As far as I can tell all other developed economies spend far less on health and do have universal cover (with optional top up private cover for those who can pay for it eg for elective surgery in most countries). They spend far less because universal cover probably means 1. everyone has more ready access to health care early - and less waiting til illnesses worsen and costs are greater, 2. yes - private insurers were shafted in some countries when universal govt health cover came in - but they cost so much in beauraucracy, health care workers having to waste time checking on what or if a patient is covered and paying salaries of employed lobbyists and marketeers etc there are huge savings being rid of most of them. 3. regulation of medications can cut costs. The USA according to figures of 5 years ago spent over 15% of GDP on health, all other 19 OECD nations spent between 7% (Ireland) and 15% (Switzerland). Australia with an excellent two tier system of public and private spent just over 9%. In a more efficient equitable preventative medicine friendly, less beauraucratic system if the USA still wanted to spend 15% it would truly have the world's best health care - or it could cut a third of the budget and still be better off and spend those savings wisely or pay off debt. I'm not an economist but I am relating a lot of what I've learnt from conversations and readings over the years - not just my own ideas. Just look abroad and find the countries with the best health care and copy them.

It's not that I didn't like Obama to begin with, but I've never liked his health care plan. It's really just Mitt Romney's health care plan. There is only one group that will benefit if health insurance is mandatory and that is insurance companies, and there was an article in the New York Times earlier this week about Obama now pushing for caps on medical malpractice lawsuits. Thus with mandatory medical insurance you won't be able to choose your doctor, you'll have to do what he tells you under force of law, and if he screws up, you can't sue him.

Here's the scary scenario, your doc says quit smoking or lose 10 pounds or have a hysterectomy or take zyprexa and you don't, what do you think will happen, oh yeah, your health insurance rates will rise, i.e. you'll be fined.

As for medical records, it's good to see more people are finally realizing the electronic thing will be bad. It won't just save doctors the time of examining before treating, a terrifying thought in itself, but since doctors under a mandatory scheme will be employees of insurance companies themselves, the insurance companies will force the doctors to treat without examining by not allowing them the time or money to examine. And there's no way to opt out other than having a hacker destroy your records and leaving the country.

Meanwhile, the problem with medical malpractice isn't the people who sue, it's that doctors are legally mandated to have malpractice insurance. If we took away that mandate, then if a doctor really committed malpractice, a patient could only get assets the doctor really had, not insurance coverage and doctors wouldn't be driven out of business by high malpractice insurance rates because in the real world hardly anyone ever wins a big malpractice lawsuit and doctors never go broke because of them. Doctors go broke because of greedy insurance companies who raise premiums out of greed on doctors who can do nothing about it because malpractice insurance is mandatory. Remember AIG anyone?

So I think the AMA and AHA are right to oppose mandatory insurance but they're wrong to oppose a single payer system. 1 trillion is the number we're given. Hey didn't we just spend that on the bail out?

Still, the implications of a single payer system are scary for psych patients but considering that electronic records are going to happen no matter what, psych patients are going to be discriminated against no matter what as long as psychiatry is considered a valid branch of "medicine." So as I understand it, we'll all have more control over our health care under a single payer system, it will be cheaper to administer, doctors will be able to practice medicine rather than take orders from health care management companies, med mal carriers and such. Still the AMA and AHA oppose single payer too.

I have to admire Obama for at least trying to fix this as the status quo just won't hold forever. I think us citizens need to keep this debate in the public.

Good luck opting out of any computerized record keeping. You won't be able to because it's simply not an option. It actually happens without your even knowing about it. Our local hospital now owns ALL of the medical practices, labs, imaging centers, etc. for about 30 miles around. All of my medical records are now on computer for anyone to hack or anyone in that system to look at. I have no control or say over any of this, was never asked if I wanted it. There IS no opt-out feature. The only control I have is to keep my mouth shut and let my doctor know as little as humanely possible about my health and life. Sometimes I will ask for him/her to not put something in the record but that's not really an option.

I despise computerized records. I want to throw up every time I see one of those stupid-ass HIPPA pages, knowing I have less privacy now that I ever have and knowing that I'm forced to sign off on it if I want to see any doctor. There's nothing voluntary about this stuff. Welcome to Big Brother Land. Don't even get me started on forced health insurance purchase, that's nothing but a subsidy for private insurers.

I'm pretty disgusted with what's coming out of Washington these days.

This may be a little beside the point but personally I want to see better electronic records because I seriously want society at large to start evaluating outcomes a whole heck of a lot more carefully than we are now. It's the only way to drive down health costs. It's the only way we will really begin to see how useless a lot of treatment is. Outcomes currently are highly obscured by privacy issues. Now I also believe in preserving people's privacy and wish there was some way to measure outcomes anonymously but if there isn't, I think we have to figure out some fair way to measure outcomes. If people have to give up the anonymity then they need to know that they are getting something really important in return -- the chance for a cost effective and valid outcome to their health concerns. I think this is fundamentally the most pressing issue in our health care system, believe it or not, and that nothing can get straightened out if this isn't figured out.

What surprises you most, Philip? That Obama is, in fact, a mediocre speaker (at best) whose unscripted remarks are filled with monotonous platitudes and a prodigious number of "um's" and "uh's"; or, that Obama would ultimately serve his corporate benefactors when it came time to propose healthcare "reform" legislation? I have NEVER understood, from campaign day 1, why Obama was presented as a spellbinding orator. I was never moved by his rather stiff presentation. Give me Maxine Waters, Ted Kennedy or Dennis Kucinich any day; all are more inspiring speakers. Hell...he looked like a nervous high school kid next to Hillary Clinton in most of the debates (disclosure: my heart belongs to Hillary, even though I know that she, too, is corporately bought and paid for).
My pre-election research on Obama revealed that he took more money from pharma and the healthcare industry than any of his Democratic oponents. And, frankly, the healthcare plan he promoted as a candidate was never as progressive as Hillary's.
So I am not disappointed in Obama because he is doing exactly was he was paid to do -- maintain the status quo (with obscene amounts of taxpayer money if necessary). I was willing to cut him some slack if he agreed to prosecute Bush Administration war criminals; sadly, but not so surprisingly, he has made clear that he will not challenge the military state and its servants.
And we will continue the budget-devouring occupation of Iraq and Afghanistan in to the next decade, it appears. In the meantime, you, Philip, and millions of others will suffer while military contractors, banks, investment brokers and other ravenous parasites feed on the federal treasury.

I wish for you the best, Philip, and know that there is no acceptable justification your vulnerability. Let's hope that Medicare still exists when we are old enough to retire (according to my calculations, I will be approximately 93 years old).

Philip, I get a sense (and it may be a wrong sense, so forgive me) that you have a bit of a self-fulfilling prophesy about Obama from the outset - perhaps because you are deeply suspicious of government intervention, generally?

The man isn't even 6 months into his term, and already you are throwing your hands up, predicting doom and gloom.

Obama walked into an economic disaster - thanks to Bush and right-wing libertarians thieves on Wall Street who believed they could do anything they please under the guise of Adam Smith's invisible hand. The economy collapsed under Obama's feet just as he's stepping into the White House. The fact he is even talking about health care this early in his presidency - quite remarkable.

I think it's natural to fear the unknown. Americans don't know what single-payer or universal health care is, so naturally there's a lot of fear, especially given the recessionary times. But it's times like this when government intervention is needed, when social programs are needed. The most vulnerable of the 40-million uninsured are dying as we speak, because they've lost their home, their job and their health.

I say keep asking the questions you ask. They are valid questions, but cut your president a little slack - let's see how his plan unfolds and stop crying "the sky is falling" while it's still only in the discussion phase.

Health care is a universal human right. It is not a luxury to be enjoyed by only those who choose to purchase costly insurance.

The last group I would expect you to support is the AMA - who in addition to enjoying the lavish pork trappings of a private health care system, are also part of the problems plaguing our big pharma psychiatric system.

My $00.02

Regarding electronic medical records, let's not forget that all these systems must communicate and exchange health information. Only "certified" systems will be eligible for stimulus incentives. In other words, all the major players will control the EMR market just like your current pick of 4 or 5 insurance carriers. Doctors will be locked in to long term support contracts and complex systems.

Sara,
Research is done all the time whilst protecting privacy. You strip off the names and replace them with numbers, very simple.

My medical records are replete with errors and outright lies so I don't really see medical records as being terribly great places to mine for facts. Most people who've had malpractice perpetrated upon them have records full of ass-covering lies.

While we're on the subject (I think), I do NOT favour any sort of tort reform. As long as docs refuse to clean up their profession's act I have no sympathy for them. Most malpractice is committed by a small percentage of doctors. And in any hospital in which I worked everyone knew who they were. But no one will step forward to stand up for the patient so no, tort reform is a non-starter for me. It's the only protection the patient has because the medical profession and hospitals have abdicated their responsibilities in the matter.

sorry - was a typo in my post before - Switzerland the next highest spending after the USA only spent 11% of GDP not 15% - only the USA was way out ahead of the pack in health care costs at over 15%. So much money and the only country to have uninsured people. Has to change.

I still say that unless we really evaluate what treatments lead to what outcomes in real clinical practice we are not going to get anywhere and so far doing this extremely basic analysis regarding health care seems to have eluded the system. It's a joke. Each and every victim on this blog might have avoided their fate if what had happened to other patients before them had been described and tracked in a rational, reasonable fashion. And this goes for autopsies too. We should have complete disclosure regarding the tox reports on people who died violently, in particular, and this should be accessible to anyone doing research and the tox analyses should be done thoroughly and transparently. Instead it all gets buried and lost to history forever if it's even done at all. Sure change it to numbers but people often feel this doesn't really protect privacy since it can be easy to figure identities out in many cases from the history details.

Sara,

I don't think you're right though your point is one to be discussed. Complete disclosure is problematic because it conflicts with the right to privacy. Meanwhile, here on this blog we talk about the tragedies in the realm of "mental illness." These tragedies are a perfect example of why disclosure wouldn't work. A person diagnosed with mental illness who dies of any other cause has their death attributed to "mental illness" because that's what the psych industry wants to see. Death from a heart attack with a history of "depression" well chalk up another death to depression, never mind the social problems such as lack of access to a healthy diet, lack of exercise and mental stimulation that caused the death.

And then there's this, a different point. Really though there are certainly problems, in the last 100 or so years the life span of humans has doubled and our quality of life has improved in ways previously unimagined. What we need is a way to determine how to handle our longer lives and the problems that come along with them like obesity and vocational obsolescence, still you raise thoughtful points...

Sara,
I do agree with you about the need for that sort of research. It seems to be an endless Gordian knot of economic interests served by secrecy on the part of providers/vendors. I don't know what the answer is...
Sherry

And I'd also like to add one more point. I think medical professionals and drug companies might start acting a lot more cautiously and intelligently if they really knew outcomes were being closely monitored. I suggest that people start thinking of their medical histories as something that really could serve the community as a whole and not just be something to be hidden and kept secret. I know this is very thorny. There are lots of things to be worked out but truly it is something that is incredibly important.

Sherry,

I agree - no tort reform. It's our only check on medicine. No organization that I'm aware of effectively polices its own. I'm also very concerned with centralization of power of any kind. It's a recipe for tyranny. I want government to be weak and ineffective. I want it out of my life and circumscribed to very limited functions.

I wish I could believe that a greater good will be achieved through electronic records. If the records are held and controlled by their owner (you, me) then it's possible. Otherwise, the risk of fraud, control, misuse is all too apparent for me. I'll just stop using medical services if electronic records becomes mandatory. I think progress ought to be be slow and considered.

Electronic medical records are already a problem. I don't think people realize how much is available to other people. For example, if a person sees a psychiatrist at a hospital/university that utilizes an EMR then there's a really good chance that what they said to the psychiatrist is accessible by the dermatologist when they go in to have a mole removed, or the gynecologist, the nutritionist, the chaplain, and whoever else they see at that hospital or university. I honestly don't think people would say half of what they do if they realized how many people can read it.

While I understand the need for research, when it comes to my personal health, I want to be the one to choose which research I participate in and what researchers have access to. I did not then, nor do I now want to be a part of any research pertaining to my mental health. Other people who want to do that can consent to that.

I absolutely do not want any of those records ending up in a database accessible by other physicians. What happened at the psych hospital needs to stay there. Now, when I see a physician she doesn't look at me as "mentally ill." She doesn't know I was ever classified that way. I would never be able to leave this crap behind if it was captured in an EMR that followed me for life. No thanks.

Paul,
That's basically the effect computerized records have had on me. I avoid going to the doctor like the plague and avoid telling my doctor anything if I can possibly help it. I have hypothyroidism and have to submit to blood testing and interrogation once or twice a year in order to get the pills I need to stay healthy and reasonably happy. This annoys me no end.

My doctor is not my confidant, he is a conduit to my insurance company and to the local wart of a hospital which owns his practice and every other one for miles around. I have no privacy whatsoever since my records were digitized without my knowledge or consent.