Have I missed any major us economy news?

[3asAbird]

So many fb statuses saying the broke and about to go bankcrupt? as republicans wont vote the right way?

I know detroit and other cities when bankrupt and they produced a trillion dollar coin which made out quantative easing looks good.

Are they in serious trouble? seen very little on news.

[MinnesotaNice]

In the US, it is illegal to turn a patient experiencing a medical emergency based on ability to pay. Not saying it has never happened, however, you can be sure in those instances the hospital is exposing itself to huge (talking muti-million $) lawsuits, not to mention the PR nightmare. So, as a general rule, these instances are extremely rare and just isn't a feasible way for hospitals to operate.

As far as paying for healthcare, yes Americans do have to consider costs. However, keep in mind that in the US both taxes and, in a lot of areas, the cost of living are significantly lower. For example, the last place I lived in the US, my local taxes were only 4.9%.

Additionally, just because you aren't considering costs as your loved one is in the hospital, doesn't mean that someone else is as altruistic. Someone, somewhere in the food chain is taking in to account healthcare costs. I believe that here in the UK, NHS Trusts are managing costs? To be honest, I would rather not have some bean counter deciding what kind of healthcare my loved ones are entitled to receive.

Noddyholder, Republicans are blocking it because that is what the voters they represent have expressed as their preference. IMO, Republicans screwed themselves by not fixing the broken healthcare system years ago when they had control of the House and Senate. It's been an acknowledged issue for ages and by leaving it unaddressed, it left it wide open to being handled by the Democrat party in the manner they saw fit.

[3asAbird]

I get confused with healthcare.

how does candada, oz and new zealand do it better.

Im not sure replicating nhs would work its black hole here and we small country.

think health insurance could work better here.

Locally nhs care been patchy. us hospitals some look more like hotels.

[MinnesotaNice]

MadCap what about the exemptions for all the members of Congress? It's a bit silly to simply blame Republicans when both political parties are being a bit hypocritical.

[OhYouBadBadKitten]

All I know is that I have an American friend who has become literally bankrupt after her c-section went wrong. she will be forever paying off those bills. Sickness is a frightening thing in their house - they can't afford it.

[Absy]

Canada has huge natural resources and a relatively small population, and thanks to quite clever regulation they didn't have the property bubble that the UK/US had pre-2008 and so didn't have the same sort of crash. Effectively, Canada is more solvent.

France has an excellent healthcare system, more in line with the way the US treats patients (lots of referrals to specialists, rather than more GP focused healthcare) but it isn't sustainable - it's way too expensive.

There's arguments either way for socialised vs private medicine. Socialised medicine means that everyone is entitled to care, regardless of how poor or rich they are, but it has to be funded through taxes (expensive), can be overstretched (so end up with long waiting periods, run down hospitals) and not necessarily the most flexible with few options. Private medicine can mean higher standards, more flexibility, and less expensive for the state but that's because the cost is borne by the user, and by definition it excludes the poorer in society.

The best is a mix of the two.

[noddyholder]

Thanks

[niceguy2]

I would rather not have some bean counter deciding what kind of healthcare my loved ones are entitled to receive.

But you ultimately are not the decision maker. You just think you are. Your insurance company ultimately is and/or the company who is paying for your premiums.

Correct me if I'm wrong but I've heard a lot of stories about situations where insurance companies have decided that xyz treatment isn't covered. Or have weaselled out of paying because of some technicality or small print. Don't they actually have teams of adjusters who are paid on how many claims they can reject?

In reality in the UK the NHS trust doesn't decide the treatment on a day to day basis. The doctor does. And only in extremely unusual or rare cases would the NICE board or the trust get involved based upon the cost.

[MinnesotaNice]

niceguy2 OK, the NHS Trust doesn't get involved with treatment on a daily basis, but I was under the impression that they do set the overarching policies and procedures for those under their management. Surely these policies do affect the treatment that a person is going to receive? (I.e. perform this operation, not that one because it is cheaper even though the more expensive op is less invasive/has faster recovery time.) Somehow, I don't see how doctors in the NHS are simply given free rein to recommend whatever course of treatment, no matter how costly it may be--am I mistaken?

You are correct that in the US treatment can often be determined by one's level of insurance coverage. However, the only stories of insurance companies "weaseling" out of paying I've ever seen is on TV (dramatized for ratings, I'm guessing). Not saying it never happens, but I am inclined to want to hear of actual, first-hand stories. If there is rampant insurance fraud on the side of the insurers, then I would be inclined to favor legislation to stop that--not change the entire structure of the American healthcare system.

[Absy]

On the other side of the insurance thing, I have heard (anecdotally, so it might not be widespread) that insurers can take a while to pay back practitioners, or being very difficult about paying out claims. So, not only can it be a pain for the users, but also for the practitioners.

[CheerfulYank]

MinnesotaNice are you actually from Minnesota? I am :)

I'm discussing the shutdown/Obamacare with a friend right now. She's a Republican and I'm not so it's all very interesting.

[Talkinpeace]

American health system .....
my sister got her Kidney transplant paid for by medicare
but not the good anti rejection drugs that cost $26,000 a year
but she's poor enough to be on medicare .....
so she gets the weaker ones that leave her too ill to get a job

give me the NHS any day.

[lljkk]

I'm a Kaiser baby. I'm told that's the gold standard for HMOs, and of course they bean count, to some extent. My mother with Kaiser had an op cancelled due to flu epidemic while back, same time as ops were cancelled in UK during flu epidemic. My step-mum said it's weird how some of their friends like to brag how much some of their medical treatment cost, like cost is an indicator of quality.

Of course my folks are old enough to be on Medicare now, which transitioned seamlessly straight over to Kaiser too. My dad says Obama went all about it wrong & should have started by extending Medicare down to age 55+.

It's very weird how Americans don't like clean streets, safe places to live, decent schools, regulation of hazardous chemicals, tests for competency at driving, etc. All the things that governments do.

[niceguy2]

@Minnesota. To a certain point you are correct. There is a group called NICE who set guidelines on what technology/medicine is appropriate and affordable. But that isn't a group made up of people who are looking at the profitability of the hospital but it's made up of healthcare professionals. But someone somewhere has to set those guidelines in the US system. Be that the insurance company or the hospital. Neither system has a blank cheque.

Otherwise yes...our doctors get to treat the patient based solely on their medical need rather than what they can pay. So a poor homeless person diagnosed with cancer would get the same treatment, same drugs, same timescales as say a rich person.

But the thing that confuses me is why the animosity? America has 50 million people that do not have insurance. That's practically the size of the UK. I cannot imagine what government would say it's perfectly acceptable for 50 MILLION people to not have access to decent healthcare. To say it's acceptable to go bankrupt because they cannot afford the drugs they need or to pay for the operation they needed.

I just don't. And bear in mind that in the UK I'm considered right wing.

[ProbablyJustGas]

I am American.

My mother's cousin - a father of two - died of lung cancer years ago, when his daughter was just a child. There were some treatments coming onto the market that could have perhaps extended his life. However, his private insurance company refused to pay for these treatments as they considered them "experimental", and he therefore went without, because his family could not possibly pay for the costs out-of-pocket. That was a bean counter's decision.

A good friend of mine contracted HPV years ago and needed a procedure to remove the cells on her cervix. Despite this being a fairly common virus for women in their 20s to contract, and despite the procedure to remove pre-cancerous cells on the cervix being a fairly common procedure, my friend's private health insurance refused to subsidize this and billed her hundreds of dollars. Their justification was that they viewed the procedure as "experimental" rather than routine. Bean counter's decision.

My brother finished graduate school on the wrong side of the recession and spent an entire year looking for a job, despite holding an advanced degree. He is asthmatic and manages this condition with regular prescription inhalers, but it has required trips to the hospital before. Despite eventually finding a job in landscaping after a year of searching, he - and my parents - were panicking about his 26th birthday, the day he would no longer be covered by my parents' private health plan. Because although his job in landscaping allowed him to live with my parents rent-free and pay down some student loans, his income certainly did not allow him to buy insurance as a single man on the open market. And the good state of Alabama did not allow him access to Medicaid - he was not considered eligible, because he was young, male and did not have a child.

In the meantime, I have lived in the UK for seven years. In those seven years, I have had access to:

• Seven years of prescription inhalers (I am also asthmatic)
• Antibiotics for several bouts of tonsillitis and an option for surgery if it became chronic
• Cervical smear tests, both routine and on demand when I've panicked about abnormal bleeding
• Birth control pills and options for non-pill longer term birth control like implants or IUDs
• Hospital care
• Evidence-based prenatal appointments including blood tests, ultrasound scans, measurements and antenatal classes on labor, childbirth and breastfeeding
• Midwife-led childbirth in the hospital, with access to doctors and consultants at the same hospital, should the need arise.

And that's just me.

Nearly all of that has been for free - no copay up front, no invoice sent home. Literally nada. During the years Scotland required payment for prescriptions, my inhalers cost £4 (about $7 at the time) per refill. That is the only time I have ever paid for healthcare in the United Kingdom.

Are my taxes higher than in the USA? Absolutely. I pay 20% on my income - and that is a low-tier tax band - and 20% sales tax on just about everything. My husband also pays 20% on his income. We had to pay tax when we purchased a house. We have to pay tax on our cars.

But back in the days when I was in $3,000 of credit card debt, $40,000 of US student loan debt, and making so little per month that the best I could do for housing was share a flat with four other people, I really appreciated not having to worry about how I would pay for my next inhaler, or whether to get that bleeding checked.

And that's not even touching how countries with national health systems are better able to keep the cost per procedure down. There are finally some well-written new articles coming to light about how.

[Absy]

Another e.g., a friend of mine was pregnant, and went for a test just before going back to the States to get family. The result came back while she was in the States, and the doctor said that she had an infection and should have penicillin. She says it cost her around $300 to get penicillin - not a fancy anti HIV drug, or an experimental drug, penicillin.

[ProbablyJustGas]

The issue is, the way the US health insurance market is currently set up encourages price gouging on medical procedures/prescriptions and the denial of coverage to patients. The New York Times has a pretty good series looking into how this could be, starting here.

In order to cut down on this type of fraud, the market itself must be overhauled - the incentives to screw over patients on prices for treatment have to be eliminated. The ACA is the very legislation attempting to do that. The status quo is not good enough.

[CheerfulYank]

It's not always as black and white as "people don't want others to have health care."

A friend of mine opposes the ACA vehemently because it insists she get health insurance or pay fines. She feels that no one should tell her how to spend her money.

[ProbablyJustGas]

Understandable that many people disagree with that, but not enough people disagree with the ACA to overturn it. Congress passed the law in the first place. When a presidential candidate promised to repeal the law, he lost the election. When Congress held votes to repeal the law again, post-election, those calls for repeal failed. When the law was challenged in the Supreme Court, the Supreme Court decided it was still Constitutional. Of course there are people who don't like ACA, but they are not in the majority.

Funding US government branches and honoring US government debt payments should not be a bargaining chip here. It is incredibly dysfunctional. It's very "do this or I'll...".

The news is saying the shutdown could be ended today. Apparently, there might be just enough moderate House Republicans willing to vote with Democrats and pass a condition-free stop gap spending bill. It seems, however, that House Speaker Boehner is more interested in appeasing the most extreme members of his party. He appears to be unwilling to allow a vote.

An old friend of mine has been furloughed because of this. He is a scientist for NASA. He and his wife had a baby a few months ago, and she is not currently working. I am not entirely up to speed on maternity leave policies in their particular state, but I doubt she is on a maternity leave with full (if any) pay.

[Talkinpeace]

Maternity leave does not exist in the USA in statute

[ProbablyJustGas]

Right, but a lot of people cobble together a maternity leave using short-term disability, vacation and sick time, and unpaid FMLA leave if the company they work for is large enough.

[ReviewsOffers]

Am I understanding it correctly

the new Obamacare bill requires people to take out private health insurance, or a combination of their employer and themselves to have health cover.

Is that kind of the same as the way we on this side of teh Atlantic are required to pay over part of our wages to the state which entitles us to free healthcare?

Except in one case you are paying the state for your health cover and in the other you are paying private companies. But in either case, it's mandatory

[Talkinpeace]

shocking socialist stuff eh?
and to think its worse than lots of people being bankrupted by medical bills
or going to prison to get medical treatment

[ReviewsOffers]

I thought I was misunderstanding it
makes sense to me. It even makes sense to Niceguy who is a self confessed right-winger!

So what are the objections?

Cheerfulyank's friend opposes it on the grounds that she doesn't want the government telling her how to spend her money. strikes me as a rather libertarian view

[Talkinpeace]

Libertarians are against "socialised medicine"
but have no problem with the government taxing and then spending on

• police
• fire service
• armed forces
• prisons
• schools
• mortgages

can you IMAGINE the uproar in the UK if people could hand back their mortgage arrears and the taxpayer would pick up the shortfall
and yet that is deemed not socialist in the USA