Excellent questions, Philip. Sorry I don't have any answers. As a Canadian, I take free health care for granted and really cannot imagine otherwise. I did wonder, though, what happens to an American uninsured person who is forced to take psych drugs. Does an unwilling patient really have to pay for their own abuse?

Criticising Obama, however reasonable, = racism. Be careful. You will be banned from all tony microbreweries.

Philip asks:

"How are we going to pay for this, consistently and over time, without taxing the public to death?"

The same way 95% of the industrialized world pays for it. This question you raise is uniquely American, since it is your country that is the last First World nation to holdout on some version of universal health care.

As a Canadian, I've never thought of health care as a privilege, but as a human right. I think my European cohorts likely feel the same way to one extent or another.

To answer you question, I think you need to do two things. First, stop framing the health care question as a purely fiscal issue, but rather as a rights issue. Second, look at how other industrial nations pay for it and learn from those examples. Are there shortcomings and budget issues in the Canadian and European systems? Of course. No human-run system is perfect. But it works, and you oughta try it sometime. Imagine a life where the thought of a major illness for you or a loved one doesn't conjure up all sorts of financial nightmares, such as the prospect of bankruptcy, foreclosure, further debt, or the like.

The question for many of us who enjoy universal health care looking from afar at America isn't about Obama's strategy for bringing in a more comprehensive system, but rather, why has it taken the most powerful nation in the world so long to do so.

I know the insurance lobby in the US is massively powerful, so I don't expect Obama to get much further than Hillary got with it during the Clinton years. But we'll see.

If Washington can bail out failed industries and Wall Street as though money grew on trees, I'm confident that they can find a creative way to fund a universal health care system - which by the way, would have much better public benefit than any bailout could hope to produce.

Philip,

As one who also doesn't have health insurance and who voted for Obama, I am very disgusted at the way things are going. The only option should be single payer and nothing else.

Here is a site written by a Canadian who has lived in the US for several years who debunks the popular myths such as it would be nothing but socialized medicine.

http://www.denverpost.com/opinion/ci_12523427

Here is a site that clearly illustrates the cost savings:

http://www.grahamazon.com/sp/compare.php

Even if you don't agree that a single payer system is the way to go, health care is not a democrat vs. republican issue. Those of you who are screaming foul, what happens when you lose your insurance? You don't think it could happen to you? I certainly never thought I would be uninsured as it didn't happen until I was past 50. But here I am without health insurance and it is scary as heck.

By the way, I tried to buy a plan after my cobra expired but was excluded thanks to my psych med history in spite of the fact I am tapering off of the meds. Yeah, great life saving treatment. NOT!

Anyway, it sounds like what is being proposed would limit me to plans with high deductibles and high monthly premiums before I would get any benefit. I doubt I would get any assistance even though I am definitely not in the well off category.

Frankly, I fear what is being proposed will greatly worsen things vs. making them better.

Anyway, to hell with all the gutless politicians who many of them are bought by special interests.

Francesca,

The answer to your question is yes. They will send you a bill even if you are declining their services and tell them you can't afford it. It's particularly helpful when you're depressed to be forced to take on more debt for something you don't want, isn't helpful, and you cannot afford.

I think AA makes a valid point in saying: "health care is not a democrat vs. republican issue." It really does seem like one of those motherhood non-partisan issues, at least in my country of Canada. Here in Canada, we have political parties that range from conservative to social democratic, and while some may tinker with aspects of our universal health care system, the Canada Health Act ensures that it is firmly woven into our social fabric.

I realize the US has a very different history. For one thing, you guys had a successful revolution and liberated yourself from the monarchy - a strong libertarian tradition is embedded in your constitution. But in no way should this be preventing you from implementing a single payer system - that assures the basic human right of health care for all.

I actually hold US citizenship as well as Canadian. I love my second country, I have roots in the US, I've even considered living there. But the idea of living in a country that forces me to view and address my health care like I do my private home insurance or car insurance, no thanks. Especially as I get closer to my golden years.

Anyway, I've said more than my share.

OK, We can all see how well the government runs things in the health care realm over at the FDA.

If you love how the FDA runs, then you will cheer up and down for nationalized medicine.

I don't have health insurance; but if the government is running it, I know it's not worth the price.

I must not have a whole lot of faith in Washington D.C. really caring a hoot about my health needs.

Anywise, isn't government going to be to busy running GM, AIG, Wall Street, and half the banks?

Just my opinion! and yes opinions are like a-holes, since each of us has one

"Health care system" in this country is an oxymoron. We must begin to call it what it is: a "medical-insurance syndicate." Too harsh? Try listening to the millions of horror stories about death and financial ruin. We have to directly confront the AMA and Congress with the truth, and force them to stop using euphemisms. It's a profit making syndicate built on the suffering of people without (and with) medical insurance.

I remind you that American auto manufacturers were able to delay including seat-belts with a simple tactic: "whoever owns the name, owns the game." They used "accidents" in their lobbying; implying inevitability. It worked for them for years.

This is a critical public debate, one which citizens must win. Let's change the name and take back the game, now.

AA: Philip asked some basic, straightforward questions. If Canada is so great, then simply give the elegant answers. I looked at this editorial that is supposed to simply answer these questions. Right off the bat, I see things that are simply not accurate. I am aware of some of the issues since I have done unique, original, health care research at a province-wide level, using real data - fortunately for me, accessible because of the universal access ins arrangement. But while that is great for researchers who want to avoid the biases inhernet with the various coverage statuses in the U.S., I just don't see the panacea:

"The provincial single-payer system in Canada operates with just a 1 percent overhead."

One percent? Are you kidding me? Dig deeper, Oh Canada, and tell us what they consider overhead. Is there any major service delivery endeavor running anywhere in the world with 1% overhead?

"In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be."

This is quite a misleading over-simplification. What happens in Canada is a two-stage disposition/determination of health care dollars: first, the the slice of the nation-wide budget pie for healthcare is decided, then with that pre-determined amount of pie, all of the various health care factions are set at odds with each other to battle over their slice of the slice of the health care slice. So, yes, doctors DO administratively determine how much money will go where - after the whole sum is determined.

If I decide my family is going to Disneyland, not Disneyworld, but I let the kids pick the rides, it is not true to say that the kids totally get to pick the rides - they have no chance to pick DisneyWorld.

Then, with the money already divvied up, each area of practice is free to deliver services - as long as there is the pre-determined allotment of money to cover it; when the budgeted money runs out for, lets say, a heart bypass, or for substance abuse treatment, the money is gone.

Maybe that form of "rationing" will be better overall than the default form of "rationing" we have here, where it is either feast or famine: you get too much care or substandard-to-none. Nonetheless, we deserve to ask decent questions, as Philip has, and to use our common sense: if Obama provides more doctor-hours of care, where will they come from? Either the current set of docs will deliver more per doc, or we will need to add docs. If you add docs, it costs more; where will you take that money from? If the answer is "administration," then simply run the numbers and give us an answer, Ocanadabama.

Here's a radical idea that might free up some public moneys to fund a single party healthcare plan -- reduce military spending by abandoning our imperialistic claims on any country with resources the U.S. wants to control. The reason Canada and other less-aggressive countries can afford universal governmnet-run healthcare is that they don't feed mountains of taxpayer money to a massive war-making machine.

Oh...and for any conservative who fears that his or her taxes will be spent funding a "socialized medicine" program -- you can rest easy. The AMA, big pharma and private insurers are making certain that a government-run healthcare plan is off of the agenda before the real debate even starts. Obama and his Democratic colleagues in Congress are so compromised by ties to industry that we will see very little "reform" in whatever legislation makes its way to the President's desk.

I too voted for Obama and am disgusted with the turn things are taking. Mandatory health insurance is not the same as universal health care. It's sort of like mandatory auto insurance which we've had for years in most states. Since it's mandatory you can't threaten to leave your insurer if they don't pay out benefits because you're captive, though once people with psych labels see how high their mandatory health insurance premiums will be, I think getting those labels expunged from records will become a booming industry and one I'd love to work in.

Still, single payer is how we should go. Corporations like Kaiser and such spend much more money on risk management, that is determining who not to insure, than they do on paying health benefits to the people who pay them premiums. If we had a single payer system the entire gigantic waste of money that is risk management and cost containment could conceivably be put into providing health care. The cold managed care model doesn't even save money, it increases costs.

But then I believe the AMA, insurance companies, and big pharma give equally to the dems and the repubs and you can really see the dangerous mediocrity on both sides of the aisle in this one.

Dear not a chance,
I have Medicare, a single payer US government run health system. It's the best insurance I have ever had in my life. I finally have some peace of mind.

I've lived in a third-world country that had better health care than the US. Why? Because I had access to care. For the colds, sniffles, flu, broken leg, etc. that consitutes most health care needs. Without that kind of access the more exotic needs are kind of irrelevant.

By the way, my good friend who lived in Ireland died of asbestos-related cancer. I was able to track his treatment on the US NIH site. He got state of the art care--and home visits from the doctor--and didn't have to go bankrupt to do it. His widow was not left destitute. As you may have noticed, Ireland is not as rich and powerful as the US. They just have the will we lack.
Sherry

I can't point to specifics, but the USA may well have a cheaper health system if it followed any of the other OECD countries - all cost around 50% to 70% to run better more equitable health systems than the USA's current fragmented patchwork quilt of cover.

-- American medical colleagues and others I've spoken to put the cost of the current USA system down to 1) the inefficiencies of managed care that for some colleagues take nearly 50% of their time just attending to the beauraucratic stuff; and 2)the millions of uninsured and underinsured delay seeking treatment until illnesses are further progressed - the opposite of good preventative medicine, whereas in most developed countries it is very affordable to seek help early. And 3) from Michael Moore's movie Sicko and other sources - it is clear a lot of money goes to the managed care insurer middlemen and 4) the shareholders of so many for profit managed care firms. 5) medications are overprescribed - as FS highlights very well!

-- So Obama and indeed all Americans should look to other nations on this one, scrap the current system and start again. Australia did something similar in the 1970s - it was controversial at the time - but no govt left or right would ever dare go back from universal health cover we have today - there'd be rioting in the streets.

-- That's not to say everything is perfect, but it is darn cheaper and more universal health care than the USA.

-- The USA does many things better - scientific innovation in particular. Moore's movie suggests your health care problems really began with Nixon in a political ideological move not based on what the evidence suggested was best.

medsvstherapy: "Then, with the money already divvied up, each area of practice is free to deliver services - as long as there is the pre-determined allotment of money to cover it; when the budgeted money runs out for, lets say, a heart bypass, or for substance abuse treatment, the money is gone."

I don't understand your statement. There is no "pre-determined allotment of money" in Canadian health care. Services are covered until the patient recovers or dies.

Francesca,

Seems like Medsvtherapy is in need of the same paradigm shift that so many here in the US are in need of. mvt, here when we run out of money for the wars in Afghanistan and Iraq, we just print more money. If we really wanted the nation to be safe, we'd stop printing more money for war and decide to apply the no cost is too great mentality to provide our citizens with health care.

Had the nation applied all of the money we spent on the financial bailout to health care we would have already solved all of our medical problems many times over with this troubling and huge exception, mental health. What saves the lives of so many in the country labeled mentally ill is the inability to afford "forced mental health care." Under a single payer system refusing would never be an option.

How do nations like Canada and Great Britan and France handle the right to refuse care and privacy, my two biggest concerns about a single payer system?

Sally, that's interesting (and reassuring) that in the US forced mental health care can be overridden by an inability to pay. I guess I had assumed that some sort of payment system kicked in. What about E. Fuller Torrey's street people, then? How on Earth are they supposed to pay for meds?

Can't speak for Great Britain and France but in Canada every province has some version of a Mental Health Act with varying degrees of broadness. In British Columbia, the standard for forced care is as low as "capable of mental or physical deterioration" (or words to that effect). Of course, such a broad brush can be applied to anybody and that's just the way psychiatrists want it. The BC Schizophrenia Society (family group with a NAMI-like agenda) wants the bar lower still. Now what I haven't investigated is whether opting out of a provincial health services plan makes a difference but I doubt that it does.

Not sure what your concerns are about privacy. All our medical billing is through a provincial plan, thus your psych label is available to any other doctor or authorized health professional. Employers, etc. would not be authorized to access your records. I'm not sure how that differs from other countries.

Francesca,

One of Torrey's big things is that all homelessness is caused by untreated mental illness. He uses this idea to push AOT, in other words, don't give the homeless homes or jobs or food, just force drug them and I would imagine that some homeless shelters, particularly those run by the Salvation Army which won't let you stay unless you provide your social security number, turn people off meds away. Though here in the US these days there are so many more homeless than shelter beds that the number of homeless who find temporary respite in a shelter is statistically insignificant.

Scary, still many homeless, non homeless and/or working poor stop taking expensive psych meds because they don't have the money to pay for them and in the med gap realize how much better they feel without the drugs, or the psychotherapy for that matter. As for the privacy thing, electronic records are scary for many reasons, psych labels at the top and may be inevitable but I hope not, at least here in the US.

Yeah, Sally I'm with you on the privacy thing. I hope to god we don't get one giant medical record that follows us for the rest of our lives. The way it is now, I was able to start over fresh with a new physician. I like being the one who gets to decide what information the doctor has access to, and that's as it should be - it's my body.

I moved to another city, I chose the physician I wanted, and she doesn't know that I was under psychiatric care 6 years ago because I don't want her to know. I feel free. The only way my psych history follows me is if I were to lose my job and have to apply for private insurance, then it would be an issue.

I'm really glad that at least when it comes to psychiatric treatment we do not have universal health care. I think it's easier to be released from psych hospitals if you've got insurance because you have the case manager of the insurance company poking around to be sure you don't stay a moment longer than necessary - and thank god for that. I may be wrong about the number of days, but I think insurance companies usually approve 3 days, and then they make the physician justify an extension. Doctors can and sometimes do lie to get it extended, but at least it is a pain in their backsides which is good for those who want to be released.

Doctors usually will release psych patients when their benefits run out - that's when the patient is considered to be all better. Such a crock.

How about the long lines and waiting lists Canadians have? Some come to the USA for their serious medical care. In fact, people from all around the world people still come to the USA for medical school because our medical schools are the best in the world. Why? Because of our capitalistic system. Doctors who are better trained and have better skills make more money. In socialistic medicine, it's not that way. When the last bastion of capitalism - our great country - falls to socialism, as it seems to be doing, where will the doctors be trained? If the US is so bad, then why do so many people still want to move here from around the world. And most Americans want to remain US citizens no matter where they live in the world?