come from?

Don't tax you,
Don't tax me,
Tax that man behind the tree.
posted by grouse at 8:24 PM on March 30, 2008

16% uninsured? Really? Where I work the health insurance is very very good, we have dental and vision for $20 a month per spouse, $1 per kid and still, 90% of the people I work with decide to not get it, stating cost or forms that are too confusing. I have tried, horrifyingly unsuccessful, to get these people to sign up and get the coverage for their families. Of course the major demographic of the people I work with are non-white under 25 with no college education. They just haven't been taught how fragile health is and still have the invincibility of youth syndrome. One of my co-workers owns 2 houses, put her 2 kids though college without getting loans and comes to work at a crap job for money she doesn't need because the health insurance is great. She's over 40 and works 4pm to 12am 5 days a week for health insurance and cannot believe the blind stupidity of the majority of her co-workers.

If only 16% of the population is uninsured then they all live where I live and they have chosen to be as such. It boggles the mind.
posted by M Edward at 8:39 PM on March 30, 2008 [1 favorite]

Just a hunch...but MeFi leans way left, and generally speaking, lefties are not employed by Large Corporations that offer health insurance. They tend more towards the arts and creative professions, which are not as well-known as Big Business for providing health coverage.

Rudi Guiliani actually joked about this on the campaign trail, saying that democrats cared more about universal healthcare because they were less likely to be able to afford it. And that's true, because poor people are more likely to be Democrats.

That said, Metafilter leans towards the well educated, and the well educated are more likely to have employer provided healthcare. I'm sure the average MeFite is more likely to have health insurance then the average American overall. But those without healthcare are much more likely to pose questions about it. And I'm not sure how many employer health insurance plans provide psychiatric care.
posted by delmoi at 8:41 PM on March 30, 2008 [1 favorite]

I'm confused by the stat in the article that only 16% of the US population is uninsured... it seems like every day (or more) that people post medical or mental-health AskMe questions predicated on not being able to afford health or psychiatric care. Is it just that MeFi is a weird demographic?

In addition to confirmation bias, even 'good' insurance has a lot of holes - need a wheelchair, even though you can walk a little bit? How about hearing aids?
posted by spaceman_spiff at 9:06 PM on March 30, 2008

A trade-off for Pacific Northwestern states like Oregon and Washington seems to be that, with lower taxation (Washington has no state income tax; Oregon has no state sales tax)

Actually, Washington is ranked 16th in state taxation in the country. Sure, no state income tax, but the state sales tax is 6.5% and the state levies property taxes and the B&O tax on business revenues.

Washington's uninsured population was between 8.4-9.8% in 2004. 600K uninsured / 3.4M residents = 17.6% of Oregon's population is uninsured.

Honestly, Washington is putting their dollars where they can, but when providers are hiking costs at 10% a year it's nearly impossible to keep up. For as much as Eyman's wrecking Washington's tax system, they've at least avoided the draconian initiatives Oregon has been saddled with, ones that have effectively left the state with a third-rate public school system and this health care lottery.

I've heard people up here argue for years Washington needs to go to an income tax, but then I look over the border at Oregon and wonder if our whacked-out system (no, really, schools are funded by profits from timber harvests and taxes on restaurants fund the stadiums) may not be such a bad thing after all.
posted by dw at 9:12 PM on March 30, 2008

I'm confused by the stat in the article that only 16% of the US population is uninsured... it seems like every day (or more) that people post medical or mental-health AskMe questions predicated on not being able to afford health or psychiatric care

Mental health isn't necessarily covered by insurance. Starting this year Washington requires mental health parity (so in-patient is covered the same as a hospital and the limits on psych visits are much higher). I think there are only a handful of other states that do that.
posted by dw at 9:15 PM on March 30, 2008

The healthcare situation in the US is ridiculous. I have personally chosen to ignore 3 separate minor (that could have grown to major) health concerns in the past 3 months waiting for my new job's health insurance to kick in. My blue-collar dad just cut off the family policy because he was basically paying $500 per month for a plan with a $5000/per 6 months deductable and hardly any medication coverage, and this was "the best" his employer could offer. My uncle with a rare form of cancer has exhausted all his chemo options, and Medicare won't cover any new, more experimental treatments.

Along with the recession and rising gas/food prices, this is a very tough time for the working poor and middle classes, and they are the ones who are going to suffer the most while the more privileged get to insulate themselves from the effects. (Unless this really the beginning of the end, in which case, I need to get started on that bunker.)
posted by lychee at 9:19 PM on March 30, 2008

Well then maybe it's about fucking time they instituted a state tax. Or increased taxes on high tech. Or someway or other made it necessary for those who have so benefited by the State and its pepole give back to the State and its peoples. There's one helluva lot of wealth up there: there's no excuse for not having excellent public health services.

Two things:
1. There are probably more high-tech companies inside the city limits of Seattle than there are in the entire state of Oregon. For as "progressive" as Portland is seen, it isn't because it has high tech wealth to fund it all. Most of the state has been suffering through a two-decade long economic decline from falling timber prices and failing fishing grounds.

2. Public health != national health insurance. "Excellent public health services" means disease recon, vector identification, and disease prevention. It doesn't mean providing health care for all. (Though most public health advocates support some form of national insurance, whether single payer or a public-private system. But that's not what public health is, it's just something public health advocates.)
posted by dw at 9:34 PM on March 30, 2008

five fresh fish: "There's one helluva lot of wealth up there: there's no excuse for not having excellent public health services."

That's a bit simplistic. Start ratcheting the taxes up and a lot of that wealth would pack up and leave. There are lots of other states (not to mention countries!) that would roll out the low-tax welcome mat to catch some of that clean high-tech industry; you have to be very careful if you're raising taxes that you don't exceed the cost of relocating somewhere else. There's a very fine line that you have to walk if you want to maximize revenue generation, beyond which further increases in tax rate may actually cause long-term decreases in revenue, as well as damage to the local economy overall. It's entirely possible that given the volatility and mobility of the industries in question, tax rates are as high as they can be.

Practically, it is very difficult to extract taxes, in excess of the cost of relocation, out of taxpaying entities for services that they don't value. The key to expanding services is getting buy-in from the people or corporations who are going to end up footing the bill: if you can make the case that they're going to benefit, they may be willing to suck up the rate increase rather than see it as reason to move to a more desperate friendlier jurisdiction.
posted by Kadin2048 at 9:42 PM on March 30, 2008

What's insane is that big business is harmed by this state of affairs. An unhealthy workforce = an ineffective workforce. Not only is the majority public stupid for not demanding state-controlled healthcare, but the corporations are as well.

What are the things that are pre-requisite to having an orderly society in which every individual has maximum opportunity to contribute best to the good of that society? Surely universal healthcare in up in the top three.

Modern society requires that every individual have the ability to secure their basic needs, because with that comes the ability for that individual to become a net gain to society: it's the only way to sustain our collective long-term survival. The other path leads to chaos, which in modern society leads to global pandemics and crop disaster: things which will threaten the ability of even the wealthiest and most-privileged to survive.
posted by five fresh fish at 9:45 PM on March 30, 2008 [5 favorites]

"You have Died Of Dysentery"
posted by poe at 10:28 PM on March 30, 2008 [5 favorites]

it seems like every day (or more) that people post medical or mental-health AskMe questions predicated on not being able to afford health or psychiatric care.

That's because, for a major portion of people in the middle, i.e. not poverty line poor but not well-off either, healthcare costs are high and actual coverage/ailments covered/peace of mind is low. My wife's old plan when she still lived in the US cost her a third of her wages and was next to useless, given that she had to drive half the state to find a doctor who took her plan (hence take a day off work to go to the doctor, hence lose even more money) and the deductibles were so high that a trip to the docs would set her back a hundred bucks or more easy. And when that's groceries for a week, and there's not much room in the budget, and a serious illness or accident will put you tens of thousands of dollars in the red regardless, well, that's not really 'insurance' is it? It's something, but it's not insurance.
posted by Happy Dave at 10:55 PM on March 30, 2008 [3 favorites]

Start ratcheting the taxes up and a lot of that wealth would pack up and leave

This is why I think we should tax the trees, and the rocks, and the land first. Real wealth -- not money, the wealth of our natural resources and land valuations, ain't going nowhere.

This nation needs to look at what is actually being consumed in health care, and why we have to pay so much for it.

Sweden, the so-called socialist paradise, idiotically lowered land tax rates recently and immediately saw land valuations shoot to the moon in response. Shoulda raised the rates, instead.
posted by tachikaze at 11:12 PM on March 30, 2008

Whenever there is a discussion of universal health care in the US there are always a million reasons given why it wouldn't work there. Many countries have done it (it's not like we all had it from the dawn of time -- we had to institute it too) and oddly, the US's economy is the one that's tanking. So although I'm no economist, maybe these old excuses about prosperity drying up and businesses running away really need a second look.
posted by loiseau at 12:12 AM on March 31, 2008 [2 favorites]

Sweden, the so-called socialist paradise, idiotically lowered land tax rates recently and immediately saw land valuations shoot to the moon in response. Shoulda raised the rates, instead.

That was democracy in action and it didn't really work out that way. The tax was removed because land values had shot to the moon, filling the press with sob stories about little ladies being forced to sell their houses because they couldn't afford to live there. Noone wanted the tax and it didn't bring in that much anyway.
posted by uandt at 12:48 AM on March 31, 2008

I'm confused by the stat in the article that only 16% of the US population is uninsured...

We are easily distracted by focusing solely on the uninsured, as if all problems are solved once a family actually has insurance. In fact, the uninsured are just the ugly tip of one big, nasty iceberg.

In the US, having insurance doesn't necessarily mean you can afford to use the insurance. astronomical deductibles...high co-pays...lack of co-pays in favor of the insured paying the adjudicated doctor fees out-of-pocket...restricted networks...expensive details not covered...etc. It can be incredibly frustrating, depressing, etc. to be shelling-out $600, $700, $800 or more each month for health insurance that you can't afford to use. Or knowing that, if you DO use it, your annual renewal will include a huge rate increase or deductible increase...or both.

While focusing on the national shame of the uninsured, the bigger problem, IMHO, is the growing part of the population being driven to the poorhouse by expensive coverage that falls short in terms of coverage.
posted by Thorzdad at 4:25 AM on March 31, 2008 [2 favorites]

By the standards of actual civilized nations

So, by U.S. standards, then.
posted by oaf at 4:31 AM on March 31, 2008

I'm not saying other nations are uncivilized, but you're pointing out a nonexistent difference, fff.
posted by oaf at 4:32 AM on March 31, 2008

An unhealthy workforce = an ineffective workforce.

You know that, I know that, and big business doesn't care, because instituting universal coverage now won't increase profits by the end of the fiscal year, so they say "fuck it" and we end up back where we started.
posted by oaf at 4:36 AM on March 31, 2008 [1 favorite]

From the second link:

During 2001-03, Oregon had the highest unemployment rate (7.4 percent) in the nation. The economic downturn had a profound impact on state revenues. During five of the six biennia (Oregon's budget runs on a two-year cycle) between 1989 and 2001, state general revenues increased more than 15 percent and twice exceeded 20 percent. Those revenue increases fueled OHP's initial success. But during 2002-03, personal income tax collections declined 19 percent in Oregon.

The decline in income taxes was crucial because Oregon has a narrow financing base. Oregon is one of only five states without a general sales tax; about 70 percent of its tax revenue comes from personal income taxes. Furthermore, an unusual budgetary provision that requires the state to pay out tax refunds whenever collected revenues exceed forecasts by 2 percent or more--the "surplus kicker"--prevents Oregon from building up reserve funds, making the state more vulnerable to abrupt revenue declines. Because there is a two-year lag between forecasts and the kicker trigger, as Oregon's economy and budget floundered in late 2001, the state found itself in the incongruous position of sending out $254 million in kicker rebates.

The crisis isn't caused by the health care program, it's inherent in the funding mess that comes from anti-tax political pandering. And the pandering will probably continue, because it's hard to campaign on the truth, which is that Oregon needs to have tax increases and to quit sending out those silly "rebate checks". It's a lot easier to tell voters that "OHP didn't work", even though that really isn't the case.
posted by gimonca at 5:29 AM on March 31, 2008 [1 favorite]

From the second link:

The strongest challenge to sustainability, though, may come from rising medical costs...Cost control, which triggers intense opposition from medical-industry interests that profit from the status quo, requires much more political will to impose than insurance expansions do. Avoiding cost control and gaining the support of system stakeholders is perhaps the key to short-term political success. However, its absence may be, in the long run, the Achilles' heel of state-led health reforms that seek to move toward universal coverage without serious mechanisms to control spending in their own programs and without limits on medical care inflation in the broader health system.

I think this is a very important point. If we moved this to the federal level (in the form of a single-payer system), the requirement that states must balance their budget every year wouldn't be such a stumbling block during economic downturns. But I do think it would create its own set of problems, similar to the ones that are forecast for Medicare over the next 20 years. Health care costs have been rising at a rate much higher than inflation (roughly double to triple the size) over the past 5-6 years, and it's ultimately unsustainable.

Single-payer systems work wonderfully in Canada and in Europe and in countries whose citizens have fundamentally different attitudes towards rationing care to control costs and towards taxation. Do I wish that Americans had the same attitudes? Hell yes. But it seems like wishful thinking to institute a similar system here and hope for the best. I don't think it's any coincidence that a single-payer system is not championed as a realistic way to achieve universal coverage by either of the Dem presidential candidates--the Oregon Health Plan model has largely given way to the Massachusetts model that relies on requiring people to buy health insurance, reforming the individual & small-group markets to make that possible, and subsidizing poor and lower-middle income people who can't afford to buy at market prices.

While the insurance market is prone to its share of asshole shenanigans, I'm not sure I see any other way to really close the loop between the cost of health care and the benefits covered in the average (American) taxpayer's mind. It's such a stereotype that the average voter wants to cut taxes and expand social programs at the same time and doesn't really see the contradiction there (hello, Oregon), and it's unfortunately somewhat true. At least with an insurance-based universal health care model, as sketched out by both Democratic candidates and implemented in Massachusetts, people are forced to confront the trade-off between more benefits and higher costs directly by choosing how much coverage they will they will purchase, rather than simply hoping we can expand coverage to everyone, keep the relationship between a patient and the doctor totally sacrosanct and unpolluted by *any* money considerations, and pay for the inevitable explosion of costs with the magic money fairy.

Weebot--thanks for the links. It's really interesting (and somewhat depressing) to see where the OHP is today, and that second link was some really excellent context to the issues around it. Stuff like this is why I love the blue.
posted by iminurmefi at 7:00 AM on March 31, 2008

>big business doesn't care, because instituting universal coverage now won't increase profits by the end of the fiscal year, so they say "fuck it" and we end up back where we started.

The thing I've never understood is why big business doesn't get behind universal health care. In actual fact, moving to a single payer system would increase profits. If we remove the artificial link between jobs and insurance, businesses can stop paying out huge amounts of money to the insurance companies. The non-profit where I work (and I'm one of the insured Americans who can't afford to go to the doctor, see Happy Dave's excellent comment) is shelling out 71% of the cost to insure me. For just me, that's around $350 a month (an additional $150 or so comes directly out of my paycheck.) Freeing up all that money would do a lot for the economy and spreading the burden across everyone's taxes instead of directly on each individual business would end up costing people less. I hate that argument: "Well, if we had socialized medicine, our taxes would go up and we don't want that!" People. Look at how much is coming out of your paycheck each month for health insurance and recognize that that amount is going to keep on increasing exponentially. And as it goes up, face it, your job is going to cover a smaller and smaller proportion and more and more is going to come out of your check. Why is it better for that money to go to, say, Blue Cross rather than the government?

I wish they'd have a lottery like that here in North Carolina. I can't afford to insure my son, since my job won't cover any portion of his costs and I don't have an extra $315 a month lying around. I make just above medicaid wages and the waiting list here to get one of those slots for the working poor that they're raffling off in the NW is about 3 years, by which time he'll be too old anyway.
posted by mygothlaundry at 7:07 AM on March 31, 2008

Why is it better for that money to go to, say, Blue Cross rather than the government?

Because those evil tax-and-spend liberals can't be allowed to spend your hard-earned money for you.
posted by oaf at 7:23 AM on March 31, 2008

While focusing on the national shame of the uninsured, the bigger problem, IMHO, is the growing part of the population being driven to the poorhouse by expensive coverage that falls short in terms of coverage.

Precisely. A single mother I work with is technically "insured", but her insurance doesn't cover emergency room visits, and has a maximum number of visits to doctors per year, so when she appeared to be having potentially life-threatening complications from surgery and needed to see her surgeon, and when she couldn't breathe and needed a trip to the ER, she had the additional stress of worrying about how to pay for what wasn't covered. When your choice is your kids being able to eat (and your basic living expenses being covered) vs your life, even though you're insured, that's some seriously appallingly fucked up shit right there.
posted by biscotti at 7:40 AM on March 31, 2008 [1 favorite]

The thing I've never understood is why big business doesn't get behind universal health care.

I read some article a while ago saying the Big Three auto companies were quietly lobbying for some sort of health care reform, and that 1/3 of their employee/retiree costs were due to health insurance.

Why is it better for that money to go to, say, Blue Cross rather than the government?

I'm actually on a government-run plan here in Washington (thanks to being a state employee), and I will say this -- there's really not much difference between being on Premera or Group Health or the state plan (Uniform Medical). The two big advantages for me are that I can see any doctor or go to any hospital, and because Uniform pays well just about every doctor in Seattle accepts Uniform.

But working with a government agency is no different than working with an insurance company. At least with the government agency they're accountable to someone (i.e. the legislature and the state employees on the plan). Insurance companies can just about get away with murder.

I'm really unsure of single-payer. My one experience with it was the NHS, and that was terrible. I think I'd rather see a public-private system that at least guarantees every American some basic health insurance and catastrophic care, but with my experience with how Congress has done things I expect we'll see the NHS.
posted by dw at 8:35 AM on March 31, 2008

The other thing about that 16% without coverage stat is that it's a snapshot. People move in and out of coverage as their job status or other eligibility changes, so the number of people who have ever been uninsured or temporarily affected by lack of insurance is much higher than that snapshot number. (The article doesn't say, but that number is probably from the Census Current Population Survey, which actually asks if you've been covered in the last 12 months.)
posted by yarrow at 10:37 AM on March 31, 2008

I'm really unsure of single-payer. My one experience with it was the NHS, and that was terrible.

In what sense? Because although we complain, and we've all got our horror stories, we're not only pretty happy with it, most of us are actually proud of it, and can live with rationing on the basis of clinical need better than rationing on the basis of ability to pay or some other random criteria.

And isn't it people like you who are part of the solution? Because I'm guessing all those people with inadequate cover or no cover at all would be happy to embrace something like our NHS -- but those people who, for whatever reason, do have good cover aren't prepared to give up the various luxuries that come with the best cover that you get in the USA. Remember though, that the NHS isn't the only health care provider in the UK. If you want your feet massaged while you queue for your prostrate examination, you can get that too, via private coverage.

Fuck it, complain about the NHS all you want, it's gotta be better than running a freakin' lottery to decide who gets treatment and who doesn't.
posted by PeterMcDermott at 11:08 AM on March 31, 2008 [3 favorites]

In what sense? Because although we complain, and we've all got our horror stories, we're not only pretty happy with it, most of us are actually proud of it, and can live with rationing on the basis of clinical need better than rationing on the basis of ability to pay or some other random criteria.

I think the worst experience was when I had a sinus infection and just needed some antibiotics (yes, I know the new knowledge about antibiotics and sinus infections, but this was 10 years ago). They told me the doctor could see me in four weeks. And that was just a wee bit frustrating.

But the other experiences I had were just about as bad. Overworked doctors, six minute appointments, a general sense that I was disturbing their day, and how DARE I have more than one issue I need to discuss?

Mind you, the pediatrician's office is just about as much of a zoo as the NHS clinic was (and the queues can be horrible), but at least the pede takes the time to do everything that needs to be done with my daughter. And I can usually get a same-day appointment if I call first thing.

And isn't it people like you who are part of the solution? Because I'm guessing all those people with inadequate cover or no cover at all would be happy to embrace something like our NHS -- but those people who, for whatever reason, do have good cover aren't prepared to give up the various luxuries that come with the best cover that you get in the USA.

The one thing I won't give up is choice. If I have a crappy experience with a doc or a dentist, I can fire them and get someone else. I couldn't do that necessarily on the NHS. My flat was locked into the local clinic down the road.

If you want your feet massaged while you queue for your prostrate examination, you can get that too, via private coverage.

Oh please. You think that's what we're getting over here? You think we're all getting "happy endings" after our annual physicals? Most of the time we're arguing with the insurance company over whether they'll pay for a doctor-recommended test.

The American system isn't great, and no one is happy about it. But single-payer doesn't seem like a great system for us, either. Americans value choice, to the point that there's too much choice.
posted by dw at 12:08 PM on March 31, 2008

Because although we complain, and we've all got our horror stories, we're not only pretty happy with it, most of us are actually proud of it, and can live with rationing on the basis of clinical need better than rationing on the basis of ability to pay or some other random criteria.

This is a bit of an oversimplification of the differences between the U.S. health care system and NHS, though. In the NHS, "rationing on the basis of clinical need" includes not covering treatments that are determined to be not cost-effective, in terms of cost per quality-adjusted life year. That type of rationing doesn't happen for people in the U.S. with good health insurance or full government coverage (e.g., Medicare or Medicaid). In fact, Medicare is explicitly prohibited from looking at cost-effectiveness in determining whether to cover new procedures. Insurance companies may try to weasel out covering people with expensive illnesses in some cases by challenging whether the person obtained the insurance under false pretenses (cancelling coverage for people who fail to disclose a prior condition), but in general, they don't deny benefits on cost-effectiveness grounds (although they try not to cover "experimental" new treatments, which are likely to be the most expensive). If you've got good insurance through your employer, or you're over 65 and on Medicare, you're never (or almost never) going to be in a situation where you can't get a certain drug for your cancer because it's been determined to be too expensive.

In a very real sense, moving to a system like NHS would be a step down for millions of Americans who currently have good coverage, and it's not all about cutting frivolous and unnecessary spending. Is it a more fair way to distribute limited health care funds? Absolutely. And I'm sure that more and more people are going to find themselves losing their top-shelf coverage as costs rise and businesses choose to go with skimpier plans that leave people uninsured. But it's not really like NHS and other single-payer systems are better in every way and it would be a step up for everyone. Some people would be better off, particularly those who are uninsured or underinsured now, but some people would be worse off.
posted by iminurmefi at 1:12 PM on March 31, 2008 [1 favorite]

The American system isn't great, and no one is happy about it. But single-payer doesn't seem like a great system for us, either. Americans value choice, to the point that there's too much choice.

In what way does a single-payer system restrict your choice of physician?
posted by oaf at 3:09 PM on March 31, 2008

We got to see this video in our staff meeting earlier today. Let's hear it for "the world's worst animal-headed team of superheroes defend insurance companies against patients."
posted by rtha at 3:59 PM on March 31, 2008

oaf: The American system isn't great, and no one is happy about it. But single-payer doesn't seem like a great system for us, either. Americans value choice, to the point that there's too much choice.

In what way does a single-payer system restrict your choice of physician?

I've lived in six of 10 Canadian provinces and I can go to any doctor, clinic or hospital I want to.

A lot if not all of the arguments against single-payer are myths, rumours, strawmen, exaggerations and lies.
posted by loiseau at 5:34 PM on March 31, 2008 [1 favorite]

Not to oversimplify, but as a lifelong Oregonian, I can say pretty confidently that this asshole has been a huge factor in Oregon's decline. The "supermajority" rule (property tax bond measures sshall not pass unless turnout for that election surpasses 50%) has been crippling Oregon schools for years. I'm not exactly sure whether the OHP is funded through income taxes or property taxes, but Measure 5 (also a Sizemore project) moved most school funding from property taxes (through school boards) to income taxes (through the State), so either way you look at it our budget has been squeezed halfway to death.

Another victim of this ridiculously anti-tax lobby has been our once-proud library systems - Jackson County, OR, home of the highly venerated Oregon Shakespeare Festival in Ashland, recently saw the closure of its entire public library system due to the supermajority rule. It seems unthinkable that libraries could close in the same state that boasts Powell's City of Books (much less next door to a celebration of Shakespeare, for God's sake), but so it goes.

There have been nine efforts to levy a sales tax in Oregon and they have all failed. I don't really have evidence to back me up, but I would be willing to bet that Portland's influence has been a huge reason for this - our local economy here in P-town is buoyed by visitors from Vancouver, WA looking to evade their own sales taxes. However, a lot of people who shop and work in Portland also buy their homes in Vancouver to avoid paying Oregon's higher property taxes - which makes sales tax an issue that I suspect Oregon will have to deal with sooner rather than later, what with the precipitous dropoff in property tax revenue we are likely to see as the bottom falls out of the housing market. It will also be especially hard for the Portland housing market to recover if it is dramatically cheaper to buy property in Vancouver. A sales tax would not only allow us to lower property tax rates to create a more competitive housing market, but it would also help tide the state budget over until that market stabilized.

Sadly, though, a lot of Oregonians are also contrarians - and we're proud of our lack of a sales tax. It's a part of Oregon culture, in the same vein as not being allowed to pump your own gas. A lot of people would see enacting a sales tax as betraying our state identity.
posted by pikachulolita at 6:31 PM on March 31, 2008 [2 favorites]

The one thing I won't give up is choice. If I have a crappy experience with a doc or a dentist, I can fire them and get someone else. I couldn't do that necessarily on the NHS. My flat was locked into the local clinic down the road.

You were misinformed. While you might sometimes have less choice when it comes to specialists, you've always had complete freedom about which GP's practice you use. And the issue about choosing specialists is changing as well, with the publication of league tables, and things like choose and book.

I'll concede the point about short appointments -- though when it's an issue that needs more time, as opposed to simply the worried well needing reassurance, I've never had a problem with that. Nevertheless, the issue of putting people's mind at rest is an important part of health care, even if it isn't always the best use of the doctors time, and that's changing as more of that less critical work is devolved to nurses and nurse practitioners.

Some people would be better off, particularly those who are uninsured or underinsured now, but some people would be worse off.

Sure, I'm making the case that it's fairer, not necessarily better. Also, I'm not sure about how true your arguments are any more. Have you tried getting, say, in-patient drug treatment on your coverage lately? Ten years ago, you wouldn't have had a problem getting sent to a 28 day detox place. Now, you'll be expected to do that detox in the community as most insurance companies will no longer foot the bill for that type of long-term in-patient treatment. Why? Because the outcomes don't justify the expenditure.

If that isn't qualy's by proxy, then I don't know what is. The difference is that here, the decisions are made by clinicians, health economists, researchers and other stakeholders, including patients and published openly. Over there, they're made by insurance companies seeking to maximize their profits.

And while we might not be able to get some newer, highly untested drugs of unproven efficacy, we don't have co-payments -- so nobody ever gets bankrupted by the cost of a critical illness over here. I'd be astonished if anyone here in the UK would see a move towards such a system as a step down -- on the contrary, whenever it's suggested, the reactions against are fierce and almost unanimous.
posted by PeterMcDermott at 1:21 AM on April 1, 2008

Ugh. Sorry, that should be step up.
posted by PeterMcDermott at 1:22 AM on April 1, 2008

Happy April 1st!

Oh.
posted by MuffinMan at 5:27 AM on April 1, 2008

[a few comments removed - take the "who is quoting whom how effectively derail to MeTa or discuss it without calling people names, thanks.]
posted by jessamyn at 7:36 AM on April 1, 2008

Lots of people in the UK have private health care insurance through their employer, or have purchased it separately. My impression is that the quality of care available through such plans is better than typical U.S. insurance plans. It's certainly a lot better than most HMOs.

As far as I can tell, in the UK the people who can afford it get better care than in the U.S., and the people can't afford it get better care than those in the U.S. who can't afford insurance either.
posted by grouse at 10:39 AM on April 2, 2008

dw writes "Insurance companies can just about get away with murder."

Seems they routinely do, or at least negligence causing death.
posted by Mitheral at 12:39 PM on April 2, 2008

I've lived in six of 10 Canadian provinces and I can go to any doctor, clinic or hospital I want to.

Only if they're taking patients. (That may actually be improved by the U.S. going single-payer. I think I'm only slightly less likely to win the lottery than we are to go single-payer, though.)
posted by oaf at 1:59 PM on April 2, 2008

Only if they're taking patients.

The only sensible response to that statement is "Well, duh."

You can go shopping at any store or mall you want to... if they're open.

You can have anything you want at Alice's Restaurant... if she has the ingredients.

You can go to any concert you want... if there are still tickets available.

You can go to any doctor you want... if s/he's accepting new patients.

D-oh.
posted by five fresh fish at 7:38 PM on April 2, 2008

In certain places Toronto, it's about as easy to find a doctor as it is to find an open store.

On Sunday.

In Halifax.
posted by oaf at 4:58 AM on April 4, 2008