Talk:Universal health care

Archive 1 (March 13, 2006 - June 9, 2006)

---

Not encyclopaedic

I assert this article cannot be called encyclopedic. Wouldn't it be more useful, even to the debate, to elaborate on how other countries pay for health care? The debate on what should be implemented in the US, though important, should not be on an article titled "Universal health care." Some information can be found in articles on the countries themselves, but not much, and its not organized. This would also make citing sources in a debate much easier and clearer. —Preceding unsigned comment added by 70.134.57.120 (talk) 03:14, 28 September 2007 (UTC)

List of Countries with "Universal Health Care" is Deceptive

This reads like it was written by advocates or activists for universal health care in the United States, with the intention of making the rest of the world look like nirvana, for the purpose of promoting a particular kind of universal health care in the United States, a kind perhaps not available in the countries listed as having universal health care in the article.

I live in Japan, which is listed, without qualification, as having universal health care. Here's what Japan actually has: Either your employer administers a health care plan, or you buy it from the city. Only larger employers have their own plans. They cost maybe $350 per month. Cities charge maybe $500 per month. These costs will vary with location. You get a health insurance card when you join. With that card 70 percent of your costs are covered. If you don't work for a large employer who deducts the payments and you don't pay the city's fee, you don't get health care. If you don't have the 30 percent co-payment, you don't get health care and you don't get medicine.

Is this what most Americans understand to be universal health care? In the U.S. if you don't buy health insurance, you don't get health care. In Japan if you don't buy the city's health insurance, you don't get health care. (There is some free health care: most cities offer a free annual exam (blood and urine, chest X-ray, electrocardiogram, weight and height), and there is some 100 percent care for the disabled in some cities.)

I wonder how many of the other countries "with universal health care" in the list don't really have universal health care when examined in detail.

Japan's system basically works because the population is mostly homogeneous, there is a large middle class and fewer poor than in the U.S., and people just pay for health insurance. They put priority on paying for the insurance, over buying a car or eating out or having another kid or whatever. Those who don't pay are in the same boat as the U.S.

Don't get me wrong: I love the Japanese system. I get to choose my doctors, mostly showing up without an appointment. I can just go to another doctor for the same problem if one doctor's treatment doesn't satisfy me. There are no records or cross-checking to prevent that.

You seem to imply that health insurance in Japan is optional and that there are uninsured persons. But from what I have read, it is not. It is compulsory. In other words it's just like a tax except the money goes into an insurance Fund and virtually the whole population is covered. So in that sense it is quite unlike the US system and IS universal.

• ...every government jurisdiction, whether city, town or village, was required to provide health insurance to every uncovered resident by 1961. Since 1961, virtually all Japanese have been covered by either employers or the government. (From an academic web site http://www.nyu.edu/projects/rodwin/lessons.html#II.)
• In 1961, health insurance was established for all, enabling anyone to afford necessary medical care. To make this possible, everyone was (and still is) required to join some kind of a health insurance plan (From a Japanese government web site http://www.sg.emb-japan.go.jp/JapanAccess/health.htm). Can I ask you to double check your information? --Tom 17:28, 4 September 2007 (UTC)

Me again. Those sources are not correct.

Practically speaking, most employers will deduct your health insurance payment, and you don't have a lot of choice about it, I suppose. But I know expats working for Japanese employers who have talked them into not deducting the payment when they told them they had purchased their own insurance from overseas providers.

If you are self employed, unemployed, or work for a small company (I have experienced all three of those states), you simply do not have to pay for health insurance, and nobody tracks you down and asks you about it. The only way to get insurance is to hop on the subway to the ward office and apply for it and pay for it, about 50,000 yen a month (it varies by city, this was Nerima Ward in Tokyo circa 2004). If you don't pay for insurance, you don't get a card. If you don't have a card, one of two things happens (I have personal experience with both): (1) The doctor refuses to treat you, or (2) they ask for 100 percent payment in cash, rather than the normal 30 percent copayment. If you have a card an forget it, same thing. They either ask you to go get the card, or they take a deposit of 100 percent of the cost pending your return with the card, at which point they refund 70 percent. And, by the way, if you have a card and don't have the 30 percent copayment? No treatment.

Now mind you, practically speaking, a very large percentage of the Japanese population has insurance compared to the United States. Your statement "virtually the whole population is covered" is probably true. It's true because virtually the whole population pays insurance premiums, monthly, with "cash-money," not because it's just magically there from the government.

And those who don't and who get sick, usually get their bills paid by relatives (who may be pissed off at them, but this is kept within the family and dealt with outside the public system).

As for the statement on the Japanese Web site to the effect that "everybody is required to join," I suspect that is similar to the "requirement" that you pay for public television. Since there is no sanction, many people don't pay their NHK bill. Even if you may be in some sense "required" to buy insurance, there is no followup, audit, investigation, census, central record keeping or whatever by the city to check on this. And if you don't have it, you don't get care.

So in summation, there is a single nationwide system to which doctors bill for medical care (actually, two parallel systems, as I explained in my first post), but it's not a universal entitlement, but rather a monthly premium billed, cost controlled insurance plan that is the same for everybody, without the requirement of medical checks and the like to qualify. But still, you need to pay your 30,000 to 45,000 yen monthly premium.

My problem is that Japan is being used here as implicit support for the idea that there should be a zero-premium entitlement style universal health plan in the United States ("because _everyone else has it_"). That is not what Japan has, and I suspect if a country-by-country, ground-level check by informed expats living in other countries in the list here were made, there may be similar discrepancies.

The acid test: does a homeless person living in a cardboard box on the west exit of Shinjuku station get health care? No. He gets nothing. In a Canadian style system would that person get health care? My understanding is yes. So you can call these two systems universal health care, but they are different. If you apply Canada to the U.S., everybody gets care, but if you applied Japan, you'd get a huge number of people not paying their three or four hundred dollars, and things might not be so different than now. The cost differences between a Canadian and a Japanese style health care system would be pretty massively different in the U.S., I'd reckon. —Preceding unsigned comment added by 203.216.99.100 (talk) 11:20, 17 September 2007 (UTC)

Opposition to Universal Health Care

"Not dying from an easily treated disease because a person cannot afford health insurance is not a right." I don't think even the Nation would phrase things in this manner if it were asked to list criticisms its opponents have to universal health care, hence I edited this. Furthermore, is it really appropriate to have unsourced rebuttals to the criticisms?

There are some serious NPOV problems with this section, but I'll leave it to a more experienced Wikipedian to fix it.—The preceding unsigned comment was added by Tin Man (talk • contribs) 15:32, 6 September 2006 (UTC).

Regarding: "[I]s it really appropriate to have unsourced rebuttals to the criticisms?" Rebuttal to criticism is OK, but Wikipedia policy is that content must be published by verifiable sources. -AED 18:25, 6 September 2006 (UTC)

pro and con lists

The lists have some serious problems, and should probably just be summary sections that point to a full article on the topic. For example, it is misleading to state "health care is a right" without explanation, and it is also embarrassing because the artics] 18:51, 4 January 2007 (UTC)

UHC is not always SP, but SP is a type of UHC, so I thought it would be better incorporated into that article. Kborer 19:38, 4 January 2007 (UTC)

It's not true that SP is a form of UHC. Contray to what many people think, including many single-payer advocates, the two are distinct concepts. Single-payer is a economic model for financing health care. UHC is a concept that all people are guaranteed access to needed medical care; that there is universal coverage, such as under a private and/or public health insurance system. That's it. Single-payer is, in it's literal meaning--which is what's most relevant--simply an economic model for financing medical services delivered to patients. Single-payer also denotes--for nearly all of its advocates--a way of setting up a fee negotiation structure between the payer and providers (this can be referenced by leading SP advocacy organizations such as Physicians for a National Health Program). The payer of single-payer can be either a private or public payer. Single-payer does not imply UHC; they address distinct concepts; respectively, a financing model and access model. Some of the confusion comes from that fact that virtually all single-payer systems also utilize universal coverage, and most single-payer advocates--in the US and elsewhere, also advocate for universal coverage. But they are distinct. UHC is not a type of single-payer, and single-payer is not a type of UHC. I wrote a fair amount of the entry for single-payer and addressed these issues in a slightly more expanded manner there. Single-payer advocates also call for a number of other health system elements, but those, too, are not literally "single-payer." I'm new to this, so I have more to comment about in the article--not having made any edits yet, most saliently the misstatements regarding UHC and socialism and the inapt inclusion of this entry in the Socialism category. If anything is to be done, rather than repeating the info from other entries, like single-payer, or merging, is to hyperlink to the more expanded commentary elsewhere and to strip it out of here, allowing the focus on UHC itself, and secondarily referring to the related issues such as financing mechanisms. ---- my sigg isn't showing up, so by JackWikiSTP

You're right. I removed the suggested merge tags awhile ago, but I guess there's no harm in continuing to talk about it. There is a lot of misunderstanding with this and related health care topics. Originally I had thought that bringing together the ideas that were being miss used would help clarify the situation, but currently it seems best to have separate pages which specify what is what, and what is not what. Kborer 22:30, 23 January 2007 (UTC)

Leads to make this a better site:

Two important details to research on this topic.

The top two systems Italy and France, (Canada way back, because it is controlled by the Doctors Union, and most services are privatly supplied, with no quality control.)

France. You pay the doctor first, and then the government re-imburses you, so that you are the audit system.

Italy. Doctors receive a per capita annual salary, so the system, the payment system rewards health.

Canadian system rewards visits.

I will try to do the research...asap...

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 00:10, 24 January 2007 (UTC)

The first paragraph

User:Caesarjbsquitti's edit of the 24th January[1] leaves the first paragraph making no sense:

This type of socialized medicine is practiced in many countries, especially first world nations such as Canada, the United Kingdom, and France and Italy ranked in the top three in the world

How can four countries rank in the top three in the world? (And the top three for what?)

As a separate matter (which long predates that edit), I'm not sure it's NPOV to use the loaded term "socialized medicine" without qualification in the first paragraph (at least in the US, it's a term used primarily by opponents of such a system, as noted on the Socialized medicine page). The Wednesday Island 14:46, 26 January 2007 (UTC)

Regardless of whether you feel socialized medicine is a loaded term, it just doesn't apply to universal health care and should be removed. Kborer 00:00, 27 January 2007 (UTC)

Of the countries listed, only the UK practices true socilaized medicine (although it is also a system of universal healthcare), because physicians are government employees and most of the healthcare system is run by the public sector. In France, Italy, Germany, Canada, etc., physicians are not salaried by the government and the private sector still has a presence, thus they are simply countries practicing universal healthcare, not socialized medicine. Refer to "International Healthcare Systems Primer," by Hohman & Chua, published by the AMSA.

This Article Is Not Neutral

It has a pro big buisness insurance company slant as if written primarily by the sellers of Health Insurance and without much consideration towards the 40million plus people in the United States who have no more access to health care above what they might get in an impoverished country like Mexico. The article needs to defend the rights of all citizens to Health Care, rather than having a bias and implying that its as good for the rich in a country to have superior health care than for most people to have access to it. This writer feels it would be best for modernized countries to make laws that make it illegal for companies to make money off the misery, pain and suffering of others. Companies who often refuse to pay claims as things are. This article needs a rewrite or side article relating what it feels like to be uninsured person in a rich country. --merlinus 21:05, 26 January 2007 (UTC)

What you are suggesting is that the article be rewritten to push your personal political agenda. That is not what wikipedia articles are for. Kborer 00:10, 27 January 2007 (UTC)

Those 41.2 million people "without healthcare" in the U.S. are only 14.2 % of the population, so what's the problem? Looks like we're doing great to me. Note that that number is actually people who were without healthcare for at least part of the year surveyed (meaning many of those may actually have healthcare but were in between jobs or something). Also, approximately one-third of that 14.2 million people live in households with an income over $50,000, with half of these having an income of over $75,000 [2] That means these are people who can afford to buy healthcare but are choosing not to for their own reasons (many of these are young and healthy and choose to put off purchasing it). Another third of that 14.2 million are people who are eligible for public health insurance programs but have not signed up for them. That leaves only 4.5 million people out of a nation of 300,000,000 people that don't have access to healthcare. That's only about 2% of the population. That's so small that half of that may even be an accounting error. The solution is not a welfare state. Find these people who make up that 2% of the population, put them on a list, and let bleeding hearts like you give them charity. All Male Action 07:21, 27 January 2007 (UTC)

These are all interesting points -- why don't you add a section to health care politics about these ideas? Also, if anyone knows a forum for arguing about health care topics, that would be a great link for these pages, judging from how the talk pages keep getting off topic. Kborer 13:02, 27 January 2007 (UTC)

"Those 41.2 million people "without healthcare" in the U.S. are only 14.2 % of the population, so what's the problem? Looks like we're doing great to me." Doing great if you're a white male living in the suburbs with $50,000+ a year coming in. 40 million people getting left behind isn't "doing great." It's never those on the bottom who comment that everything's great, seems like there's a telling pattern there, right? —The preceding unsigned comment was added by 149.31.51.59 (talk) 15:24, 10 April 2007 (UTC).

It really boggles my mind to see how someone can sit on a high horse and act like 41+ MILLION PEOPLE don't matter because they fall into a "percentage" of only 14+ percent so therefore, THEY DON'T MATTER, SO WHAT'S THE PROBLEM? <Let the bleeding hearts pay for them> This statement alone makes me sick. If our country would have used this same formula when electing a president, we wouldn't be in the situation we're in now. Who will ever know if it could be better but it's a certain, it couldn't possibly be worse. Someone needs to stop and think about individuals instead of percentages. If we used HALF of the money we've spent on this revenge "war" on health care, that 41 million people could have health care. Why are the citizens of Iraq more important than the citizens of The USA? Oh, right, the oil. I forgot. I must be a bleeding heart. My concerns are more for my fellow man than a barrel of oil. And don't forget about those FAT contracts Halliburton gets out of the deal for rebuilding everything we spent ALL of our Defense Funds BLOWING UP ! < shock and awe > I'm definitely in shock and in awe of the "percentage" of people who support this tactic of greed. But don't forget, KARMA is a MOFO!!! Big Johnson By the way, when I say "revenge war" I'm NOT refering to 9/11 because that would be a war against Osama Binladen. This war is just revenge for the first president Bush against Sadam Hussein and now that he's dead, the present president Bush doesn't know WHAT to do from this point forward so all he can do now is attack his own country with propaganda. Again, KARMA is going to be rough on him.

---

My family and I are part of the 41 million without healthcare. My mom, who is recently divorced and raising my two sisters on her own, cannot afford the monthly cost of healthcare for the entire family. Yesterday night, my youngest sister took too much of her medicine because she didn't know any better. While we sat on the phone with poison control, we all worried about the costs of taking her to the emergency room - without health insurance, the cost would be astronomical. Fortunately, it did not come down to that, but even after that emergency, we still know that we cannot afford the monthly cost of health insurance for the entire family, unless we wanted to give up our electricity, something we struggle to pay every month. If there were some form of universal health care, it would be far easier for us, but there is not, so we continue to live without healthcare and hope that an emergency does not arise. (May 14, 2007)

I'm skeptical of All Male Action's numbers. In the source he cites, Table 8. People With or Without Health Insurance Coverage by Selected Characteristics: 2004 and 2005, in Income, Poverty, and Health Insurance Coverage in the United States: 2005 U.S. CENSUS BUREAU, 30,000 of the uninsured had income under $50,000.

I would like further proof of his claim, "Another third of that 14.2 million are people who are eligible for public health insurance programs but have not signed up for them." According to several reports, some people are technically eligible for public health programs, but the federal and state governments have made it so difficult for them to establish eligibility that they can't do it, like Nikki White, for example. Some federal rules require a birth certificate, and many elderly people never got one. The New York Times reported that infant mortality rates were going up in Mississippi, because among other things it was too difficult for pregnant women to establish eligibility.

I'd like to see All Male Action make a good argument based on solid numbers from reliable sources. Can you do it, All Male Action? Nbauman 19:52, 14 May 2007 (UTC)

"According to several reports, some people are technically eligible for public health programs, but the federal and state governments have made it so difficult for them to establish eligibility that they can't do it, like Nikki White, for example. Some federal rules require a birth certificate, and many elderly people never got one. The New York Times reported that infant mortality rates were going up in Mississippi, because among other things it was too difficult for pregnant women to establish eligibility. "

This paragraph makes no sense. First of all, elderly people would be automatically eligible for Medicare and/or Medicaid. As for the idea that they "can't establish eligibility" because they don't have a birth certificate - as it turns out, my father was born in Pennsylvania coal mining country. He was born at home, and never had a birth certificate registered. When it came time for him to get Social Security, he needed a birth certificate. it took about two weeks, but he got a certified copy by telephone. It wasn't at all difficult if you can establish you were actually BORN here (surely most people know where they were BORN.)

My father is over 65, so I can see why he had that problem. I find it very hard to believe that anyone born in the US who is younger than him has a problem getting a birth certificate.

Unless the New York Times has some other reason why women in Mississippi have problems establishing that they're American citizens via a birth certificate, it's ludicrous to say that it's some kind of major problem. It simply is not - not unless your mother delivered you in an alley and you were raised by wolves - or unless you're trying to pull a scam on the govt and that's why it's impossible for you to get the paperwork.Simplemines 09:45, 13 August 2007 (UTC)

Read the Wall Street Journal story about Nikki White and the New York Times story about Haley_Barbour#Infant_mortality and then tell me what you think. Nbauman 16:21, 13 August 2007 (UTC)

I read the Nikki White article. From the timeline: "2001-October 2003: Uninsured. Ms. White leaves her job because of illness and loses coverage. Unable to obtain individual private insurance, she eventually submits to mother's entreaties to apply for Medicaid."

When you leave a job, your employer HAS to offer you COBRA. She must've been offered it. She apparently rejected it, let her coverage lapse, THEN tried to get a private policy. For someone with a pre-existing condition, that is incredibly stupid.

COBRA can be expensive, but not nearly expensive as letting your coverage lapse and then try to get insurance.

I'm sorry the woman died. I'm also sorry she made such stupid mistakes.

Let's assume, though, that socialized medicine is passed. For all the things she went through, she would've been put on a waiting list for anything from a CAT scan to surgery, and may very well have died in the wait. This is something that happens in countries with socialized medicine, and sadly it's not rare or unusual. Socialized care is RATIONED, meaning there's only so much to go around, so even if you need a test ASAP, it makes no difference. You will be made to wait your turn.

The situation now is bad. State control will only be worse. Simplemines 10:21, 19 August 2007 (UTC)

Simplemines, watch out for that word "apparently." COBRA wouldn't have kept Nikki White alive.

COBRA only lasts 18 months, with an 11-month extension, or a total of 29 months. See [3] "Can individuals qualify for longer periods of COBRA continuation coverage?"

Nikki White quit her last job, with benefits, in 2001. Her COBRA coverage would have ended in 2003 or April 2004 at the latest. The WSJ story said, "She couldn't get private health insurance at any cost." She was accepted into TennCare in 2003. TennCare informed her that they were dropping her in 2005, and she did everything she could to appeal. In August 2005, they stopped paying for the MRI scans that she needed to stay alive. The article also says that she applied for SSI and was rejected because she didn't meet Tennessee's definition of "disabled".

WP:Talk is not the place to debate universal health care, it's the place to discuss improvements to the article. You shouldn't give your own opinions about universal health care, you should cite reliable sources.

If you believe that under socialized medicine, Nikki White would have been put on a waiting list for a CAT scan and died anyway, then find a reliable source to document it. In Canada, for example, according to articles in Health Affairs and elsewhere, urgent patients are given CAT scans immediately -- that's why there are waiting lists for non-urgent patients. But I'd like to see evidence to the contrary. Nbauman 18:16, 19 August 2007 (UTC)

Nbauman, I'm aware of the limitations of COBRA. I also know if you transfer from COBRA to a Blue Cross plan, your preexisting conditions CANNOT be held against you if you do not let there be any lapse in coverage from COBRA to Blue Cross.

Since you're so interested in Canada, a new article in City Journal would seem to shred some of your notions about Canadian healthcare. Here is the intro graph: "Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada."

The link is http://www.city-journal.org/html/17_3_canadian_healthcare.html

Just as Canadians, fed up with the severe problems of their system, are moving toward a market solution, unschooled, ignorant, or leftwing Americans move toward socialism.

Read the article and see if it makes a dent.Simplemines 09:51, 21 August 2007 (UTC)

First, on Nikki White -- are you saying that in Tennessee she could have transferred to Blue Cross when her COBRA ran out, without increased charges for pre-existing conditions? Can you document that? In the WSJ article, her mother said that she couldn't get insurance at any price. Do you have any evidence to the contrary? I know people in some states, including one person whose COBRA is running out, who have pre-existing conditions and either can't get insurance at all, or would have to pay a premium of $10,000 a month.

Second, on the City Journal article -- I've read David Gratzer's articles and I've heard him debate. Thanks for pointing this one out. I also read the New England Journal of Medicine, which is where they published the studies of cetuximab (Erbitux). When they published the studies, they also published an editorial commenting on the unusual, extraordinary cost of cetuximab, and its disappointing effectiveness. (The Price Tag on Progress — Chemotherapy for Colorectal Cancer, Deborah Schrag) The cetuximab treatment would cost $160,000, and extend life an average of 1.7 months (the most expensive treatment in medicine). The government health care systems in Canada, England, and the U.S., and most American insurance companies, calculate the years of life saved by a treatment. The British and Canadians pay something like $70-100,000 to gain a year of life. Cetuximab would gain a month of life for $100,000, the equivalent of $1.2 million a year. Many Americans can't afford that with their private insurance coverage (NYT, Costly cancer drugs bring hard decisions). Realize Gratzer isn't talking about saving Suzanne Aucoin's life. She has stage IV colon cancer, with a 10% chance of surviving 5 years with the best treatment. The issue is whether the Canadian health system should spend $160,000 on a drug that would extend her life by 1.7 months, a drug that many Americans don't get because they can't afford it. Do you think the Canadian health system should be forced to spend $160,000 for cetuximab to get 1.7 months survival?

And back to the original point -- do you have any evidence that patients with lupus who are taking immunosuppressive drugs like azathioprine don't get CAT scans to monitor their treatment? Nbauman 18:19, 21 August 2007 (UTC)

Single Payer Health Care merge.

It seems to be that single payer and Universal health care are very seperate things and should not be merge.

It is posible to have a Single payer system that is not universal and it is possible to have a Universal system that has multiple payers.

I think that merging these two topics whould only make it harder to seperate the two different ideas and might make it harder for readers to tell the difference between these two ideas. 72.228.90.129 19:04, 5 February 2007 (UTC)

Neutrality of this article needs to be examined!

I have added a neutrality icon to this page - the section on universal coverage in the United States cites examples in other countries that are not backed up with sources, true examples or figures. I also added links to tables dealing with life expectancy and infannt mortality rates among nations, as published by the CIA World Factbook online, found here.Dmodlin71 11:02, 11 February 2007 (UTC)

Also, the statements pertaining to states enforcing monopolies on state-funded healthcare services should be deleted, unless they can be backed up with verifiable references. Dmodlin71 11:06, 11 February 2007 (UTC)

I removed this, first because there are a few references and second because I'm helping out in changing the page, and weeding out the POVs. Please help too!Wikidea 15:42, 22 May 2007 (UTC)

Definition

Does anybody have a source for a definition of "Universal health care"? As far as I could tell, the source cited, Massachusetts Nursing Association. "Single Payer Health Care: A Nurses Guide to Single Payer Reform.", does not have a definition. Nbauman 20:05, 17 February 2007 (UTC)

For a definition of Universal health Care please visit http://www.euro.who.int/observatory/Glossary/TopPage?phrase=U

which states in summary, that Universal Health Insurance provides health care coverage to the entire population (100%)

"Universal Health Insurance Core definition: A national plan providing health insurance or services to all citizens, or to all residents. Source: Getzen, 1997 Example/s: Ninety-five percent of the population was covered in 1997, but it was not until a law was passed in 1999 providing universal health insurance that the entire population was covered. "

204.174.219.3 19:57, 7 March 2007 (UTC)

I erased the the part that stipulated a requirement to pay. Although the definition cited above refers to Universal health Insurance and not care, I think it is more than obvious that the concept of universal coverage requires everyone to be covered and not everyone to pay. Of course, universal coverage is often implemented with an obligation to insure (and pay) for those who can, but for universal coverage inability to pay cannot be a reason for exclusion. Jonas78 23:35, 24 July 2007 (UTC)

My objection to the definition is that it doesn't distinguish between the universal right to be treated for necessary healthcare and a system that provides universal a universal system of paying for healthcare that is a system, rather than a patchwork of mandates that apply to doctors, hospitals, and so on, to shift the costs of required care to them so they will force the government and charities to pay for required coverage.

In the US, doctors and hospitals are required to provide all necessary care to preserve life regardess of ability to pay. And public hospitals are required to treat all patients who show up and need care. So, while the US doesn't have a system of universal healthcare payment, it does have a requirement for universal healthcare if you can get through the rationing that not having the means to pay erect. Mulp 18:52, 23 September 2007 (UTC)

Article quality

This article is really bad right now. It provides no good information, has many unsourced and POV statements, and it glances over the topic in favor of playing up emotions. It needs to have less emotion and more information. As it stands, it reads like something off a short website instead of an encyclopedic article. Topics that should be included could include things like how countries implement care, what restrictions there are, and possibly political or social response to the topic if done so in a neutral manner that documents support and dissent. It should also not be presented as a list of opinions as the last two sections are, because they run into the same problem of merely glancing at the topic and offering no information beyond talking points. Rebochan 13:00, 6 March 2007 (UTC)

One Heck of a Mess

I began work to correct this mess but gave up in favor of commenting here. I comment not only as a dual citizen of the USA and Canada [more than 30 years lived in each nation] but also as a provider of healthcare services in hospitals on BOTH sides of the border.

My attention to the need for HEALTHCARE REFORM began back in 1991 with the fascinating Walter Cronkite TV Documentary entitled "Borderline Medicine". Walter followed 2 cases of normal pregnancy, 2 of cancer, and 2 of cardiac bypass surgery, one on each side of the border. The subsequent effect upon American cries for UHC surpassed Cronkite's 1968 aposty concerning the winabiity of the Vietnam War, a statement that convinced LBJ not to run again. Most advocacy for UHC in the USA is tracable back to Walter's nifty film.

The worst mess on the article page is the misunderstanding that Canada has national UHC. It does not. Canada is not a republic. It is a federation of ten provinces. Each province has its own government-regulated HC insurance plan. Services covered in Manitoba [which has universal state-operated automobile insurance!] are not the same as services covered in Newfoundland, and so forth. The federal government now provides only Guidelines for the provincial systems. Two decades ago it had purse string power over them by Federal Grants, but those days are now over.

Second, Americans presume that UHC in Canada was implemented under the reign of Left Wing governments. This holds true ONLY for the system implemented in Saskatchewan back in 1949 -and man is THAT a story to be told some day in Wikipedia! But it was the late 50s to early 60s federal CONSERVATIVES that brought UHC from sea to sea. But not a single, national scheme, such as Britain has.

Universal Health care is barely understood by persons who already have it, and dreadfully misunderstood by those who don't have it but either WANT IT or DON'T WANT IT. The former group tend to idealize UHC irationally and misunderstand what can actually be achieved. The latter group defame UHC irationally and misunderstand that it has nothing to do with Karl Marx.

The name of the game is the label one succeeds in imposing upon the facts. Canada does not have a single-payer heathcare system. That term was never used in the lively debate before adopting this kind of healthcare delivery. Canadians did not WANT a nation where the rich would live and the poor would die. The ethical aim of UHC is to ameliorate the biological connection between health and wealth, also between health and social class or rank. The most impressive researcher into this human condition remains British professor of epidemiology and public health, Sir Michael Marmot. Dr. Marmot was also the 2002 winner of the Nobel Prize in Economics. Look him up on the I'net.

Across six decades, a conclusion I have reached is as follows. The system used by a nation or society to distribute health care among its members is that society's answer to the question: Why have a society in the first place? At bottom, different HC delivery systems provide varying degrees of opportunity not to individuals, but to DNA units in our H. sapien gene pool.

Trylon 04:24, 7 March 2007 (UTC)

Can you cite a reliable online source to say that? Nbauman 12:59, 6 April 2007 (UTC)

I doubt anyone can; only in the US is Socialized Medicine used as a strawman for a rational system of paying for healthcare. In Canada, the debate, as I think Trylon is trying to point out, is how to pay for Socialized Medicine and how to ration care, because no matter what, care must be rationed - no health insurance plan says "we pay for anything you want that is related to health." The stigma attached to Socialize Medicine caused those wanting a rational system of payment to relabel it Universal Healthcare, but the issue continues to be framed by those who attack the strawman Socialized Medicine Mulp 19:08, 23 September 2007 (UTC)

Good points, Trylon. If you write you comments up, get them published even as an op ed, then I or someone can cite it. As the article is covering a term of art in political framing, I don't think any article can be anything but a hash. I think the article should be reduced significantly to focus on the political use of the political slogans, like "Universal Healthcare" because the words are intentionally vague and shifting meanings. Mulp 19:08, 23 September 2007 (UTC)

US-centric

Apart from the list of countries with UHC, this article bearly mentions any actual UHC systems.

Also, the primary focus of the article should not be a debate on the *worth* of UHC, taking place in a country that doesnt have it. surely the article should focus on UHC as it actually exists in countries where it actually exits?! The article should define what is it, the historical development of the concept and historical attempts at implementing it, describe where and how it is implemented in specific terms in the contempory context, philosophical underpinnings, etc, etc. There is lots that could be discussed other than its good, no its evil, ad infinitum. After that is done then you could have a section on particular pros and cons, etc. But as usual on wikipedia, you come to find out dome iformation and yo just get an argument. aussietiger 05:47, 6 April 2007 (UTC)

Economics of Medical Insurance

It's a false statement to claim that medical insurance is subject to market failure in an article about Universal Health Care. Health care is the market failure, single payer and hybrid models are responses to that market failure. Medical insurance is consumption smoothing. Milton Friedman opening and often asserted that one of the biggest issues with the current system in the US is that without medical insurance and without access to medical care is synonymous. Medical insurance is subject to adverse selection, medical care isn't. When you're sick, you want medical care. Access to medical care likewise is something everyone wants. —The preceding unsigned comment was added by DJFLuFFKiNS (talk • contribs) 12:51, 25 April 2007 (UTC).

This section needs to be reworked by someone with access to Economic literature and not educated guessing. As an example, there are four standard market failures put forward in relation to the workings of private health care markets (Following Arrow: externalities, returns to scale, supply-side restrictions and asymetric information (-> adverse selection, moral hazard). They cause ressources in health care to be allocated inefficiently. Thats is the rationale for state intervention and regulation. Universal health care addresses these issues, but it does not magically solve them, it produces problems of its own. Thats why most European countries actually have neither socialized medicine nor private health care markets, but in very different ways have tried to achieve "quasi-markets"... A good overview is given by Ch.17: Healthcare, in Connolly and Munro, Economics of the Public Sector, 1999. I am not a native English speaker, so I will abstain from making any major edits. Jonas78 00:01, 25 July 2007 (UTC)

Knowledge and the interest to add good content are far more important than phrasing. In other words, your English sounds fine, please edit away.--Gregalton 04:20, 25 July 2007 (UTC)

Userbox?

Is there a userbox to indicate a user's support for universal health care? Wooyi^{Talk, Editor review} 04:28, 5 May 2007 (UTC)

PRC

I know the text included the woolly phrase '....are among many countries that have various types of universal health care systems.', but the map actually shows more than are listed. Why are other countries, notably the PRC, not listed? If it is because no reference can be found, why is it still on the map? Is it OK to have something on an image without references, but not OK to have text without references?
Davidmaxwaterman 05:11, 14 May 2007 (UTC)

I agree - it's a nice map, but I'm a bit sceptical about some of the countries there too. Wikidea 08:18, 22 May 2007 (UTC)

Structure

This is a good page, mainly because it's got anything on it at all. I've made changes to the structure, however, to simplify it. Here are the main ones:

• Separate title for Funding of health care has been removed, and put with economics
• Separate title for Health care in times of disaster has been removed, and put with the US section
• Deleted the section on Private Universal health care - this idea pops up on a few pages - it's fiction, because every system of health care (universal or not) has some form of regulation, and none of it's private. There will always be drug standard regulation, price regulation, subsidies, or something. It makes little sense to talk about something that doesn't exist.
• Inserted table (from Canada page) on costs by country in the economics section.

Can I also have thoughts on whether the arguments for/against should be slashed a bit, possibly removed? It's pretty mundane when the first "argument" for health care is "health care is a right" and the first argument against health care is "health care is not a right". Arguments usually require the word "because", and I'm afraid it rather sounds like something you might see on Fox news at the moment. There is also a distinct lack of facts, and the opinions of right wing think tanks, like the Cato Institute certainly don't count. It's also a "debate" so far as I know, that only exists in the United States, so I'm not sure how relevant it is. As I say, what does everyone think? Wikidea 08:17, 22 May 2007 (UTC)

When about half of the references in the article are from Cato (better described as a Libertarian think tank that is far right on spending/tax issues) you certainly have a point. At the very least, opponents of universal healthcare would benefit from having a larger variety of sources rather than most coming from a fringe source. There are many other sources that argue against universal health coverage.Gmb92 05:49, 17 July 2007 (UTC)

Regarding costs by country, here's a good link on this, which measures it on a per capita basis and as a share of GDP. [[4]]

One of the arguments for (mentioned in one form in this article) is that universal coverage will improve early detection and thus survival rates. This is backed up by the American Cancer Society (page 7):

A lack of health insurance is associated with lower survival among breast cancer patients. Moreover, breast cancer patients with lower incomes are more likely to be diagnosed with advanced stage of the disease and to have lower 5-year relative survival rates than higher-income patients. [[5]]

Gmb92 05:59, 17 July 2007 (UTC)

Merging

I've been looking at all the pages around these topics and I want to propose a merger between this page and the general Health care page. This one is better, but the other has a more appropriate name. This page is quite details, covers economics and politics, plus references to other countries. So I suggest the content there be added in the appropriate place here, and that Universal health care redirects to the Health care title. Wikidea 09:10, 22 May 2007 (UTC)

I oppose merger. I don't understand your reason for merging. Health care, and universal health care, are both enormously complicated topics. If universal health care were merged into health care, it would have to be condensed to a paragraph, and it would be impossible for people pro and con to present their views in enough detail to satisfy them. Furthermore, universal health care is an important policy debate. Nbauman 00:05, 16 July 2007 (UTC)

Yes, you're right, thanks for reversing it. Now the page content is about the UHC debate specifically, without the extra things that belonged on the Health care page, so cheers.Wikidea 00:20, 16 July 2007 (UTC)

Map of countries with universal health care

It would be helpful to know on which reference this map bases. Personally, I think the classification of some countries are disputable, especially for Switzerland. In my opinion Switzerland has universal health care at least with respect to the definition in the first sentence. Hermes Agathos 16:19, 25 May 2007 (UTC)

Also, why is China colored on the map? The article gives no indication that China has a universal healthcare system.

Format problems and de-marging

The current format is strange and clearly an artefact of the merger/demerger. Could we perhaps simply go back to the last version before the merge, and then clean up? The 31 May version seemed pretty good.--Gregalton 10:13, 17 July 2007 (UTC)

The information that was taken out was more appropriate on the Health Care page, so information needs to be added to this article specifically about Universal health care.--JEF 16:37, 17 July 2007 (UTC)

Yes, that's right. The problem is that the concept of universal health care is a pretty specific term, used only in the U.S. In the rest of the world, nobody gives a second thought to whether health care is universal or not, because it's taken for granted that it is. So what you end up with, if you're talking about UHS is a specifically American political debate - for all the stuff on the article before, it really belongs better in the Health care page itself. I was tempted to delete the "debate" points that exist on the page now, because it's all very specious - I mean the first points are "health care is/is not a right" - what a spectacularly inane entry for an encyclopedia (oh no it isn't!) Wikidea 11:51, 22 July 2007 (UTC)

Keep in mind that this is not a typical encyclopedia. We are trying to build the most complete encyclopedia ever created, so to that we need to take on all well sourced relevant material which often means going where traditional encyclopedias shy away from. A written encyclopedia cannot be continuously updated and adapt so it is limited in the material it can cover.--JEF 21:20, 24 July 2007 (UTC)

Content merge

We now have most of this document already included in health care so we might as well erase that part from this article as we should follow DRY. I am in favor of keeping a seperate article for universal health care, but I also feel that much of the previous content is more appropriate for the Health care article. The lack of consensus is for a complete merge, but I think there is a consensus for the merger of much of the material. If there are any major objections to this then speak now.--JEF 05:43, 25 July 2007 (UTC)

I object. Removing 90% of the content of this article as was done turns it into a list. I'm all for editing selectively so that there is less overlap (although some overlap is not necessarily bad). It must be done, however, in such a way that it doesn't gut the content or context of this article. One of the principles under DRY is 'Imposing standards aimed at strict adherence to DRY could stifle community involvement in contexts where it is highly valued, such as wikis.' To me, this is a clear example of this instance. If there is a broader effort to organise all of the content about countries, etc., then in that context. This is a separate and distinct concept and issue, and arguably much clearer in meaning than "health care" alone. So yes, major objection registered.--Gregalton 05:58, 25 July 2007 (UTC)

There is no doubt that this article needs major work (thus the tag), but the content that was here was distracting from what is supposed to be the purpose of the article and that is to explain the universal health care system and not health care around the world.--JEF 06:03, 25 July 2007 (UTC)

As for some overlap being good, this is true especially per WP:Summary, but the amount of overlap here is unproductive as it means that we will essentially have two different copies of the same article. Merging two similar articles is the most annoying merge to do (I am speaking from experience).--JEF 06:07, 25 July 2007 (UTC)

I understand your point, but there is quite a bit of content that is specific to universal health care that would be lost (and in the interim, the article would essentially be gutted). The consensus seemed to be against merging (or more specifically, there was no consensus to merge), so discussion of how to merge them may not be relevant. Parts of this could be removed, but given the back and forth and objections to the merge, I would suggest this needs a light hand for deletions until a better sense/consensus emerges of what each article needs (to minimize overlap, among other issues). Best,--Gregalton 07:00, 25 July 2007 (UTC)

On the Neutrality of "BalancedPolitics.org"

I'm opposed to BalancedPolitics.org being listed as a neutral source on this issue (or any issue, for that matter). The name of the website gives the impression that it's neutral, but every article on the website is written by the same person, a person named Joe Messerli, who admits to having a conservative or libertarian perspective on most issues. Not surprisingly, most of the statements he makes about UHC are from that perspective. Many of the statements he makes are also unsupported opinions, such as: "There isn't a single government agency or division that runs efficiently", "Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness", "Government-controlled health care would lead to a decrease in patient flexibility", "Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.", and "Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care." In his explanations of these statements he cites no studies or statistics. Anyway, I think the link to this website should either be removed from the page or at the very least it should be labeled as a conservative/libertarian-leaning site, as opposed to a site that's "neutral". AnomyBC 02:03, 26 July 2007 (UTC)

Thank you for your suggestion! When you feel an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the Edit this page link at the top. You don't even need to log in (although there are many reasons why you might want to). The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes — they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. --Ryan Delaney ^talk 19:27, 29 July 2007 (UTC)

Bizarre reliance on docs from the Cato Institute

Is there a reason that every single anti-UHC point in the For/Against section is derived from documents from the Cato Institute? I know they have different contributors, but it seems a bit limiting... What's the WP view? Is one Institute's POV on a subject enough to cite it? I don't believe so.

--Conor 22:56, 30 July 2007 (UTC)

WP:NPOV requires that we represent all significant points of view. The Cato Institute is a significant point of view. Politicians and lobbyists bring out their reports to justify their positions.

Their positions are ridiculous. They believe that if people can't afford to buy health care in the free market should do without it. Ridiculous positions are a significant part of the debate, and they belong in an encyclopedic article. If you disagree with them, you can find a reliable source with good response to their ridiculous positions, and let readers see how ridiculous they are. That should be easy enough. A debate is often a good way to explain these ideas. Nbauman 02:00, 31 July 2007 (UTC)

The problem isn't that their views are silly - that's a matter of opinion - rather the difficulty is that an entire section of the page is supported only by reports from this one institute. The heading says "Common arguments forwarded by opponents of universal health care systems" but lists only those found in Cato documents. One would expect "common arguments" to be sourced from multiple credible reports. What we have here is essentially a list of reasons why Cato think UHC is a bad idea. Surely that's not conducive to a good Wikipedia page? --Conor 00:19, 6 August 2007 (UTC)

Graphic

Kborer, I challenge the text in that graphic.

Where is your reliable source WP:RS to support your claim that "The availability of health care to a population is independent of the system used"?

Where is there a system with private financing, and universal care? Nbauman 19:32, 1 August 2007 (UTC)

The point is that universal health care is not a health care system or something you can implement. Rather, it is something that can be achieved. The graphic does not make any claims about what percentage of the population is covered by different systems, it merely illustrates that you could plot different health care systems along those three axes. If that is unclear, we should rewrite the image caption. Kborer 20:39, 1 August 2007 (UTC)

That's an interesting point. I think that's a personal opinion and a matter of controversy. I don't believe that universal health care can be achieved in a free market system. Personal opinion doesn't belong in a WP article. If you can find a reliable source to say that, you can include it by attributing it to a reliable source. Nbauman 22:24, 1 August 2007 (UTC)

It is by definition that universal health care is independent of health care systems. The matter of opinion is whether certain systems do lead to universal health care. My intention was not to claim that all systems do lead to universal health care, and so I have changed the caption text to clarify that. Kborer 22:52, 1 August 2007 (UTC)

I do tend to agree that universality is unlikely to emerge in a free market system. The graphic would make sense as a means of scaling a particular type of system. But they are unlikely to be independent factors. I certainly think the heading is wrong and should be changed.--Tom 23:15, 1 August 2007 (UTC)

I propose to delete the graphic. Are there any other editors other than Kborer who are strongly of the opinion that it should stay?--Tom 10:43, 5 August 2007 (UTC)

I agree it should go; the claim that it is 'independent' is not supported (or original research). I don't know that this was intended, but 'independent' on a graph clearly evokes the statistics meaning (no causal relationship); in certain political systems it clearly does have a causal relationship.--Gregalton 12:06, 5 August 2007 (UTC)

If you were to plot the locations of currently implemented systems on those three axes, you might certainly see a causal relationship. However, the graphic is not plotting anything, it is merely showing some dimensions along which health care systems could be plotted. Kborer 15:42, 5 August 2007 (UTC)

The text reads "The availability of health care to a population is independent of the system used. With any health care system you might have universal health care, no health care or anything in between." The use of the word independent, as noted, implies that there is no causal relationship, whereas there may well be. Since there is effectively no support on the talk page for retaining this graphic, please leave it off for now.--Gregalton 16:04, 5 August 2007 (UTC)

I can see how the caption could be confusing, since it refers to "systems" instead of "types of systems". How does this sound? "With any type of health care system you might have universal health care, no health care or anything in between." Kborer 16:19, 5 August 2007 (UTC)

That is definitely better, but I still don't think the graphic adds much to understanding (part of my objection). My other objection is content: even the revised statement is questionable, since (as others noted) there are in fact no examples of universal health care (or even non-universal health care) without significant government financing. I appreciate the effort, I'm just not sold that it appreciably makes things easier to understand. Perhaps if you simply removed the government/private financing axis? Looking at this, I can see that by government financing/private financing you may be referring to single-payer vs compulsory insurance (for example), but that's not clear either. Another thought is to split the graph into two: one that includes the universal health care axis, one that includes the financing axis. To me, this would be more instructive.

Dang, I've written that para and I'm not sure I'm being clear. Are you trying to classify systems of universal health care? It may be more feasible to classify types of universal health care systems separately from the non-universal, and not raise the issue of causality. On the other hand, if you're trying to classify systems by their universality, the question of causality becomes very important and it may be better to leave it off.--Gregalton 16:33, 5 August 2007 (UTC)

In a different graphic I try to classify types of health care systems. [6]. However, in this graphic I am only trying to explain that the opposite of universal health care is no health care, and that different health care systems can have different levels of universality. The graphic is helpful because it shows that universal health care is not a type of health care system, but a way of measuring health care systems. Maybe the two should be combined into one graphic.

Your other concern is that there are no implementations of universal health care without public financing. Even if this were true [7], it would still make sense to include them in the graphic for people to think about. Kborer 17:40, 5 August 2007 (UTC)

Kborer said above that "in this graphic I am only trying to explain that the opposite of universal health care is no health care", but it is obvious that the opposite of "universal health care" (heath care for everybody) is "no health care at all" (no health care for anybody). We do not need a graph for that. This article already establishes that this is not a matter of "public versus private funding" or "public versus private provision" because as the article already makes clear, the various univeral health systems in existence have a mix of all of these. So the other axes of the graph are completely irrelevant.

I disagree with the notion that the information is obvious to everyone and that the graphic is not helpful. The graphic illustrates basic concepts, which is especially useful for people who are new to the subject. For example, some people think that universal health care is a type of health care system. Kborer 19:30, 5 August 2007 (UTC)

With respect to the point above "even if this were true...", the WaPo article does not seem to support the comment. Even without mentioning federal funding, the article directly refers to (state) government funding: "Next, the plan aims to cover 300,000 more residents by expanding Medicaid eligibility for lower-income residents and by creating a new subsidized state insurance program." I also don't see the point about "different levels of universality"; it is commonly accepted and in the article's lead sentence that universal health care refers to coverage of substantially all of a given population. Would it be meaningful to refer to universal health care for 20% of the population? (Everybody but the unhealthy, for example?).--Gregalton 19:11, 5 August 2007 (UTC)

Different levels of universality was a bad way to put it. I only meant different levels of coverage. The point of the WaPo article was that most people under the MA plan would have private insurance. It is not completely private, but then again, the Canadian and UK systems are not completely public either. Kborer 19:30, 5 August 2007 (UTC)

I made the point that there were no universal systems w/o government funding (not many non-universal, either); the WaPo article does not support that point. I appreciate the effort on the graphic, but still don't think it contributes substantially to understanding. Given the discussion on this talk page, it doesn't seem to have clarified much, and incited much more discussion on what it means. I don't mind the two-axis graph, although it's not really specific to universal health care.--Gregalton 20:13, 5 August 2007 (UTC)

Single Payer /Hybrid sections

These sections seem to very overly concerned with the US health system which ís not universal and therefore does not really have a place in this article. For example the term "single payer" is mentioned in both sections, but it is a term entirely born out of that current debate in the US.

Surely this article should describe what is meant by Universal Health Care and how it has been implemented in different places around the world. The rest of the article seems to do that very well but these two sections seem out of place with that. For this reason I am proposing the deletion of these two sections. I am sure the information in them can be obtained via the section on United States and related articles with about US health care such as Health care in the United States and single-payer health care.--Tom 10:18, 5 August 2007 (UTC)

Single payer sand hybrid systems aren't just part of the American health care debate. They are two different types of universal systems; Germany is an example of a hybrid while Canada is an example of a single payer. I am restoring these sections as it is an important difference between universal systems.--JEF 02:49, 6 August 2007 (UTC)

It sure is important to point out that there are other systems than "single payer" ones, but the division made here seems indeed very US oriented(the only important characteristic seems to be whether the government "pays" or not). No mentioning of social insurance, income related vs risk related insurance premiums, legal obligations to be insured, non-profit (not state run!)insurance companies vs. profit oriented insurers, the extent and regulation of competition between insurers, binding legal definitions of insurance packages...

I think an appropriate synonym for hybrid would be "everything else". And it is noteworthy that the article does not describe a single so called "hybrid system", it only describes the UK and Canada in some detail. And I don`t want to say its wrong, but stating that Germany moved from private insurance to a hybrid sytem kind of leaves me clueless. When? What is meant by that? What do you define as private insurance? What literally translates as the "private insurance system" in Germany is not a free market system. Jonas78 11:56, 6 August 2007 (UTC)

It is a basic differentiation between universal health care systems; anything more would overwhelm the article. Germany's system has basic universal health care coverage, but people can pick up any extra insurance from the private market. This is what is meant by a hybrid system.--JEF 22:43, 6 August 2007 (UTC)

You say its a basic differentiation, but I would insist it is not a very clear one. In the single payer article you will find this definition for single payer: "An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company." by the National Medical Library. First, the term refers to the financing of health care. A logical opposition should then also be defined in terms of the financing of a system. I guess thats why 'multi-payer' system is often used as an opposition, and that would only say that those sytems have not a single centralized source of finance. What you refer to in the German case is more a Two-tier health care system, according to the article Canada is the only Western country not to have one, and its not an opposition to single-payer. When you insist that Germany is a hybrid system, because you can pick up extra insurance from the private market, I would ask you, isn´t that the case in Britain, too? Jonas78 01:15, 8 August 2007 (UTC)

The two sections seem to imply that there are two different funding models for UHC. The two models being either "Single Payer" insurance or a "hybrid" system being some mix of "Single Payer" legislated compulsory insurance plus a "free market system" (paid for either by private medical insurance or pay-as-you-go private purchase). But all over the world, UHC has been been achieved with a hybrid model. There seem to me to be two main exceptions to the hybrid model. One being UK, which does not have a compulsory insurance scheme, and the other being Canada, which has legislated against private practice in areas where there is Single Payer coverage.

And here comes the confusions.

• According to some definitions, Canada's is a pure Single Payer system whereas the UK's system has been dubbed in the US with a POV name "Socialized medicine". This is confusing because it is not a term that is used outside of North America.

• According to some, the UK does not have a Single Payer system, even though in reality it is more single payer than most insurance based schemes because taxation pays for virtually everything.

• The Canadian system is somehow seen as more "free market" than the UK's because the NHS institution is run by the government and the Canadian institutional providers are independent from government. But in reality there is more freedom in the UK as there is a flourishing private sector and anyone can choose to pay for or insure themselves for service in the private health care sector and unlike Canada there are no bars to doing so.

• The media and pressure groups, and sadly too some medical people who ought to know better, falsly imply that people in the UK have no choice of doctor, surgeon, and have to wait for medical service and suffer great pain. The NHS system is often dubbed in the media as "socialized", "socialistic", "dirty", with "no choice". This is not how the people in the UK see their NHS. Sure, you can always find some exceptions. There will be a miniscule minority of people who would argue that the NHS is a bad thing. And there will be sensational stories in the press from time to time. These often prove to be exceptional and sometimes downright misleading. Good news does not sell newspapers and hardly ever hits the press whereas sensational stories always will. The media therefore paints an unrepresentative picture.

• The press similarly dub the Canadian system as beset by queues and people in pain with people fleeing over the border. I have no direct experience of the Canadian system, but I suspect this is a very small part of the total picture and just as sensation as the stories about the UK's NHS.

• People in the US, for largely historical reasons going right back to the founding of their nation, have a great distrust of government and taxation. They argue, almost as though it was axiomatic, that involving the government in medicine will cause costs to rise. This in spite of the fact that their nation spends more than twice as much per capita on health care as the next highest country, has an almost totally private system of provision, and yet has worse heath outcomes and still has many uninsured people and people who go bankrupt and even die for lack of care or the affordability of medicines ot attendant care.

• Because of the way the US debate has been shaped (deliberately in my view) this tends to mean that the world of UHC is represented by Canada at one extreme and the UK at the other with every other country having UHC somewhere in between, but largely ignored. But as I and I think Jonas too would point out, if one looks at the world as a whole, the UK and Canadian models are not representative of UHC as a whole.

• Putting the UK at one extreme and Canada at the other is an entirely misleading way of looking at it. From a funding perspective the UK and Canadian systems would be very similar if, say, Canada adopted to allow private medicine, the only difference being that in Canada, the health institutions are mostly privately owned whereas in the UK they are partly publicly owned and partly privately owned and maybe in part sub-contracted directly to the public system. In the UK, the public and private systems compete with each other. People in the UK mostly do not choose to pay for private medicine because the NHS is really quite effective. These realities are not conveyed in the article or in the media.

Many of the external links and references in this article discuss the US and Canadian models, partly one suspects because of the predominance of the English language and the strong cultural and historical links between the US on one side where the debate is raging, and the UK and Canada on the other. But the UK and Canadian sysyems are not representative systems and they are often misrepresented.

I have strayed a bit from the intended focus on the removal of the sections. But my main point is that if the sections on Single Payer and Hybrid (and potentially that horrid word "socialized medicine") are to remain in the article, they should be seen from a proper global perspective. Can I suggest we now discuss the issues I have raised and how they can be incorprated to improve the article--Tom 09:20, 8 August 2007 (UTC)

OK on the premise that it is best to be brave, I have re-arranged the article slightly and moved discussion of these topics into Economics and a new sub section called Funding. I have tried not to delete anything but some of the discussion about the reasons for hybridity has been dropped, primarily because it seemed to me to be gibberish and not relating to anything I know about in the real world. As for Single payer, the meaning is still clear and I have deliberately put it as a sub-heading so that it can be seen in the index at the top. Some of the details have been cut because they can be obtained from the relevant article. I have moved the US down a bit because its not a Universal system yet and put it under politics because the issue for the US is one of political change. I have explained a bit more about insurance.

The lack of European examples trouble me. Either we should have more examples of implementations (probably with smaller sections for the UK and Canada) or we should drop the examples altogether. I prefer to keep them in myself. --Tom 12:00, 8 August 2007 (UTC)

Tom, thanks to your edit things look improved to me. I agree on the lack of European examples, but at least there is now an idea that health care systems are not to be distinguished along one single dimension.... Jonas78 16:58, 10 August 2007 (UTC)

Right, because nobody ever generalizes or sensationalizes the US health care system. Nobody ever says horror stories are typical. Uh huh.--Rotten 04:19, 20 August 2007 (UTC)

And incidentally, while the polls I've seen do indicate that US voters want change (and it needs big changes indeed), they usually rate their own personal health care very high. And single payer initiatives failed in the two most pinko kooky moonbat states (my state of MA and Oregon). You've been swallowing too much "Guardian" bullshit, my friend. --Rotten 04:23, 20 August 2007 (UTC)

To Rotten. I presume that barbed attack was on me. One again you are resorting to personal attacks. My knowledge of the health care system in the UK comes as a user not from the press. As an example, when my then 74 year old mother fell and broke her hip 5 years ago the emergency room doctor told us she would be operated on the very next day to receive a new hip joint. She was admitted to the hospital. When I went to visit her the next day she had not had the operation. It had been cancelled because an emergency patient with a severe heart problem took the theater slot that had been allocated. But she got the new hip joint the following day instead. I don't know if someone else's operation had to be cancelled for Mum to get hers, but if it was, that would be 2 cancelled operations contributing to the so called "horrifying" statistics about cancelled operations in the UK. Mum was only too pleased to lose her slot to someone who was in greater need. She was in bed and not suffering in any way. There was no hospital bill to be paid. I just wish people in the US could get more balanced information about universal health care as it operates in other countries.--Tom 15:55, 2 September 2007 (UTC)

I thought Rotten's attack was on me. I would like to see Rotten supply facts rather than sarcasm. And I'd like to see Rotten cite reliable sources that we can use in the article, rather than his own opinions.

Your story, Tom, makes a good point, but of course we can't use personal experience in WP. However, I have a story from the Wall Street Journal that made exactly the same point about the Canadian system -- a man's scheduled surgery (coronary bypass, I think) was delayed by a couple of days, because he was bumped by more urgent cases. The reporter asked him about it and he said, he didn't mind, the other cases were more important than his.

So Rotten is wrong on one point -- I don't just read The Guardian, I also read the Wall Street Journal, including their right-wing editorial page (along with several medical journals, including Health Affairs). Nbauman 17:51, 2 September 2007 (UTC)

There is nothing newsworthy about my mother's case... its an everyday reality and people are sensible enough to accept it and trust the doctors' judgements about these things. Its a bit weird that, as you say, news items might be quotable in WP, but individual personal experience is not. News items about the NHS are nearly always sensational and negative and therefore overall, press reports are totally distorting of the true picture. The good stories are not newsworthy. The exceptions that hit the headlines do not make the rule but they are very often quoted by certain editors here and in the articles of pressure groups and so called think tanks that these editors reference.--Tom 19:10, 3 September 2007 (UTC)

I think that the way the health care treats ordinary people is newsworthy -- especially for us in the U.S. where the question of whether government-run systems can deliver good health care is important in the health care debate. That's why the Wall Street Journal (pre-Murdoch) was such a good newspaper. Since I read the UK science and medical magazines, I have a perhaps overly-favorable view of UK journalism.

The reason you can't use personal experience on WP is that there is no way to verify it. People often exaggerate. For example, one flaw in Michael Moore's Sicko is that a woman complained that her husband would have survived kidney cancer if the insurance company had paid for a bone marrow transplant. Bone marrow transplants actually can't cure kidney cancer. The WSJ has published stories very similar to the ones in Sicko, but they checked them out carefully. I'm sure you're telling the truth, but I have no way to verify it. Nbauman 01:55, 4 September 2007 (UTC)

Criticisms?

Theres no section about criticisms of this type of system, other than the pages as external links? I've been known to not notice things in front of me, so please dont flame me if I'm just not seeing the section lol.

Sicewa 02:02, 16 September 2007 (UTC)

It was taken out by an anonymous IP a long while ago. Thanks for noticing. If you see something strange on a Wikipedia page, then it is a good thing to back a month and check if it due to unnoticed vandalism.--JEF 19:41, 16 September 2007 (UTC)

Canadian System Consistently Better?

There's a contradiction between two wikipedia articles I thought I'd point out.

In this article, it says "According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S[19]."

However, the article "Canadian and American Health Care Systems Compared" states "n 2007, Gordon H. Guyatt et al. conducted a meta-analysis, or systematic review, of all studies that compared health outcomes for similar conditions in Canada and the U.S., in Open Medicine, an open-access peer-reviewed Canadian medical journal. They concluded, "Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Guyatt identified 38 studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies with the strongest statistical validity, 5 favoured Canada, 2 favoured the United States, and 3 were equivalent or mixed. Of 28 weaker studies, 9 favoured Canada, 3 favoured the United States, and 16 were equivalent or mixed. Overall, results for mortality favoured Canada with a 5% advantage, but the results were weak and varied. The only consistent pattern was that Canadian patients fared better in kidney failure"

I'm far from an expert of either the topic of health care or encyclopedia articles, so I leave it to the jury to decide.

-Dev —Preceding unsigned comment added by 142.104.167.64 (talk) 03:55, 21 September 2007 (UTC)