I don't know how much you guys track the news, so let me fill you in. And I apologize if this post has an alarmist tone to it, because I am alarmed.

Right now, the American auto industry is having a lot of difficulty in trying to turn things around. Detroit has just had its famous auto show, and there are rumors that things are going to get worse.

The world's largest auto manufacture, General Motors, is in quite a bit of difficulty. In 1962, this auto industry giant made up 51% the US vehicle market. Now the Detroit company is in the process of cutting over 25,000 jobs by 2008 and will shut down 12 facilities.

Today, GM's US market share has declined to 22%. I did an MSN search and they've lost well over $ 3 billion dollars in the first three quaters of 2005.

Ford is also in dire straights too. The nation's 2nd largest auto company has recently announced that it will cut upwards of 30,000 jobs. I think they are also going to shut down 14 facilities, but unlike GM, there are also facilities in Mexico and Canada that will also be shut down by 2012. As of right now, their market share of vehicles is about 18.9%.

Ford is working pretty hard to take care of the workers that have been laid off. I know that they're offering to pay for college for many of their former workers. I got to give them credit for that.

For companies like GM and Ford, SUVs are a prime cash cow. In general, an SUV generated $6,300 in profits for the Big Three automakers in 2004, compared with $3,800 for a full-size car.

So what's hurting Ford and GM? There are numerous reasons. But basically I think it comes down to these three:

1) Stiff competition from Toyota, Honda, and Nissan.
2) Rising gas prices are hurting the sales of trucks and SUVs
3) The UAWs have grown very powerful
4) Very high health care cost

And it's this number 4 that I want to talk about. It has been estimated that each vehicle GM sells, that vehicle suffers from the cost of health care. Health care cost adds $1,500 to the cost alone!

Whenever you see a GM vehicle driving by at 50 mph, you are not only looking at an automobile, but also $1,500 in health care cost traveling by at 50 mph.

In 2004, GM's health care cost came to over $5.2 billion expenses for its 125,000 active employees and 339,000 retirees. Ford Motor Co. and Chrysler Group spent $2.0 billion and $1.3 billion, respectively. (The latter two numbers I can't really confirm for sure)

Just to shed further light on Detroit’s financial crisis I ran across this information:



GM’s average revenue per vehicle averaged at $20,659. For Toyota it was $26,514 per vehicle. Not only is this higher, but Japanese profits per vehicle were significantly higher than GM, with a per car profit of $1,433 at Toyota , $1,250 at Honda , and $1,603 for Nissan. Ford Motors had the highest figure among the Big Three, at $620, while GM lost -$2,311 per vehicle in 2004.



Ford was making well less than 1/2 profit for each of her vehicles sold compared to foreign brands. As for GM, I think -$2,311 is a tell tale sign of a very sick company.

In an effort to control the spiraling health care cost, Ford and GM have been in a lot of heated negotiations with the United Auto Worker Unions. Both companies have reached agreements to shave the cost, but the plans still need to approve by the union members.

On SDN, I've seen several threads about a universal health care system. However they aren't too receptive. I've noticed that we premeds / doctors are all concentrated on the quality of care issues and the potential back up of patients who will be waiting to see a specialist. We have discussed that the US can’t pull it off because we have a much higher population than many other nations, more drug related problems, more AIDS, and a larger population of poor families.

But I’m worried that by not having a national health care system, we will all be digging our own graves economically. Our industries are struggling to compete. I have used the automotive industry to show that.

American industries are getting themselves in trouble because of cost – and one of the costliest is healthcare.

Guys, I tried to find out what health care cost was for Japanese companies and I found little that could shed light on what the Japanese industries were paying for health care. Rather I found some really important information as to why Toyota was building a plant in Canada. A Google search generated this:




In addition to lower training costs, Canadian workers are also $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada, said federal Industry Minister David Emmerson.

"Most people don't think of our health-care system as being a competitive advantage," he said.



The first thing that went through my mind was like, why the hell is Ford closing her factories in Canada! Henry Ford is rolling in his grave right now!

Then I read this and it has solidified my thoughts on the need for a national health care plan:



In fact, according to a recent AutoWeek article, Toyota’s health care costs are so negligible they aren’t even a line item in the company’s financial statements.



Japan, like Canada has a national health care system. The benefits are giving thier industries a signifigant advantage over us in the US.

My fellow SDNers, in America we have over 45 million people who do not have health insurance. If we as physician drag our feet in place of advocating for a national health care system, we contribute to even more Americans loosing their jobs to more competitive foreign countries. Consider the ramifications every time Ford or GM fires another 30,000 workers; consider all the ripple effect that has on the US economy. Our automotive industry has been cutting workers for the past 20 years at an alarming rate. Imagine all the smaller companies that work with them. Less high paying jobs in America will mean everyone gets hurt one way or another. Ask yourself, would you as a physician want to operate at a -$2,311 loss to yourself for each patient you cared for? The evolutionary model affects bussiness, and I feel that we are on the path to the extinction of even more blue collar American jobs.

For those of us who are afraid that a national health care system will cut our physician salaries - perhaps a national health care system will preserve a higher physician salary. Without a national health care system, America will loose jobs and less jobs could very well mean an ever decreasing physician salary.

What are our opinons on this? Are we digging our own graves economically?




Good night and good luck

C & C

In your example, healthcare costs are simply shifted from the employer to all American taxpayers. A national healthcare plan would require significant tax increases. Canada, for example, has a much higer tax rate overall than the U.S., and they're still having problems keeping their system going. Higher taxes mean less disposable income to buy things like expensive SUVs in the first place. The cure could end up being worse than the disease.

Change is coming, no doubt. The question is whether or not a national healthcare system is the answer, and I have mixed feelings about that. It may be that a tiered system, with national healthcare available to those who need/want it (along the lines of Medicare/Medicaid) in addition to private insurance for those who can afford it, is more the American Way. I can't see Americans in general being satisfied with only one (probably lousy compared to what we're used to) healthcare plan for everyone. Plus, unlike the Canadians, we'd have no South-of-the-border safety net.

You raised a good point, though, and stated it well. :)

I have been wondering for about a year why there hasn't been significant advocacy for national health insurace coming from corporations, particularly those involved in manufacturing.

The truth is that the US automotive industry has been victims of themselves just as much as the Japanese or the UAW. Still, their health care obligations certainly hamstring their competitive edge.

My main concern is that if the burden of providing health care was lifted from Ford and GM, they would go from selling cheap crap to selling cheaper crap, and nothing would really change. Both of those companies need an executive flush, starting right at the top.

Of note: (http://www.cbc.ca/cp/business/050630/b0630102.html)

Toyota to build 100,000 vehicles per year in Woodstock, Ontario, starting 2008

"In addition to lower training costs, Canadian workers are also $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada, said federal Industry Minister David Emmerson."

But the part I found truly sad/funny:

"Several U.S. states were reportedly prepared to offer more than double that amount of subsidy. But Fedchun said much of that extra money would have been eaten away by higher training costs than are necessary for the Woodstock project.

He said Nissan and Honda have encountered difficulties getting new plants up to full production in recent years in Mississippi and Alabama due to an untrained - and often illiterate - workforce. In Alabama, trainers had to use 'pictorials' to teach some illiterate workers how to use high-tech plant equipment."

In your example, healthcare costs are simply shifted from the employer to all American taxpayers. A national healthcare plan would require significant tax increases. Canada, for example, has a much higer tax rate overall than the U.S., and they're still having problems keeping their system going. Higher taxes mean less disposable income to buy things like expensive SUVs in the first place. The cure could end up being worse than the disease.

Change is coming, no doubt. The question is whether or not a national healthcare system is the answer, and I have mixed feelings about that. It may be that a tiered system, with national healthcare available to those who need/want it (along the lines of Medicare/Medicaid) in addition to private insurance for those who can afford it, is more the American Way. I can't see Americans in general being satisfied with only one (probably lousy compared to what we're used to) healthcare plan for everyone. Plus, unlike the Canadians, we'd have no South-of-the-border safety net.

You raised a good point, though, and stated it well. :)

I also have mixed feelings (shhh, don't tell the advocacy groups I belong to; they're almost militanty pro-single-payer :p). What I definitely believe and support is that there should be national coverage of some sort. I lean towards single-payer.

Anyway, as far as tax rate increases, there are some great suggestions here: http://www.pnhp.org/facts/singlepayer_faq.php

An excerpt:

A universal public system would be financed this way: The public financing already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and any and all other out of pocket payments. For the vast majority of people a 2% income tax is less than what they now pay for insurance premiums and in out-of-pocket payments such as co-pays and deductibles, particularly for anyone who has had a serious illness or has a family member with a serious illness. It is also a fair and sustainable contribution. Currently, over 41 million people have no insurance and thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but they would receive health insurance for the same low rate as larger firms. Many small employers have to pay 25% or more of payroll now for health insurance – so they end up not having insurance at all. For large employers, a payroll tax in the 7% range would mean they would pay less than they currently do (about 8.5%). No employer, moreover, would hold a competitive advantage over another because his cost of business did not include health care. And health insurance would disappear from the bargaining table between employers and employees.

My mother is in a private practice law firm with one other attorney. She strongly supports the single-payer system, because she is unable to provide her employees with health coverage of any sort. It would cost about 30% of her payroll to do so, which would bankrupt them.

Some food for thought :)

Oh yeah, and as far as Canada -- we wouldn't have to make the same mistakes. For one thing, our healthcare infrastructure already far surpasses theirs. We have more money available (already in the system, but being used inefficiently) than Canada to maintain that infrastructure. And of course this would remain in the hands of the private sector (for-profit healthcare being a different issue to get into another time :p). Plus, we should learn from other countries' mistakes. Certainly no system will be perfect, but I know we can do much better than we are now, and I strongly suspect that we could do better than any current system if we just start out knowing where they've gone wrong.

In your example, healthcare costs are simply shifted from the employer to all American taxpayers. A national healthcare plan would require significant tax increases.

Very important to keep in mind, as this was overlooked by the OP.

To get an idea of how the US automakers are feeling:

"Robert "Steve" Miller, Delphi's chief executive...bluntly says that the social contract written after 1945 is being -- must be -- repealed because, given globalization, unskilled manual labor cannot be paid $65 an hour, with the cost passed on to consumers. 'When you buy a Hyundai you get a satellite radio as your option, but if you buy a Chevrolet you get social welfare as an option. Long term, the customer is going to desert you if you try to price for your social-welfare costs."

The answer of course is not to subsidize the auto industry, but simply let these corporations fail due to the presence of heavily entrenched labor unions. Eventually, Americans will realize that production is always first, not the needs of the "little guy". I don't care how fair your redistribution policies are, if you choke off the means to run a profitable business, there's no money for anyone.

Unfortunately, the direction the country is heading is the wrong one: government and labor influence are dismembering the corporate freedom that America needs to remain competitive in the world market. See: http://www.washingtonpost.com/wp-dyn/content/article/2006/01/12/AR2006011201251.html

Any major overhaul to the way health care is paid for needs to include some means to incent Americans towards healthier lifestyles, something that is absent from the present system. Any efforts to make healthcare more affordable must also focus on wellness and prevention, not just treatment. It's time to bring personal responsibility into the equation.

Very important to keep in mind, as this was overlooked by the OP.

To get an idea of how the US automakers are feeling:

"Robert "Steve" Miller, Delphi's chief executive...bluntly says that the social contract written after 1945 is being -- must be -- repealed because, given globalization, unskilled manual labor cannot be paid $65 an hour, with the cost passed on to consumers. 'When you buy a Hyundai you get a satellite radio as your option, but if you buy a Chevrolet you get social welfare as an option. Long term, the customer is going to desert you if you try to price for your social-welfare costs."

The answer of course is not to subsidize the auto industry, but simply let these corporations fail due to the presence of heavily entrenched labor unions. Eventually, Americans will realize that production is always first, not the needs of the "little guy". I don't care how fair your redistribution policies are, if you choke off the means to run a profitable business, there's no money for anyone.

Unfortunately, the direction the country is heading is the wrong one: government and labor influence are dismembering the corporate freedom that America needs to remain competitive in the world market. See: http://www.washingtonpost.com/wp-dyn/content/article/2006/01/12/AR2006011201251.html


While it's certainly fashionable to blame the unions for US automaker's failures, that's not the whole story. If you look at the wages/benefits of people who work at non-union car factories in this country, they are very comparable to wages/benefits at the union factories. The problem is that companies like GM are much older and are being brought down by their huge number of retirees who are living longer than they were supposed to (basically, their health care plans have been too successful). Combine this with the stretch when US automakers were complacent and manufactured a bunch of crap, it was a recipe for disaster. Even though US cars have made significant strides in quality, it's a hard stigma to overcome. Hell, Buick is now producing cars that are rated very highly, but not too many people are rushing out to buy their hip new Buick :laugh:

Thought you guys might like some numbers behind the insurance madness. Here are the Net Income figures of a few companies in 2004 (rest assure, they rose this year):

United Healthcare: $2.59 Billion
Aetna: $2.25 Billion
Cigna: $1.44 Billion
Well Point: $960 Million

This is net of all expenses/funding requirements. The government is concerned about an increase in coverage liabilities of $10 Billion by 2009/2010. Personally, I find this figure less intimidating, knowing that the war costs roughly $6 Billion per month.

Thought you guys might like some numbers behind the insurance madness. Here are the Net Income figures of a few companies in 2004 (rest assure, they rose this year):

United Healthcare: $2.59 Billion
Aetna: $2.25 Billion
Cigna: $1.44 Billion
Well Point: $960 Million

This is net of all expenses/funding requirements. The government is concerned about an increase in coverage liabilities of $10 Billion by 2009/2010. Personally, I find this figure less intimidating, knowing that the war costs roughly $6 Billion per month.
So it's wrong for companies to turn a profit? A large profit?
Please thats so anti-capitalism and anti-american.

A company owes that money to its investors, not to random people to lower costs to them.

So it's wrong for companies to turn a profit? A large profit?
Please thats so anti-capitalism and anti-american.

Please place a sock in your hyperbole.

It's fine for companies to turn profits, even huge ones. The problem is that such large profits (especially in the face of rapidly rising costs) do not suggest that the insurance marketplace possesses much in the way of competition. If it did, the companies would be forced to lower premiums and trim profits in order to attract business.

Since you seem to be comfortable letting these companies rest on their laurels, bleeding consumers with pseudo-monopolistic pricing strategies, I'd say the only anti-capitalistic poster on this thread so far is you.

Personally I hope there is never a national health system in the US. It will do nothing but ruin the excellent level of care we currently have in place (turning it into something along the lines of Canada's system) and mark the end of a medical career as an excellent profession. You will see a decline in the numbers of the best and brightest students seeking to become physicians, or they will be seeking outwhat few opportunities there would be to make a decent living in that profession- ever notice how many Canadians and other foreigners want to come to the US to practice here? There's a reason for that.

Please place a sock in your hyperbole.

It's fine for companies to turn profits, even huge ones. The problem is that such large profits (especially in the face of rapidly rising costs) do not suggest that the insurance marketplace possesses much in the way of competition. If it did, the companies would be forced to lower premiums and trim profits in order to attract business.

Since you seem to be comfortable letting these companies rest on their laurels, bleeding consumers with pseudo-monopolistic pricing strategies, I'd say the only anti-capitalistic poster on this thread so far is you.
They are not without competition- there are many, many insurance companies out there.

Please place a sock in your hyperbole.

It's fine for companies to turn profits, even huge ones. The problem is that such large profits (especially in the face of rapidly rising costs) do not suggest that the insurance marketplace possesses much in the way of competition. If it did, the companies would be forced to lower premiums and trim profits in order to attract business.

Since you seem to be comfortable letting these companies rest on their laurels, bleeding consumers with pseudo-monopolistic pricing strategies, I'd say the only anti-capitalistic poster on this thread so far is you.
I can see it now Havarti666 insurance company. Why not? Create the competition if it isn't there. Produce a better product yourself than just complain and ask the government to step in.

They are not without competition- there are many, many insurance companies out there.
OT- Praetorian, I like your latin saying. I have it on my facebook.

I was reading the link that Tigress provided us and it has an interesting argument on what a universal health care system would do to competition.



Won’t competition be impeded by a universal health care system?

Advocates of the free market approach to health care claim that competition will streamline the costs of health care and make it more efficient. What is overlooked is that competitive activities in health care under a “free market” system have been wasteful and expensive and can be blamed for raising costs. Not only have they NOT contained costs, they have raised costs. In fact it has been shown that in some states where competition among insurers and HMOs is fiercest, such as California, costs are higher than the national average.



This is an interesting claim to make. I am going to try to look into it.



Continue...

There are two main areas where competition exists in health care. Among the providers, and among the payers. When, for example, hospitals compete they often duplicate expensive equipment in order to corner more of the market. This drives up overall medical costs to pay for the equipment. They also waste money on advertising and marketing. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of the public.

Competition among medical care providers can be beneficial in terms of improving the quality of medical care. Take for example, three primary care doctors in a certain area “competing” for patients for which they will receive equal reimbursement from every patient. The doctor who is most competent in different areas will attract the most patients in that area. One doctor may make house calls to see the elderly. Another may be very good at mental health care. This is competition based on quality not on price. Competition among insurers (the payers) is not effective in containing costs either. Rather, it results in competitive practices resorted to by private payers such as avoiding the sick, cherry picking, denial of payment of expensive procedures, marketing, etc.



Cherry picking the patients with those nice insurance plans and denying poorer folks seems completely contrary to the Hippocratic Oath - however, to what I understand, the Hippocratic Oath has been greatly modified.

I do think that the last paragraph is worth looking at. By having just one price, nobody competes based on price. Instead they are in competition over quality.

Now I am an advocate of a national health care system, but my traditional worry is that doctors are going to say to themselves: "Well, there's no point in opening till 5pm, so Susan let's close at 3 pm from now on," but the argument in the third paragraph is trying to claims that if doctors want to make more money, then they are going to need to see more patients? Is that correct or no?

So it's wrong for companies to turn a profit? A large profit?
Please thats so anti-capitalism and anti-american.

A company owes that money to its investors, not to random people to lower costs to them.

I don't want to give you a hard time or anything, but perhaps capitalism can run out of control sometimes.

Look at hurricane Katrina. A lot of insurance companies are bending over backwards in an effort to deny claims filed by a lot of people.

Yes, a company does have an obligation to its share holders, but they also have an obligation to thier clients.

It is a shareholder vs client conflict of interest; and it seems that the latest trend is in favor of the shareholders.

While it's certainly fashionable to blame the unions for US automaker's failures, that's not the whole story. If you look at the wages/benefits of people who work at non-union car factories in this country, they are very comparable to wages/benefits at the union factories.

Which is why I'm not blaming unions... entirely. I'm blaming poor management and government policy along with the unions. After all, the unions are just grubbing for the biggest piece of the pie they can get, just like everyone else.

The reason this is bad for the US is that foreign automakers simply don't have the same costs associated with unskilled laborers in this country. Many foreign automakers (especially the Japanese) are non-union and simply pay less in wages and less in benefits. This is partly due to more of a social welfare net in Japan and other countries, but it reflects superior corporate management.

Industry leaders in this country need to buckle down and stop being sissies with the whining government and labor unions. They need to cut employees, cut benefits, cut wages, and run the damn business TO TURN A PROFIT. The alternative is to continue to satisfy false and unsustainable promises, and witness the exit of the American auto industry from the world economy.

notice how many Canadians and other foreigners want to come to the US to practice here? There's a reason for that.

Actually, the flow of physicians from Canada has been slowing for a decade, and in 2004 reversed. In that year, 317 doctors returned to Canada while 262 went abroad (predominantly to and from the US). I would be very curious to see the numbers from India.

I can see it now Havarti666 insurance company. Why not? Create the competition if it isn't there. Produce a better product yourself than just complain and ask the government to step in.

Already been done, with about 95 million enrollees nationwide. It's called nonprofit healthcare, (http://www.nonprofithealthcare.com/index.asp?orgid=14) and peer-reviewed analysis demonstrates that, as a whole, nonprofit entities (hospitals, insurance plans, etc.) provided better, cheaper care than their for-profit counterparts.

Actually, the flow of physicians from Canada has been slowing for a decade, and in 2004 reversed. In that year, 317 doctors returned to Canada while 262 went abroad (predominantly to and from the US). I would be very curious to see the numbers from India.My impression is that Canadians are generally quite proud of being Canadian and want to live there.

I don't want to give you a hard time or anything, but perhaps capitalism can run out of control sometimes.

Look at hurricane Katrina. A lot of insurance companies are bending over backwards in an effort to deny claims filed by a lot of people.

Yes, a company does have an obligation to its share holders, but they also have an obligation to thier clients.

It is a shareholder vs client conflict of interest; and it seems that the latest trend is in favor of the shareholders.
I think one of the reasons is there is no flood insurance through the company and there is dispute on whether the houses were damaged by hurricane or flood.

You are right however that they are obligated to their clients, but if the client is unhappy they can switch companies. (Not as easily with prepaid insurance as something like a doctor).

They are not without competition- there are many, many insurance companies out there.

Oh really? As that hippie rag The Wall Street Journal (http://www.opinionjournal.com/editorial/feature.html?id=110007011) puts it:

"Right now Americans who aren't lucky enough to get insurance from large employers or poor enough to qualify for Medicaid find themselves at the mercy of the legislators and insurance commissioners of the state in which they happen to live. This can be OK in states that exercise this regulatory function judiciously. But in others, the young and working poor find themselves effectively priced out of the market by special-interest regulations dressed up as consumer protections."

Your right, there are some markets where meaningful competition exists, but that's not the norm. As of 2002 only 4% of Fortune 500 companies utilized Alain Enthoven's managed competition (http://www.benefitnews.com/subscriber/Article.cfm?id=37880659) to administer healthcare to their employees. Of note, when Harvard adopted such a system (based on Stanford's) it experienced a 10% drop in premium costs.

Not sure whatever happened to that legislation, by the way.

My impression is that Canadians are generally quite proud of being Canadian and want to live there.

Uhhhhhh... ...okay...

I had a very interesting conversation with a friend recently. He advocates cutting out all insurance altogether, and having people pay directly for healthcare again. He knows it's impossible, but it's his ideal. I thought it was interesting, since he certainly had some good ideas.

Anyway, did anybody read the recent series in the New York Times about diabetes in America? The authors didn't try to hide their opinions on how insurance is handling the issue. What I was interested in was the direct admission by insurance companies that they deliberately fail to provide adequate coverage for people with diabetes because doing so would attract diabetics to their company, and diabetics are across the board money-losers for them. This makes perfect sense from an economic perspective, of course, and it's why I think healthcare can't be run on a completely capitalist system. Most, if not all, diabetics, no matter how much money they have, simply cannot find insurance coverage that provides them with things like more than one blood test strip a day, prophylactic podiatrist and ophthamologist visits, etc. Of course those who have enough money can afford to pay for it all themselves.

The articles also brought up the issue that in a for-profit, capitalist healthcare system there is very little room for preventive medicine. All of the diabetes centers that opened in New York to provide diabetics with comprehensive care, and which were proven to have very good success rates at keeping people healthier than they would have been otherwise, lost a great deal of money. Three of the four closed, and one is open only because of philanthropy. Insurance companies will provide significant compensation for amputation, glaucoma surgery, cardiac surgery, etc., all of which are consequences of poorly controlled diabetes, but they will not cover regular podiatrist visits, ophthamologist visits, nutritional counseling, blood testing supplies, or patient education (and patients are much more likely to control a disease that they have some understanding of). Of course the surgeries are more lucrative for doctors and hospitals, but in the end the system saves money by preventing them. Insurance companies might, as well, but they fear attracting diabetic patients who are more likely to become a financial burden to them.

There aren't any easy solutions to this type of problem. From the physician's perspective, it makes economic sense to do more surgeries. Many (certainly not all) of us would agree that we would prefer to keep patients healthy to begin with, even if it resulted in a lower income for us -- as long as we were adequately compensated. And it's that adequate compensation that is the problem, because with the current system it doesn't exist, because these things just aren't covered. From a national economic perspective, considering the health and productivity of our workforce, as well as money put into the healthcare system, it seems like it would also be beneficial to practice more preventive medicine. This is not only an economic issue, or an issue of coverage, of course; it seems to me like it's also tied in to the very philosophy of medicine in this country. And no, I don't have any answers, I'm just raising issues :)

Oh, I also want to mention that I don't know much about economics as a whole (though I've read a great deal on healthcare economics) but I recently mentioned something to my brother about America running on a capitalist system, and he pointed out that it's a VERY modified capitalist system, certainly not purely capitalist. I'll have to ask him to elaborate on that one for me -- he's smarter than I am :p

Personally I don't have any interest in fixing this problem of poor health coverage for the poor, but I do know that I will never support any plan that will ruin my chosen career. That is how I see national health systems affecting practice as a physician.

Anyway, did anybody read the recent series in the New York Times about diabetes in America? The authors didn't try to hide their opinions on how insurance is handling the issue. What I was interested in was the direct admission by insurance companies that they deliberately fail to provide adequate coverage for people with diabetes because doing so would attract diabetics to their company, and diabetics are across the board money-losers for them. This makes perfect sense from an economic perspective, of course, and it's why I think healthcare can't be run on a completely capitalist system. Most, if not all, diabetics, no matter how much money they have, simply cannot find insurance coverage that provides them with things like more than one blood test strip a day, prophylactic podiatrist and ophthamologist visits, etc. Of course those who have enough money can afford to pay for it all themselves.



This is pure speculation on my part, but I happen to know two individuals in my work place that are diabetics.

One individual is an older gentleman, perhaps 30 or so. The other guy is about 21.

The 30 year old guy has to constantly watch what he eats, and I am overwhelmed by his dedication in looking up how many calories such and such food has and then taking the correct amount of insulin. Yesterday we were in a resturant and he was injecting himself with insulin as he always does.

Well a new waitress walked by and saw him injecting the insulin. She told us that we had to leave otherwise she would call the cops. After some really awkward moments, the manager came by and explained to her what the needle was for and the waitress said she was sorry.

My friend was really hurt. Unlike the 21 year old fellow who comes from a well to do family, he being an auto reapirman cannot afford to have an insulin pump (about $4,000 he said)

Needless to say, I thought it was really unfair because he's a pretty nice guy, whereas the 21 year old is a complete jerk.

Well, I'm talking about type II diabetes (I should have been specific). The vast majority of diabetes in this country is type II, which isn't controlled with insulin (it's a problem of insulin resistance, actually, not lack of insulin). I'm sure type I diabetics have their own share of problems.

Praetorian, there's nothing intrinsic in a national health system that says it has to ruin physicians' careers. As a matter of fact, some of the proposed plans wouldn't affect physician compensation that drastically, although some the highest-paid specialties will probably average less income. However, you also have to consider the frustration practicing doctors feel when faced with our current insurance mess. The amount of overhead dedicated to billing and insurance is outrageous; in the clinic where I work there is a whole office full of people just to keep all the plans and billing codes, etc., straight, and to argue for compensation all the time. So I'm not saying you should necessarily support a single-payer system or anything specific, but don't you at least think the current nonsense should be dealt with?

I hate to hijack, but...

This is pure speculation on my part, but I happen to know two individuals in my work place that are diabetics.

One individual is an older gentleman, perhaps 30 or so.
:eek:
I must really be getting old; when I hear "older gentleman" I think white hair, liver spots, wrinkles, cane, etc. I'm going to be 30 this year! Please, tell me I'm not old! :laugh:

**double Post**

Well, I'm talking about type II diabetes (I should have been specific). The vast majority of diabetes in this country is type II, which isn't controlled with insulin (it's a problem of insulin resistance, actually, not lack of insulin). I'm sure type I diabetics have their own share of problems.

Praetorian, there's nothing intrinsic in a national health system that says it has to ruin physicians' careers. As a matter of fact, some of the proposed plans wouldn't affect physician compensation that drastically, although some the highest-paid specialties will probably average less income. However, you also have to consider the frustration practicing doctors feel when faced with our current insurance mess. The amount of overhead dedicated to billing and insurance is outrageous; in the clinic where I work there is a whole office full of people just to keep all the plans and billing codes, etc., straight, and to argue for compensation all the time. So I'm not saying you should necessarily support a single-payer system or anything specific, but don't you at least think the current nonsense should be dealt with?
I think it should be dealt with, but I don't believe the solution is a national health system. I hope that others will realize the massive problems inherent with this option.....

I think it should be dealt with, but I don't believe the solution is a national health system. I hope that others will realize the massive problems inherent with this option.....

Quick question: do you feel that Medicare could be classified as "pseudo national healthcare?"

Quick question: do you feel that Medicare could be classified as "pseudo national healthcare?"

No, because lots of physicians don't take Medicare. If Medicare decides tomorrow that they're going to cut reimbursement in half because they want to save money, guess what? Physicians will stop taking medicare. If we have "national healthcare" and we have a war that costs 87 gazillion dollars a month and we decide we need to cut corners somewhere, hey, let's just cut doctor reimbursement by 30%. They're all driving shiny cars anyway! Nationalized health care = life at the mercy of one particular set of bureaucrats. While the current system is far from perfect competition, nobody has a monopoly so nobody can enforce things that are too out of whack or they will be rejected. That is why socialized medicine is horrible for physicians.

In France, surgeons went on strike after the French healthcare agency didn't raise reimbursements ..... for 15 years straight. I'll pass.

I hate to hijack, but...


:eek:
I must really be getting old; when I hear "older gentleman" I think white hair, liver spots, wrinkles, cane, etc. I'm going to be 30 this year! Please, tell me I'm not old! :laugh:

Whoops! Sorry. (Cat puts his hands in his pocket and hurridley walks around the corner) :D

Actually I don't know how old he is, perhaps 30, but I'm guessing he could be 35 or close to even 40.

The articles also brought up the issue that in a for-profit, capitalist healthcare system there is very little room for preventive medicine. All of the diabetes centers that opened in New York to provide diabetics with comprehensive care, and which were proven to have very good success rates at keeping people healthier than they would have been otherwise, lost a great deal of money. Three of the four closed, and one is open only because of philanthropy.

Very little room for preventative medicine is absolutely correct. This isn't because a capitalist system is wrong, it's because people don't care about their own health. The "preventative medicine" argument for national healthcare assumes that the government should be holding everyone's hand when it comes to personal health. Under a non-employer based, non-Medicare, non-Medicaid private insurance scheme, I think the system would speak much more commandingly. When you create long-term healthcare safety nets, people are significantly less likely to consider adopting personal health habits. Insurance companies would offer financial incentives for people to engage in healthy living habits, otherwise they would pay high premiums or simply be uninsurable. When chronic "Western World" diseases such as heart disease, many cancers, diabetes type II, and so on spell future financial doom for the individual, there is huge incentive to make the PERSONAL choice to adopt healthy living habits. Such a system would be much more effective than government bureauracrats whispering in your ear to engage in preventative habits. If people are too stupid to realize that this is the case, then they reap the disaster of their poor decisions. In such a case, the irrational individual is the victim, not the American taxpayers.

I agree that people would have more incentive to adopt healthy living habits if otherwise they were faced with financial doom, but I agree with little else in this post. You claim that people don't care about their own health. What is the basis of this claim? Certainly some people don't care, but in general much of what I've read, and learned from speaking to practicing physicians, is that people have trouble caring about their health conditions like early stage diabetes, high blood pressure, etc., when they feel completely normal and have yet to notice ill effects from the disease. What is missing here is, to a large part, patient education. In the series of articles I mentioned (which I grant were not in any way scientific articles) the patients who went to diabetes education classes were much more likely to take control of their blood sugar, because they actually knew what that meant. If they know what a pancreas is and what insulin does, even in basic terms, and if they know WHY it is important to maintain their blood sugar at proper levels, they are much more likely to do so. This was born out in a number of conversations I had with doctors (interestingly, one of them was initiated by the physician during one of my med school interviews).

What I'm not talking about is "government bureauracrats whispering in your ear to engage in preventative habits." I'm talking about adequate funding for preventive programs, so that people who WANT to take care of themselves can. If I developed type II diabetes I would not be able to keep track of my blood sugar per doctor's orders EVEN IF I WANTED TO, because my insurance would only cover one test strip per day, whereas most doctors suggest testing at least twice a day. This is one of the most simple examples.

I am also put off by your assertion that people don't take care of themselves because they are "too stupid" to do so. You have the benefit of a scientific education, but most people in this country don't. And yes, there are people of varying intelligences, but most normal humans wantn to be healthy. Why in the world should they take care of themselves when they feel fine and don't see any reason to? Just because somebody says they should? We all know from experience that personal habits are harder to change than simply by suggestion. There has to be motivation.

No, I don't take all the blame off of the individual. But I think until we provide adequate funding for health education and preventive services, we cannot ASSUME the blame lies on the individual. Once these services are in place, if somebody continues to neglect himself he is certainly to blame. In these situations any insurance plan could choose to restrict coverage of subsequent services. But that would be a long way down the road, after we are assured that people have the access to the resources they need to take care of themselves.

Very little room for preventative medicine is absolutely correct. This isn't because a capitalist system is wrong, it's because people don't care about their own health. The "preventative medicine" argument for national healthcare assumes that the government should be holding everyone's hand when it comes to personal health. Under a non-employer based, non-Medicare, non-Medicaid private insurance scheme, I think the system would speak much more commandingly. When you create long-term healthcare safety nets, people are significantly less likely to consider adopting personal health habits. Insurance companies would offer financial incentives for people to engage in healthy living habits, otherwise they would pay high premiums or simply be uninsurable. When chronic "Western World" diseases such as heart disease, many cancers, diabetes type II, and so on spell future financial doom for the individual, there is huge incentive to make the PERSONAL choice to adopt healthy living habits. Such a system would be much more effective than government bureauracrats whispering in your ear to engage in preventative habits. If people are too stupid to realize that this is the case, then they reap the disaster of their poor decisions. In such a case, the irrational individual is the victim, not the American taxpayers.

Quick question: do you feel that Medicare could be classified as "pseudo national healthcare?"

Well, considering the government is trying to privatize it...

Medicare has problems, no doubt about it. But it could be seriously re-vamped and made into a passable plan. As dilated pointed out, not all doctors take it. He also pointed out a very important point -- if there were one insurer, it would be in complete control of physician compensation. This is a significant problem with a single-payer system, but in my opinion it's avoidable. Truthfully I don't know what the proposed plans have suggested in this regard, but my personal suggestion is to have compensation dictated by a board that includes at least half physicians. It wouldn't be perfect, but it may help this problem of reducing compensation at a whim.

Additionally, national healthcare does not equate to single-payer. There are many other proposed systems out there, and some countries have universal coverage under unique systems. Israel, for example, has a multi-payer system under which everybody is covered (I don't actually understand the sytem though!). And I think France has legislated coverage for everybody, but private insurance remains available. There are problems with all of these systems, problems which would have to be worked out if we develop our own unique way of insuring national coverage. Not the least of the problems with multi-payer systems is plain confusion on the part of the insured (as we're seeing right now with the Medicare drug plan fiasco...and yes, it is a fiasco, just spend one day in the clinic where I work!).

Anyway, just some thoughts. Supporting national healthcare or universal coverage doesn't mean anything other than supporting the availability of healthcare to all citizens or insurance coverage of all citizens. Both of these can take multiple forms. And we're free to invent our own system, too.

I'm talking about adequate funding for preventive programs, so that people who WANT to take care of themselves can. If I developed type II diabetes I would not be able to keep track of my blood sugar per doctor's orders EVEN IF I WANTED TO, because my insurance would only cover one test strip per day, whereas most doctors suggest testing at least twice a day. This is one of the most simple examples.


Or, we can spend no government money on preventative programs. That way, people who don't take the initiative to educate themselves simply drown in medical care costs. Those who do pay low insurance premiums and lead healthy lives. Regardless of who makes the right decisions, the taxpayers still emerge unscathed.


And yes, there are people of varying intelligences, but most normal humans wantn to be healthy. Why in the world should they take care of themselves when they feel fine and don't see any reason to? Just because somebody says they should? We all know from experience that personal habits are harder to change than simply by suggestion. There has to be motivation.


Most normal humans want to be healthy? Yes. Most normal humans make it their main priority? No. You say there has to be motivation. There will be. They can just look at their friends and their parents. People who get lung cancer from smoking will be dying when they can't afford chemotherapy or even pain management. Obese people with diabetes will die from gangrene after their extremities necrose. That would motivate me far better (both to be educated and to adhere to healthy habits) than any government-funded education programs. Not to mention, I would save bundles of money paying low-risk group insurance premiums. We need to stop being forgiving and force people to own up to the true costs of their behavior.

Or, we can spend no government money on preventative programs. That way, people who don't take the initiative to educate themselves simply drown in medical care costs. Those who do pay low insurance premiums and lead healthy lives. Regardless of who makes the right decisions, the taxpayers still emerge unscathed.

Most normal humans want to be healthy? Yes. Most normal humans make it their main priority? No. You say there has to be motivation. There will be. They can just look at their friends and their parents. People who get lung cancer from smoking will be dying when they can't afford chemotherapy or even pain management. Obese people with diabetes will die from gangrene after their extremities necrose. That would motivate me far better (both to be educated and to adhere to healthy habits) than any government-funded education programs. Not to mention, I would save bundles of money paying low-risk group insurance premiums. We need to stop being forgiving and force people to own up to the true costs of their behavior.

I think we easily get spoiled by our position in life -- well-educated, if not now then headed towards being solidly middle or upper-middle class. How do you expect most people to take the initiative to educate themselves? With what resources? Also, you have this low opinion of human nature (they are too stupid to take care of themselves), and yet you don't see that having education available would encourage more people to become educated? Most people probably don't have the initiative to educate themselves; they may not even realize they need to be educated!

But you're ignoring all the arguments for a healthy workforce. Economically we WANT people in this country to be healthy. That's why WE take the initiative to encourage people to take care of themselves. In the end, a healthier population reduces healthcare costs and increases work productivity.

Perhaps, as you say, seeing other people suffer from disease should be incentive to take care of oneself. (Although, of course, not all people, especially first-generation immigrants faced with diabetes for the first time due to lifestyle changes, have other people to look to.) But that doesn't address all of my other concerns -- people CAN'T take care of themselves with the resources available, even if they want to. They CAN'T go to preventive visits with an ophthamologist, to avoid glaucoma or catch it when it starts, because their insurance won't cover it at all. They CAN'T test their blood sugar two or more times a day, because they can't afford the test strips and insurance won't help. (And personally, I wouldn't be able to afford test strips right now either. So arguing that it's their problem for not having enough money, which some people may do, begs the point. In the end providing for the test strips saves more money in the system, because it helps prevent big-budget complications.)

I also don't suggest that these education programs, or preventive services, should be government-funded, or at least not completely. Education programs should receive funding from wherever they can, and perhaps this should include government funding, but it would probably require significant private funding as well. As far as preventive services, they should be covered by insurance -- whatever insurance system is in place at the time, be that single-payer or multi-payer or private.

I don't disagree the education programs would be beneficial. My argument is that the government shouldn't be funding them through taxpayers dollars. I'm interested in making the federal government the trimmest, smallest, and most effective entity that it can be. What people do with their private funds is completely their decision. I'm not going to try to tell them what to do with their money. If you want to start a public health education program, more power to you. I'm sure it will have great results.

As for the "economically fit" argument, I would say that removing hiring restriction regulations would greatly ameliorate the health situation. Walmart had a great idea when they decided to require physically demanding tasks of employees to prevent unhealthy hires. Private companies should absolutely be able to pick and choose their employees based upon their health, and indirectly, their insurance liability (under the current US system). Without regulation, employers could screen out unhealthy people (if it is in the interest of the company) and provide further discrimination incentives for people to stay healthy.

If you complain about my low view of human nature, my only interest is in forcing people to make rational decisions by removing government leeway. If this sounds harsh, it is. It is the best way to change behavior though.

No, because lots of physicians don't take Medicare. If Medicare decides tomorrow that they're going to cut reimbursement in half because they want to save money, guess what? Physicians will stop taking medicare. If we have "national healthcare" and we have a war that costs 87 gazillion dollars a month and we decide we need to cut corners somewhere, hey, let's just cut doctor reimbursement by 30%. They're all driving shiny cars anyway! Nationalized health care = life at the mercy of one particular set of bureaucrats. While the current system is far from perfect competition, nobody has a monopoly so nobody can enforce things that are too out of whack or they will be rejected. That is why socialized medicine is horrible for physicians.

In France, surgeons went on strike after the French healthcare agency didn't raise reimbursements ..... for 15 years straight. I'll pass.

That's great, but not where I was taking things at all.

There are a lot of ways that national health coverage could be implemented. In Germany, for instance, everyone is required to purchase insurance, and their healthcare system is funded by premiums instead of tax dollars. I've been slowly falling off the single-payer bandwagon, as such a system might be more in line with our current infrastructure.

I brought up Medicare because it has been implemented in essentially two, entirely different phases. The first, from about 1965-1982 was the era of virtually unrestricted reimbursment policy. The provider sent Uncle Sam a bill, and Uncle Sam paid it. Doctors proceeded to purchase color-coordinated Ferraris and the hospitals electroplated their floors with 18 karat gold. When the doctors who have been in the business for awhile recall those years, the often get teary eyed.

In retrospect it's no wonder that our profession hasn't gotten a raise since then. The incomes at that point were generally so absurd as to be unsustainable.

In any case, in the early 1980's Congress took action to halt the systematic financial raping that unfettered reimbursement was causing. Hence the whole DRG policy took shape, where reimbursements were set based on diagnoses. Overnight the whole ballgame changed, and EVERYONE shifted to try and lowball expenditures. All of a sudden granny's two week inpatient stay after having her gallbladder removed turned into two days and a bottle of aspirin on the way out the door.

Why am I yammering on about this? To illustrate that national healthcare could be a bad thing for doctors or it could be a good thing. A very good thing. I certainly would not accept a plan that doesn't allow for meaningful, collective bargaining of reimbursement levels. You're absolutely right, having the beancounters control the reimbursements isn't a comforting thought. I also wouldn't support the prohibition of a multi-tiered system.

Even though I have my doubts about single-payer, if done right it would be a tremendous boon for our profession, akin to the early days of Medicare. Charity care would be eliminated, as would huge chunks of messy adminsistrative overhead. Employers would be completely unburdened, and care would be 100% portable. Since all doctors would bill the same central source, you could go to any one you want, anywhere.

One more short paragraph and I'll shut up. The current system is bound to change sooner or later, either slowly or in some cataclysmic upheaval. If we're smart we'll be accepting of this inevitability and try to take advantage of the opportunities it may afford. And if they find a way to make it suck, I'm going to bartend in the South Pacific.

That's great, but not where I was taking things at all.

There are a lot of ways that national health coverage could be implemented. In Germany, for instance, everyone is required to purchase insurance, and their healthcare system is funded by premiums instead of tax dollars.

This is a terrible violation of consumer freedom. Let's say I live in a country with 4 other people. I, and 4 others, generally make poor health decisions. One of us is a stuntman, one of us smokes 3 packs a day, one is an alcoholic, and one has severe glaucoma but insists on continuing his career as a Nascar driver. However, ONE makes good health decisions, exercises daily, has a good diet, and generally minimizes health risks. Why should that one person have to pay the same premiums as everyone else?

The problem with these systems is that they excise any semblance of individual initiative to reduce insurance liability. And I would argue that the most sweeping reform one could make in the American healthcare system is to make drastic lifestyle changes for American citizens. Basically, if we're all going to pay the same thing anyway, why should I try to be healthy? This is the same kind of logic we followed in the early days of Medicare, where consumers were completely divorced from the cost of care (although this persists today to a substantial extent). It doesn't work. Costs must always be brought to bear.

This is a terrible violation of consumer freedom. Let's say I live in a country with 4 other people. I, and 4 others, generally make poor health decisions. One of us is a stuntman, one of us smokes 3 packs a day, one is an alcoholic, and one has severe glaucoma but insists on continuing his career as a Nascar driver. However, ONE makes good health decisions, exercises daily, has a good diet, and generally minimizes health risks. Why should that one person have to pay the same premiums as everyone else?

I object to the financial incentive to make good health decisions on several grounds. First, long-term risk is not nearly as bothersome to people as short-term risk. If you examine human behavior when it comes to investing, the "risk horizon" for you average investor is about one year, meaning that any perceived risk beyond that point might as well not exist. It's hard enough to get people to take care of themselves when the cost is death. I'm not convinced that premium reduction is going to dissuade a significant number of trips to the Colonel's drive-thru. Not in the people most in need of lifestyle modification, that is.

Second, if you're going to base premiums on a given person's occupation, weight, diet, alcohol and tobacco consumption, etc., that means you're going to have to collect and analyze the data. This would require something along the lines of "Big Brother" who's keeping an eye on how you live. It would also provide a huge incentive for patients to lie (even more than they already do) about their lifestyles. The supposedly sacred, open line of communication between doctors and patients is strained enough as it is. Now place the doctor in the position of deciding whether someone's premiums are going to go up or down based on how dutiful he/she is at prying in the patient's bad habits. No thanks.

Finally, I'm a big fan of efficiency through simplicity, and the simplest system places everyone in the same risk pool. Besides, you're acting like sick people in Germany have no out-of-pocket costs, which is patently untrue.

I don't disagree the education programs would be beneficial. My argument is that the government shouldn't be funding them through taxpayers dollars. I'm interested in making the federal government the trimmest, smallest, and most effective entity that it can be. What people do with their private funds is completely their decision. I'm not going to try to tell them what to do with their money. If you want to start a public health education program, more power to you. I'm sure it will have great results.

As for the "economically fit" argument, I would say that removing hiring restriction regulations would greatly ameliorate the health situation. Walmart had a great idea when they decided to require physically demanding tasks of employees to prevent unhealthy hires. Private companies should absolutely be able to pick and choose their employees based upon their health, and indirectly, their insurance liability (under the current US system). Without regulation, employers could screen out unhealthy people (if it is in the interest of the company) and provide further discrimination incentives for people to stay healthy.

If you complain about my low view of human nature, my only interest is in forcing people to make rational decisions by removing government leeway. If this sounds harsh, it is. It is the best way to change behavior though.

Oh, I want to clarify. I'm not complaining about your low view of human nature. I was actually saying that since you don't have much faith in people, to me it would make more sense to encourage them to practice preventive medicine, for the financial reasons I stated. I used to have a higher opinion of human nature before I actually worked full-time with patients. I'm slowly losing that. So I don't disagree, I just differ on how to handle it.

I won't argue that private companies shouldn't be able to hire people for strenuous jobs based on their ability to do the job, which includes their health. Of course, many of those seemingly healthy people will go on to develop chronic illness if they aren't screened for it and treated early (which requires appropriate health coverage, something Walmart certainly isn't offering...but don't get me started on them because I'll simply explode). But my caveat is that most jobs do not require physical health. Would you suggest that a person with diabetes simply be unable to find work because of their disease? Even the "lifestyle diseases" sometimes occur in healthy people (e.g., my mother, a vegetarian -- almost vegan -- has fairly high cholesterol for genetic reasons; she's in better shape than anybody I know and eats a healthier diet, but her entire family before her has had high cholesterol and there's not much she can do to escape it). So if you are arguing that people should be "punished" for their health by not being able to find work, that makes no sense to me. Also, it creates a much larger burden on our system. People who have no work have no insurance. People without insurance get sicker and sicker until the end up in the ER, where they're admitted to the hospital, costing billions of dollars a year. If unhealthy people didn't have work just because of their health, it would make the problem ten times worse. Perhaps I'm understanding you wrong?

Out of curiousity, are you against a government-funded public school system? From your comments on health education it seems as if you may be. I know some people who are, or who send their children to private school (or don't have children) and therefore think it's not right that their tax money funds the public school system. My only question to them has always been who do they expect to educate our workforce. The country's infrastructure depends on having at least adequately educated people to run it. Our school system does a bum job, but it's better than nothing. Without it, many, if not most, children would simply never go to school. I suppose to a certain degree automation and computerization will solve part of the problem, but we're always going to need people to take care of basic services that require functional reading and math skills. I realize this is completely off topic, it just occurred to me.

I object to the financial incentive to make good health decisions on several grounds. First, long-term risk is not nearly as bothersome to people as short-term risk. If you examine human behavior when it comes to investing, the "risk horizon" for you average investor is about one year, meaning that any perceived risk beyond that point might as well not exist. It's hard enough to get people to take care of themselves when the cost is death. I'm not convinced that premium reduction is going to dissuade a significant number of trips to the Colonel's drive-thru. Not in the people most in need of lifestyle modification, that is.

Yeah, that's what I was trying to say before. I just didn't say it half as well :laugh:

This is a terrible violation of consumer freedom.

I disagree, but even if it is a violation of consumer freedom, the personal freedom it would grant me would be worth the price.

You're probably like me, young (if you call 32 "young") and healthy. If the government forced me to purchase health insurance I might be pissed, but it would likely obviate the medicare payroll taxes I already pay, so no worries.

What would this give me? Probably nothing anytime soon, but I've known some people my age and younger who have had cerebral aneurysms. Hell, two of them died (one in his office - locked the door to get some quiet for what he thought was a migraine). One of my med school classmates got pyelo and racked up over $8K in medical bills, and that was WITH the doctors all waiving their fees because he was a med student. Another fellow I knew was in a MVA and lost his arm. There goes six figures in surgery and rehab EASY.

When I expand my scope of recollection, for every person who dropped dead suddenly of a heart attack at age 55 there are several who had prolonged cancer-related illnesses, debilitating strokes, or progressive dementias. One of the demetia cases (Picks disease) actually moved to Canada so that she could get care without her estate being drained. Nice when our government is abolishing the estate tax while the citizenry is moving to other countries in order to keep from being bled dry by impending medical bills.

Oh, and a good friend of the family was diagnosed with PKD while teaching at a university in Buffalo. The family plan was to return to California as they edged towards retirement, but that went out the window as he became uninsurable and therefore trapped in his existing NY plan. They weren't feeling too free.

I have awesome insurance right now through my residency program, but how portable is it? Not very. If I break my leg skiing I can bet I'm going to be feeling some serious pain in the vicinity of my wallet. It's so nice to know that I'm covered... assuming I stay within the network.

So, a violation of consumer freedom? Maybe, but the peace of mind I'd feel in Germany would probably be worth the violation. To me, at least.

Yeah, that's what I was trying to say before. I just didn't say it half as well :laugh:

Awwwwww. Boy or girl?

Very little room for preventative medicine is absolutely correct. This isn't because a capitalist system is wrong, it's because people don't care about their own health. The "preventative medicine" argument for national healthcare assumes that the government should be holding everyone's hand when it comes to personal health. Under a non-employer based, non-Medicare, non-Medicaid private insurance scheme, I think the system would speak much more commandingly. When you create long-term healthcare safety nets, people are significantly less likely to consider adopting personal health habits. Insurance companies would offer financial incentives for people to engage in healthy living habits, otherwise they would pay high premiums or simply be uninsurable. When chronic "Western World" diseases such as heart disease, many cancers, diabetes type II, and so on spell future financial doom for the individual, there is huge incentive to make the PERSONAL choice to adopt healthy living habits. Such a system would be much more effective than government bureauracrats whispering in your ear to engage in preventative habits. If people are too stupid to realize that this is the case, then they reap the disaster of their poor decisions. In such a case, the irrational individual is the victim, not the American taxpayers.


Personal choice? Have you ever spent time in an inner-city. People are born into poor conditions and go to schools with poor education because their schools are not adequately funded (in addition to other factors). These folks grow up to have poor-paying jobs and have families (who can afford birth control without benefits) to support. We could always sterilize poor people, that would solve the problem. That only violates one human right... Anyway, getting to my point, in cities, there are probably 15 fast food joints for every grocery store (including little hole-in-the-wall places). In certain areas of the city my school is in, there is a McDonalds every 3-5 blocks on the same street, not to mention other fast food. Why? The dollar menu. Eating healthy isn't cheap. The dollar menu is. Most of us who are privileged to be born in decent (or better) families economically speaking, we don't realize this because we aren't put in this kind of situation. Before I came to school in a city I was just as naive as many of the people posting here who seem to be incredibly greedy. I didn't want to be taxed, I didn't want my money going to a city. I'd rather it build in a bank, that number on paper I receive in the mail every month from my bank made me feel good. Meeting great people who are screwed because of the people they were created by changed my mind quite a bit. Unless you're educated enough to care for others...ALL others...possibly at a bit of a sacrifice to your future meager (laughs) 6 figure salary, I am not comfortable with you being in medical school. This is a profession where you are supossed to care about others. To the person who doesn't want to pay premiums unless it benefits them, if that were the case, you better start saving now, because once you retire, your low premium will skyrocket because when you're old, you';re likely to need more medical care. and to the person who said "I don't care about fixing this problem of poor health coverage for the poor," seriously, do you listen to yourself talk? If you, one of the folks with some power, doesn't care, who will? Have some heart. If you get an experience to work with the poor, please do. Do an international elective or something overseas. Please. For my sanity. You don't know what you have, yet you want to keep it from others. I apologize for being scathing, but someone has to stand up for those without a voice here. I think it's ridiculous to label people as lazy when they aren't taught better and don't have the resources to buy anything better. You are a product of your environment, and they are a product of theirs. Instead of ignoring them or writing off their suffering and death as insignificant, why don;t we do something proactive? That's the only way to truly change and fix things, yet it seesm several of us pursuing a doctor of medicine degree, no less, fail to realize this.

As for what needs to be done with our health care system, I don't have all the answers. However, it's apparent that SOMETHING must be done, and I feel that it is cruel to leave out people who many assume are simply too "stupid" to take care of themselves. I, and many others I know, are willing to sacrifice a bit in order for everyone to receive adequate care. We have a caring mentality, not an Ebeneezer Scrooge mentality. Too much $$ corrupts, I'd rather not deal with it. As for "ruining a great profession," I feel that it is unethical to refuse health care treatment to anyone for almost any reason, particularly the ability to pay, and so as the system is unethical, the profession is not yet "great." Again, I apologize for the digressions and the negative tone, but I feel it needed to be said--some of you need to be educated about what it means to be human just like others need to be educated as to how to be healthy. And yes, I'm sure a number of people, once educated, still won't be healthy. This is the case now with some wealthy people. However, I'm sure also that there are a number of people who are educated in what is right in regards to treating and caring for others yet revert to greed. Our ancestors practiced religions of love; we practice religions of dollars. I'm not a commie, but I believe there is no love until there is a fair distribution of resources.

Take care, everyone

Unless you're educated enough to care for others...ALL others...possibly at a bit of a sacrifice to your future meager (laughs) 6 figure salary, I am not comfortable with you being in medical school. This is a profession where you are supossed to care about others.

I agree with what you're saying, but...medical school isn't a priveledge. People are there for a variety of reasons. Maybe some people are there out of the goodness of their hearts, but I assure you most aren't. I can understand somebody not wanting to sacrifice any of their salary (and, especially if they're planning on going into primary care, or even some academic specialties, that salary certainly isn't assured to be in the 6 figures). I mean, I'm not even sure that we should all be completely dedicated to patient care. We have our own lives. I'm going to be choosing a speciality partially on whether it will allow me enough time for my family, and I expect to treat medicine as my career but not necessarily my entire life.

Perhaps I'm over-interpreting what you said, but my basic point is that it's not our place to judge the fitness of somebody to be in medical school based solely on their motivations or political opinions. While I certainly disagree with chef_NU and others I've disagreed with on this thread, I have no evidence that they won't be good doctors. And while I agree that doctors should ideally care about others enough to make sacrifices as a result, I also think it takes all kinds of people in the world.

I agree with what you're saying, but...medical school isn't a priveledge.

Perhaps I'm over-interpreting what you said, but my basic point is that it's not our place to judge the fitness of somebody to be in medical school based solely on their motivations or political opinions. While I certainly disagree with chef_NU and others I've disagreed with on this thread, I have no evidence that they won't be good doctors. And while I agree that doctors should ideally care about others enough to make sacrifices as a result, I also think it takes all kinds of people in the world.

I didn't say anyone posting on this thread would lack clinical ability as a doctor. They may all be the most adept physicians ever, even moreso than me. However, I did some work with a physician the past couple of summers who is very good clinically, but I've lost some respect for this person. This doc is consistently making over $400,000 per year. This doctor also just stoped seeing anyone on medicaid because the reimbursements were a bit less than liability/overhead/etc. So essentially the doctor was losing a little money for working, and felt that he shouldnt be. This I understand, no one should lose money for working. However, this isn't a perfect world. While people shouldn't lose money for working, people also should have access to health care. Considering there were only a few medicaid patients coming in per week, if that, I doubt they are going to put this physician in the poor house. If all doctors take this doctor's approach, the poor will have nowhere to go in our area. In fact, he was the last person in our area in his specialty taking medicaid patients.

Indeed, he is a great clinical physician. However, his attitude is more suited for the business world/wall street with his ruthless CEO-maximizing-profits mentality to practice. If he legitimately couldn't afford seeing these patients, that's understandable. I don't expect someone to go homeless to serve others. However, there has to be a line drawn somewhere, because I feel the health of people IS more important than money. I also feel that if people don't agree, their perspective of the world is a bit distorted. Sure, mine may be distorted a bit in the opposite direction, but I refuse to put money over the human right of health care. Yes, it is/ought to be a human right, at least in a civilized society.

You think you have to have a "ruthless CEO-maximizing-profits mentality to practice" to not want to work for negative money??!!! Heck, I'm as pro-universal care as you get, I'm all about compassion in medicine and serving others, but I think it's ludicrous to expect people to continue doing something that is actually losing money for them! I think it's great if people choose to volunteer their time in clinics and such (and I hope to do this myself when I'm practicing), but why in the world should people be expected to do so? It's not a requirement in life to give yourself up for free. And this, actually losing your money for the work you're doing, is worse! Just because he can afford to lose the money doesn't mean he has a moral obligation to do so.

Obviously, the problem here is in the reimbursement system, as well as the fact that liability and overhead are so damn expensive.

Sure, health is more important than money. I personally agree with that. But if I were in that doctor's situation I would also take a serious look at continuing to accept Medicaid. (Also, you may be significantly underestimating the number of patients using Medicaid. A large percentage of older and disabled people rely at least partially on Medicaid coverage.) Nobody should be expected to work for negative money. It just isn't right. If you want to do it, good for you. I think a better response is to dedicate ourselves to fixing the system so this nonsense isn't necessary.

Second, if you're going to base premiums on a given person's occupation, weight, diet, alcohol and tobacco consumption, etc., that means you're going to have to collect and analyze the data. This would require something along the lines of "Big Brother" who's keeping an eye on how you live. It would also provide a huge incentive for patients to lie (even more than they already do) about their lifestyles. The supposedly sacred, open line of communication between doctors and patients is strained enough as it is. Now place the doctor in the position of deciding whether someone's premiums are going to go up or down based on how dutiful he/she is at prying in the patient's bad habits. No thanks.


I have trouble with this assertion because there is already financial incentive for insurance companies to monitor consumer behavior in a "big brother" fashion. After all, insurance companies don't want to pick up anyone they they see as a health liability. However, they don't.

So if you are arguing that people should be "punished" for their health by not being able to find work, that makes no sense to me. Also, it creates a much larger burden on our system. People who have no work have no insurance. People without insurance get sicker and sicker until the end up in the ER, where they're admitted to the hospital, costing billions of dollars a year. If unhealthy people didn't have work just because of their health, it would make the problem ten times worse. Perhaps I'm understanding you wrong?

Yes, you're understanding me wrong. These unhealthy people who end up getting sicker and sicker never end up in the ER and costing billions because no one pays those billions. They simply go without.


Out of curiousity, are you against a government-funded public school system? From your comments on health education it seems as if you may be. I know some people who are, or who send their children to private school (or don't have children) and therefore think it's not right that their tax money funds the public school system. My only question to them has always been who do they expect to educate our workforce. The country's infrastructure depends on having at least adequately educated people to run it. Our school system does a bum job, but it's better than nothing. Without it, many, if not most, children would simply never go to school. I suppose to a certain degree automation and computerization will solve part of the problem, but we're always going to need people to take care of basic services that require functional reading and math skills. I realize this is completely off topic, it just occurred to me.

Yes, I am against a government funded public school system. I am entirely for a government funded education program. Each student receives a certain portion of funding from the state as a voucher to finance education. The private market has incentive to compete for that money, and to be the most cost-effective that it can be. What's more, it caters to what students and parents view as valuable results, rather than results dictated by the federal government. The way we are pursuing federal education now is analagous to paying a bum $20 to slop some dirty water on your windshield out of charity instead of going down the street and paying $20 for a professional wash. The public school system is a government-enforced monopoly that carries all the ills of a monopoly: poor quality service, unresponsive to consumer demands, costs not related to performance, no innovation, and so on. Equality of opportunity is a great thing, but we are polluting it with this government nonsense.

To me, at least.

This is exactly my point. There is another sector of the population (including myself) that insurance is NOT worth your 'peace of mind.'

Our ancestors practiced religions of love; we practice religions of dollars. I'm not a commie, but I believe there is no love until there is a fair distribution of resources.

Take care, everyone

Longbottom I appreciate your anger. Any normal person would respond as you did to my ideas. It's just you haven't been around this particular forum as long as some others. Fact is, we operate from different assumptions. Frankly, humanitarian concerns don't factor at all into how I see public policy should be formulated. If you want, I can refer you to some of my previous posts....

I thought it would be interesting to examine the French health care system. In 2001, the World Health Organization study found that France had the best overall health care system among the 191 countries that were in the study. The US ranked at 37; this rank was behind all European nations as well as Morocco, Oman, and Costa Rica

Now I do hesitate to believe in such information that claims that the US is below nations such as poverty severe Albania and war torn former Yugoslavia, but I am under the impression that the study was looking at Western Europe specifically; and to say that a Latin American nation such as Costa Rica has better says that those nations are doing something good.

The US spends more GDP on health than France; 13.7% vs 9.8% respectively.

I had to use paint brush because I couldn't line up the numbers, every time the numbers were misaligned, probably SDN HTML format. But these are from WHO's World Health Report 2000, on 21 June 2001. Interesting I must say study:

http://img.photobucket.com/albums/v519/CatsandCradles/healthcareWHO.jpg

Will workers and owners of business have to pay more in a French system? Not more, but slightly less says one article I looked at. French employers and their workers pay wage levies that are 20%. This 20% breaks down to 13% from employers and 7% from the employers.

Now I'm also reading that making comparisons between the US and other nation's health care system is difficult. Why, because we in the US use dollar premiums rather than percentages of wages.

I can't know the accuracy of this information that I am reading, but it claims that in Arizona, a large employer who wants the same health coverage that is equivalent to French medical insurance pays around $9,348 per year for each employee with and the employee covers $1,704 per year.

So for a moderate income earner ($40,000 annually), US medical insurance cost are significantly higher than compared to the French system; 27% of gross wages.

Ok, now we cut to the chase about the French system. I am reading that in France, all of the worker insurance premiums go into a few quasi public insurance funds. These funds pay physician remuneration. So, like in the US, French doctors also struggle with these national insurance funds. Someone earlier mentioned French surgeons rallying at Paris, and it seems to be against these national insurance funds they were venting their anger at.

Needless to say the French system is also expensive, but it has its advantages vs the US system. France spends $2,047 per capita on health care compared to the US $4,095.
(This information I'm looking into because it may be biased as it is a French source)

So why is the US system so much more expensive?

1) The average American physician earns almost 6 times the average American worker.

2) French physicians make a little more than twice the earnings of their countrymen and women. (About $58,000 if I did the math right)

3) The low income of French physicians is offset by two factors, there are some really serious tort adverse legal systems - and medical schools while extremely competitive to enter, are essentially free. A French physician enters the workplace with little debt and pays a far lower malpractice insurance.

4) The French system has very low administrative cost: 5% vs 14% in the US.
In America, physician fees increases are rising due to the doctor trying to recover staff, office personnel and non physician payroll expenses. This article claims that the annual rate of increase is 7.1% since 1986. Because the French quasi-public insurance funds all adhere to the same conventions, French medical offices can operate with relatively few administrative personnel. Less different paperwork so to speak.

To make a military comparison, imagine an army with its soldiers all having different size caliber bullets. Now imagine another army with all of its soldiers carrying the same size bullets. The latter is going to be easier to organize and is not as complicated to supply.

I think that the primary reason why a number of US physicians oppose a more nationalized system is their concern for salaries. Considering what several have posted here, it appears that the physician's salary is a primary concern. When I look at the WHO's statistics that compare France vs the US, I can understand why the physicians in France would be upset. At the same time I also see that the French are doing something right for the patients.

I am with the impression that in France, patients seem happy, but doctors are not.

The question becomes: What is more important, your checkbook or your patient? Taking into account that 45 million Americans are without insurance, that is a telling sign of what many physicians feel. Voting with your pocket is nothing new.

To be honest, I'd love to live in nation where patients are happy and doctors are happy. But if that is hopelessly unrealistic, I'll also consider taking a situation where the patient is happy and the doctor is not.

(Of course we will see if this altruism will change as I pay that hefty West Virginia School of Osteopathic Medicine tuition )

I don't think anyone here is doubting the fact that a universal health care system is better than the current system in the US...

This is exactly my point. There is another sector of the population (including myself) that insurance is NOT worth your 'peace of mind.'

For now.

I have trouble with this assertion because there is already financial incentive for insurance companies to monitor consumer behavior in a "big brother" fashion. After all, insurance companies don't want to pick up anyone they they see as a health liability. However, they don't.

Could you rephrase this?

I don't think anyone here is doubting the fact that a universal health care system is better than the current system in the US...

Right, the question is implimentation, and choice of system type. But actually, some people on sdn do argue that a universal healthcare system would not be better than the current system. These are mostly people who would argue that healthcare is not a right but a privilege, and people who can afford it should have it but not people who can't afford it. While this may be an interesting philosophical argument, I personally think it ignores the economic benefit of having a healthy population.

But anyway, it's true that most people would probably agree with some sort of universal healthcare, though we will disagree about what system is best. (Of course I don't know what system would be best. I used to be a very strong advocate of single-payer, and I still lean that way, but I do see problems with that system as well. In the end, as I've said, we might have to develop our own sort of hybrid system to make it work for us.)

Could you rephrase this?

Yeah I was confused about this as well. Insurance companies don't currently provide coverage (and definitely not adequate coverage) for people they think are a liability. I'm not sure if this is what you were saying. That was part of my whole point with the diabetes story. The companies will readily admit this, because it's part of their business practice. And from an economic perspective it does make sense, which is exactly why I'm saying that healthcare can't be delivered in a purely capitalist system -- because then people don't receive healthcare!

Universal health care is well within the realm of possibility without raising taxes. So is universal education. So are good roads.

In 2003 alone the United States spent 3,541.3 *million* dollars on grants to foreign governments according to the Greenbook report. Read that number again if you'd like - 3,541 million dollars. In one year. On *grants*. Yes Virginia, that is a lot of zeros.

(and for those of you who are going to raise a hue and cry about babies in Africa starving if we cut off foreign aid, only 4.4 of that 3,541 was food aid.)

The money is there, the only question is what it gets spent on.

Yeah I was confused about this as well. Insurance companies don't currently provide coverage (and definitely not adequate coverage) for people they think are a liability. I'm not sure if this is what you were saying. That was part of my whole point with the diabetes story. The companies will readily admit this, because it's part of their business practice. And from an economic perspective it does make sense, which is exactly why I'm saying that healthcare can't be delivered in a purely capitalist system -- because then people don't receive healthcare!

Insurance companies do not make sense to me most times. After I left my regular employment that ad benefits, I searched out health insurance on a self-employed, individual basis. As expected I was denied due to my Hirschsprung's Dz. However, I hardly go to the doctor at all. Only refill Rx on Lomotil and B-12 IM. I dont even go for flu, colds, and other normal things. There are the occasional visits to the ER for IV fluids when I get too dehydrated, but that is only MAYBE once every couple of yrs. So, since I dont have a group of "healthy" insured around my policy I am suddenly a risk. What about all those other individuals paying their premiums? How come that wont make them feel more comfortable with my policy?
I just think that the system is flawed in many areas and it can keep many, including myself, from getting insurance, even some sort of basic service for emergencies. I also see that they are just start to promote more prevention and they should reward healthy living, like how auto ins. rewards good drivers. It will be up to us to help the system improve.

Right, the question is implimentation, and choice of system type. But actually, some people on sdn do argue that a universal healthcare system would not be better than the current system. These are mostly people who would argue that healthcare is not a right but a privilege, and people who can afford it should have it but not people who can't afford it. While this may be an interesting philosophical argument, I personally think it ignores the economic benefit of having a healthy population.


Well, in case you haven't noticed, this is my opinion exactly... but I do agree with the fact that universal healthcare is better than the US system.

Well, in case you haven't noticed, this is my opinion exactly... but I do agree with the fact that universal healthcare is better than the US system.

Yeah, but in another thread a while back there were a few people arguing that it isn't based on their understanding that healthcare isn't a right. I figured you probably agree with that premise (although you never explicitly stated it), but I wanted to point out that some people use it to argue that universal healthcare actually isn't better.

Insurance companies do not make sense to me most times. After I left my regular employment that ad benefits, I searched out health insurance on a self-employed, individual basis. As expected I was denied due to my Hirschsprung's Dz. However, I hardly go to the doctor at all. Only refill Rx on Lomotil and B-12 IM. I dont even go for flu, colds, and other normal things. There are the occasional visits to the ER for IV fluids when I get too dehydrated, but that is only MAYBE once every couple of yrs. So, since I dont have a group of "healthy" insured around my policy I am suddenly a risk. What about all those other individuals paying their premiums? How come that wont make them feel more comfortable with my policy?
I just think that the system is flawed in many areas and it can keep many, including myself, from getting insurance, even some sort of basic service for emergencies. I also see that they are just start to promote more prevention and they should reward healthy living, like how auto ins. rewards good drivers. It will be up to us to help the system improve.

I'm pretty sure there's a law that's been in place since the late 90's that makes it illegal to deny you coverage for a pre-existing condition as long as you've had continuous insurance coverage. But once that coverage lapses you don't fall under that anymore. I'm not sure if this applies to private insurance, though, or only employment-based insurance (including coverage through a spouse, etc.). So once you re-establish insurance, it's important to maintain it even after you leave a job, through COBRA until you can get a new policy.

In any case most people I know have found it impossible to afford insurance on an individual basis. I know one person who wanted to start her own business but ended up deciding not to because she wouldn't be able to afford insurance coverage, which was important to her.

Unversal health is not better than todays broken system and no, a national health care plan can't save American jobs.

However, I did some work with a physician the past couple of summers who is very good clinically, but I've lost some respect for this person. This doc is consistently making over $400,000 per year. This doctor also just stoped seeing anyone on medicaid because the reimbursements were a bit less than liability/overhead/etc. So essentially the doctor was losing a little money for working, and felt that he shouldnt be.



Indeed, he is a great clinical physician. However, his attitude is more suited for the business world/wall street with his ruthless CEO-maximizing-profits mentality to practice.

That's not ruthless.....that's just good basic business practice. Ruthless would be demanding cash payment upfront.

I don't think anyone here is doubting the fact that a universal health care system is better than the current system in the US...
I am.

By the way Cats' you need to remember that most of the big money in healthcare goes to administration of the insurance companies, not to the docs.....

I am.

By the way Cats' you need to remember that most of the big money in healthcare goes to administration of the insurance companies, not to the docs.....
Doubting that it's better for your personal economic situation, or better for resolving the financial/lifestyle crisis?

Well, it's November 2nd now.

I've been in school now for just over two months and I have never been so exhausted before in my entire life. I haven't posted in the "Topics in Healthcare" section for quite some time - so I revisited it and I stumbled across this thread. I feel like it's been an entire century! Reading this thread was like reading an old book I hadn't read in ages.

So I thought I'd give an update. Maybe you haven't noticed but there's both some good and some truly bad news.

At Ford Motor Company, last week they posted a third-quarter $5.8 billion loss - the largest in almost 15 years. The current yearly losses for 2006 are over $7.4 billion. I believe that a large portion of this huge loss is due to the buy out plans, and also this last summer the price of crude oil was hovering around $70 a barrel.

A Google search reveals that the total number of cuts in jobs now stands 43,000+/- positions. And I would venture to guess that Ford will have to offer more buy out plans as it continues to try to restructure itself. Further more the automotive company is further slashing health insurance/planning for retirees and those workers it will retain:



Ford will eliminate health insurance for Medicare eligible retirees in 2008 and raise health care premiums in June 2007 for employees by about 30 percent, the second straight year of increase.

The No. 2 U.S. automaker also will replace its traditional health coverage for salaried retirees over 65 with a $1,800 annual stipend that they can use to buy supplemental health coverage in addition to government-run Medicare.

Ford will stop paying for any health care coverage for dependent children of retirees who are over 65, Evans said.

In addition, this year, all hourly and salaried employees will also see their year-end paycheck delayed by one week.



On further grim items of importance, Ford is estimated to shell out another $3.1 in restructuring cost for the 4th quarter of 2006. It is almost certain that they'll take an additional $1 billion in losses in the 4th quater. I have seen various news pages that state that Ford has only $22-25 billion dollars available left - and these were internet sorces that were somewhat dated.

At the rate at which they are burning emergency funding, I do think that they may soon be forced to start borrowing money to finance themselves. If they utilize $4 billion a quarter, that's what? Maybe 1 and 1/2 years until they get into some truly serious trouble?

They brought in a new CEO Alan Mulally from Boeing. I wonder if he'll pull Ford through - but I got some serious doubts. I mean, what the hell does a heavy aircraft manufacturer know about the automotive industry? One things for certain, more Americans are going to loose their jobs.


Meanwhile across the streets of Detroit; and on a littler bright side, GM led by Rick Wagoner, has posted a loss of $155 million in the third quater of 2006. I know, you're probably saying to yourself that's bad news - but it does show that at least they're not tanking it as bad as Ford is.



Buyouts offered to all of GM's U.S. hourly workers resulted in the departure of nearly 34,000 workers. A deal negotiated with the United Auto Workers union on health care is saving money. And GM halved its dividend.



If its one thing that gets the Detroit all stirred up, its healthcare. But I do think that GM will be able to pull this one out and turn themselves profitable in the future. GM is further ahead than Ford in its restructuring plans by about 2 years and still has a sizeable reserve of cash on hand. They'll most likely cut several more thousand jobs at least.

Now if Kerkorian can force Rick Wagoner into an alliance with Nissan/Renault then I'll be pretty darn sure they'll GM will pull through.


I wonder how things are going to turn out by late 2006 and into 2007.


http://www.msnbc.msn.com/id/15533910/

I can see it now Havarti666 insurance company. Why not? Create the competition if it isn't there. Produce a better product yourself than just complain and ask the government to step in.

That would be good, except for the artificial constraints on free enterprise imposed by federal and state limitations on insurance. You can't have a level playing field when someone (politicians, who receive lots of $$ from in-place insurance companies) is tilting the field.

Unemployment is actually near record lows, and it was the lowest last month in 5 years. This is in spite of the fact that healthcare costs have spiraled out of control over that time. I really don't think that these things are linked in a free market. In a Universal System, people still have to pay for healthcare. They just pay with taxes instead of premiums. The effect is probably losses of jobs, as employers now have to subsidize everyone. Right now, if healthcare becomes too expensive, an employer can drop health insurance. Employees without health insurance will still be able to buy food, shelter, and other things that are probably more related to overall health than seeing us. If the employers have to pay for health insurance through taxes, they will have to lay off employees, who will now have health insurance, but no jobs.

All this came from a bunch of uncompetetive manufacturers trying to demand subsidies and protection payed for by the tax payers.

Let the uncompetetive fail and the economy adjust.

What a bunch of turd burglars posting on this thread. :sleep:

What until they've worked you like a dog. 80 hours a week during the best years of your life for pathetic pay. To the detriment of your health and social life.

We'll see how noble you feel then, once you've finished up your residency. We'll see how much of a idealist you are. We'll see if you treat people for free, and fly the banner for "**** PAY FOR PHYSICIANS EVERYWHERE, YAY!"

They brought in a new CEO Alan Mulally from Boeing. I wonder if he'll pull Ford through - but I got some serious doubts. I mean, what the hell does a heavy aircraft manufacturer know about the automotive industry? One things for certain, more Americans are going to loose their jobs.


http://www.msnbc.msn.com/id/15533910/

Their jobs don't matter; either Ford will fail and they will be fired or they will be fired and the company will be competitive again. Unemployment is low, they will find other jobs and be payed what their skills are worth.