Socialized Medicine and its consequences [Archive]

xylem29

01-29-2007, 05:55 PM

I just saw the video - the Canadian healthcare system is definitely in need of serious fixing. The wait times are a big problem but that's the compromise we make when we have socialized healthcare.

Now, in terms of quality of care, technological advancement, and world-renowned hospitals - we are certainly not short on this. It's not as if our healthcare system is backward or third-world.

At the sametime, it's quite evident that the American system is not better than the Canadian one. Our popluations and political systems are different - so our respective systems are best for our respective countries. Healthcare in the US is in need of serious fixing too. I mean, let's assume that Lindsay did not have the money to pay for the MRI and brain surgery...in Canada, he would have eventually received it. In the US, he would've died.

Also, I'll give the OP a very sarcastic kudos for posting a video that was intensley one-sided and biased (like Moore's 9/11 doc) and using that as an example of why the Canadian system is no good. Same goes for the film maker who used ONE incident to make his biased point.

We can go on and on about which system is better, and for every example you have for the sucess of the US system, we will have an example demonstrating the sucess of the Canadian system. Both are good systems - but both are not PERFECT. The world is changing, so are our economies, and our populations - with this, stress is placed on our healthcare systems, and this needs to be addressed.

But with a US govt willing to spend a large chunk of its funds for wars and a Canadian govt unwilling to even consider a modified US two tiered system b/c of ideals - don't expect anything to be fixed anytime soon.

Shah_Patel_PT

01-29-2007, 06:01 PM

BklynWill

01-30-2007, 08:37 PM

If the Supreme Court has determined that prisoners have the right to basic health care based on its interpretation of the "cruel and unusual punishment" clause of the 8th Amendment to the Constitution, then why can't all Americans be granted this right?

logos

01-30-2007, 09:47 PM

Healthcare is NOT a right - BUT many people feel that it should be a right.

In fact, I would say given the level of complexity that our society has reached (in the post-industrial developed nations) - healthcare is a human right.

If you think that healthcare is a privelege, then you are just plain cold.

Certainly then access to food, water, shelter and clothing are rights. Afterall, these are certainly much more necessary for survival than healthcare.

The idea that healthcare is a right is patently absurd and speaks to a fundamental misunderstanding of the idea of a natural right.

Shah_Patel_PT

01-30-2007, 09:49 PM

If the Supreme Court has determined that prisoners have the right to basic health care based on its iterpretation of the "cruel and unusual punishment" clause of the 8th Amendment to the Constitution, then why can't all Americans be granted this right?

It's not a moral question of right or wrong...but it's really a financial question of who will pay for the less fortunate.

logos

01-30-2007, 09:52 PM

If the Supreme Court has determined that prisoners have the right to basic health care based on its iterpretation of the "cruel and unusual punishment" clause of the 8th Amendment to the Constitution, then why can't all Americans be granted this right?

Prisoners are denied the ability to work to pay for their own healthcare.

logos

01-30-2007, 09:55 PM

It's not a moral question of right or wrong...but it's really a financial question of who will pay for the less fortunate.

It can be a moral question. The question is are we willing to use violence (being that all taxes are necessarily taken at the point of a gun) to force those who work to pay for the healthcare of those who dont.

Shah_Patel_PT

01-30-2007, 09:55 PM

You, my friend, were schooled. I see four years of medical school were not enough. Don't worry, your fellow friends at SDN are here to the rescue.

I am not done yet...by the way...i will be finishing the MD in much less time than that (accelerated program).

Instatewaiter

01-31-2007, 01:54 AM

Certainly then access to food, water, shelter and clothing are rights. Afterall, these are certainly much more necessary for survival than healthcare.

The idea that healthcare is a right is patently absurd and speaks to a fundamental misunderstanding of the idea of a natural right.

Natural rights have little to do with what is necessary for survival. Food is needed but it is not a right. Shelter is needed but it too is not a right. Nothing can be a natural right which requires someone else to provide it for you. Look at our basic 'rights'. They all involve people NOT doing something; people can't kill you (right to life) people can't imprision you (right to liberty), they cant keep you from voting (right to suffrage) and so on. The way Locke as well as our Founding Fathers framed what constitutes a right is something which necessarily cannot impinge on someone's rights (ie forcing them to do something).

Therefore, since health care must be provided by someone who is trained in medicine, nursing, dentistry etc it cannot be a right.

As to the whole supreme court ruling about prisoners, it has to do with right of access to health care, which is just an extension of freedom to choose. It does not have to do with right to health care:

Since someone is imprisoned they cannot seek health care on their own. Thus if it is not offered by the prison it would be tantamount to the prison denying the prisoners access to health care. Again note how this is prohibiting one group from STOPPING another group from doing something.

So, the Gov't cant keep you from getting water but that does not mean that they have to provide it for you. Same idea fits for health care.

EctopicFetus

01-31-2007, 09:49 PM

trustwomen

02-01-2007, 02:44 PM

Natural rights have little to do with what is necessary for survival. Food is needed but it is not a right. Shelter is needed but it too is not a right. Nothing can be a natural right which requires someone else to provide it for you. Look at our basic 'rights'. They all involve people NOT doing something; people can't kill you (right to life) people can't imprision you (right to liberty), they cant keep you from voting (right to suffrage) and so on. The way Locke as well as our Founding Fathers framed what constitutes a right is something which necessarily cannot impinge on someone's rights (ie forcing them to do something).

Therefore, since health care must be provided by someone who is trained in medicine, nursing, dentistry etc it cannot be a right.

As to the whole supreme court ruling about prisoners, it has to do with right of access to health care, which is just an extension of freedom to choose. It does not have to do with right to health care:

Since someone is imprisoned they cannot seek health care on their own. Thus if it is not offered by the prison it would be tantamount to the prison denying the prisoners access to health care. Again note how this is prohibiting one group from STOPPING another group from doing something.

So, the Gov't cant keep you from getting water but that does not mean that they have to provide it for you. Same idea fits for health care.
That's because you only believe in negative rights and not positive rights, and take a libertarian stance. http://en.wikipedia.org/wiki/Negative_and_positive_rights

What you say above is not carved in stone, it is just your opinion of what human rights include. You have a much narrower view of human rights than do the major international bodies, as well as many countries' constitutions.

And, as mentioned in Wikipedia...

"Critics argue that the distinction between negative and positive rights is a false dichotomy. Some draw attention to the question of enforcement to argue that it is illogical for certain rights traditionally characterised as negative, such as the right to property or freedom from violence, to be so categorised. While rights to property and freedom from violence require that individuals refrain from fraud and theft, they can only be upheld by 'positive' actions by individuals or the state. Individuals can only defend the right to property by repelling attempted theft, while the state must make provision for a police force, or even army, which in turn must be funded through taxation. It is therefore argued that these rights, although generally considered negative by libertarians and classical liberals, are in fact just as 'positive' or 'economic' in nature as 'positive' rights such as the right to an education."

The video is indeed one-sided; it does not explore what would happen to Americans who don't happen to inherit a substantial sum of money at around the same time they get brain cancer. Hint: they die.

random-dude

02-01-2007, 05:02 PM

Instatewaiter

02-02-2007, 08:52 AM

The difference between what the Gov't should provide to improve its society and what is a right is a distinction that is not made, and should be made, when talking about positive rights. Sure it is a good idea to have an educated citizenry but you cannot impose your will on one group to provide the right for another group. That violates their most basic rights (which trump your silly positive rights).

Note that our founding fathers, in order to maintain personal rights intentionally steered the country away from a strong central gov't. They were concerned about protecting the citizenry from the gov't. It was not about providing for the citizens; it was about leaving them alone.

So lets use the police as an example of a postive 'right.' You are gauranteed the right to property, not the right to have someone protect your property. The right to property is an idea that you are allowed to have property and it is not right for anyone to take it unjustly from you. Again this has nothing to do with helping you keep the property.

So back to our police example to show why positive rights become problematic. The inaleinable rights are life, liberty and pursuit of happiness (or property if going by Locke). Everyone will agree that these are paramount, the most important rights. Let us assume that there are not enough people who want to be policemen. But according to the idea of positive rights you must provide protection. That means that you have to FORCE people to be policemen. This is the problem with positive rights; when people are unwilling to provide the positive right you have to subjugate their right to liberty. That is just a ridiculous notion.

Now the only way to get around the above argument is to say that there is no hierarchy of rights, that is right to protection or right to healthcare or right to education are equal to right to life, right to liberty etc.
Again this is obscene. Which would you be more outraged by: a cop who did not stop a burglar from stealing someone's TV for no reason or a cop who murders someone in cold blood for no reason? Despite the fact that the Superbowl is coming up so most of you value that TV, I think the inaleinable rights (life) have it.

Note that even when all rights are equal we dont completely disrupt the argument above. Above I was saying that exchanging a smaller 'right' for a more important one is ridiculous for obvious reasons. Now, if these rights were equal you would still be subjugating someones rights. When they are equal in weight and you are giving one at the expense of another. It is the same as never giving them the first right. Give one & take one away and you have nothing.

Look I agree that there are certain "public goods" that people won't pay for. It is a good idea that the government provide these since no one else will. There are also other services such as education that will make the country run more smoothly if everyone receives 'em. Sure, I will even say that the Gov't has a responsibility to provide these goods and services. So, these ARE right then?

No! Rights have nothing to do with govenments. Rights are not things that the Gov't feels charitable enough to give you. You don't derive your rights from any governement; the are completely independent. Any 'right' that must be provided by the Gov't is no right at all.

EctopicFetus

02-02-2007, 12:13 PM

fun stuff.. ill leave the deep discussion to those of you with more time than me. Anyways.. I will say it again.. Dont force me to do ANYTHING. Health Care is NOT a right. Finished.. the end.. Finis..

trustwomen

02-02-2007, 02:53 PM

It is wrong to steal money/property/anything from one person who has earned it and give it to someone who has not. Taking earned money from someone and paying someone elses medical bills while not giving the productive person just compensation is always wrong.

It doesn't matter if the topic is health care, wellfare, or social security....Stealing is wrong.
You must explore the meaning of "earned", or "just compensation". Do we compensate people justly in this system (or any system for that matter)? When somebody makes money, does that mean they have automatically "earned" it (which is a moral judgment)? Is the market the best moral arbiter of the amounts that people "deserve" i.e. "earn"?

I am not claiming to know the answers to these questions. I do suspect that people are not always compensated justly in the current system. Why do some people make lots of money for "work" of little social value (or no work at all)? I'm not talking welfare bums here, but rather currency speculators and the like. Why do some not get financially compensated at all, despite doing work that is enormously valuable to the collective? Here, I mean those who provide quality child care, elder care, domestic work, volunteering, political/civic involvement, etc...

It's not that cut-and-dried, is all I'm trying to say.

random-dude

02-02-2007, 06:40 PM

Well when you live in reality the market is the force that drives salaries/compensation. The market is blind to right and wrong it only goes based on need/want. I'm saying that some things are cut and dry like STEALING IS WRONG.....ie: taxation without compensation.

Income tax is taken without you getting to say where that money goes so it is basically giving you nothing in return. I can't say I want my money to go to defense/police/courts only, so I don't know where it is going. It could be going to a service that I will never use (wellfare/social security/medicaid) so it is essentially stealing at the point of a gun (ie:jailtime) which is clearly wrong.

so in closing Stealing is wrong (just in case no one got it the first three times)

Instatewaiter

02-03-2007, 01:27 PM

Income tax is taken without you getting to say where that money goes so it is basically giving you nothing in return. I can't say I want my money to go to defense/police/courts only, so I don't know where it is going. It could be going to a service that I will never use (wellfare/social security/medicaid) so it is essentially stealing at the point of a gun (ie:jailtime) which is clearly wrong.

Look I agree that a lot of your tax money goes to things that I don't agree with. However 'market forces' will not provide for everything, like 'public goods.' Left to the market and people's interests we would not have a police force or an army or a good infrastructure such as nice paved roads.

As to the whole social security/welfare issue they are actually a good thing in theory. I do not agree with their growth since first installed or how they are run but they DO strengthen the economy. During down turns these end up creating a safety net that puts money in the hands of the consumer. This money helps fuel the economy and moves us back toward an up turn.

Personally I agree with a smaller, less bureaucratic central gov't so that people are left to their own. Gov'ts job is to hold order and provide things that the citizens cannot (or would not) provide for themselves. For this reason you should not have a major say in where your taxes go.

thewebthsp

02-03-2007, 01:46 PM

But the issue of rights and responsibilities are always subservient to the politics of the day... Which means if both the Executive Branch and Congress and feel something is a right it becomes a right :rolleyes:

Of course being the strict libertarian I am, I'm somewhat aghast at the government taking over our health care system. Although "government work" usually means you can do a crappy job and leave work at 2, in medicine that's probably not (and should not) going to fly. And when the government likes to pass rules if you break those rules, you don't get fined or sued or angry calls from collections agents at 3 am, you get arrested, put on trial and sent to prison. Perhaps a less sensationalistic thing -- the NIH has passed rules that prevent any of its employees from investing in any bio/biotech firm. Let's not get started about the government and stem cell research. Basically, once you get the government involved unlike private industry you can't just find another firm -- you're stuck with the politics of the highest leader, no matter how smart or stupid he (she) is.

One important remedy would be for a unified payor/payee insurance system arbitor, kind of like transunion for credit checks. In other words, let there be a service which collates all of the health insurance bills from the various companies and deals with the overhead/etc and simply refunds physicians promptly and with much less paperwork. Let the insurance companies fund the service -- do this by having most physicians refuse to accept insurance without such a service. Instant overhead remedy and no government involvement! Another way would be towards a sole capitation model-- so long as it fairly compensated physicians, it might also be far simpler.

There may be a way to have most of the 40ish million to get some kind of basic care, maybe primarily from NPs and PAs or "minute-clinics" who would refer to a doctor when serious complications arise. Basic care should be paid by the individual. If there were catastrophic costs involved, maybe have a private foundation try and collect donations and help patients pay those enormous costs without having to resort to bankruptcy. In England they have both Internet and phone services that can help direct patients for self-care in case of mild problems which can be taken care of at home with over the counter remedies. As part of that system there can be preventive health care models, say having part of the tobacco settlement fund fund tobacco cessation programs, etc.

The real danger is that the government will take over insurance companies and then begin to progressively decrease reimbursement to 50% of what they are now, over a period of 10-15 years. At least insurance companies can be limited if there is negotiation between associations of physicians and the companies. The government can basically do what it wants by fiat of the president or congress.

logos

02-03-2007, 04:46 PM

As to the whole social security/welfare issue they are actually a good thing in theory. I do not agree with their growth since first installed or how they are run but they DO strengthen the economy. During down turns these end up creating a safety net that puts money in the hands of the consumer. This money helps fuel the economy and moves us back toward an up turn.

Well, sort of. That is called keynesian economics and it probably works to a small extent. The problem is that if the government didnt distribute that money in the form of welfare and the like, it would have either spent it or never taken it as taxes in the first place, both of which would essentially have the same stimulatory effect on the economy. ie no net difference.

Thomasss

02-07-2007, 02:19 PM

I hate it that things like roads and police and firefighters are financed with MY stolen money. These should all be financed with private money. What a great world that would be!
Oh wait, they used to do that already. Firefighters used to not save houses that didn't have the firefighter medallions on them since they hadn't paid for these services. But guess what, society deemed that it was important to pay for these with public funds because it was a benefit to society as a whole.
You see no person is truly an individual, so going of of purely "individual rights" no matter how they are defined is incomplete. Eg, my right of the "pursuit of happiness" would be curtailed if it involved killing people, or in some places even not cutting my grass often enough (which I personally think is ridiculous, but anyway)!
The money you make is NOT YOURS! It exists because you have made it within a certain environment. That environment must be paid for by *gasp* taxes. A government without taxes is no government. By following your logic, then all elected official are stealing our money with their salaries and we should basically have anarchy. I don't think doctors would do very well under those circumstances.
This is not only about what is constitutionally considered a right, because that has been and will be interpreted differently at different times. It is also about whether society is better off or not. Excessive social inequality (whether it be by education, health care, etc...) is bad for society. Some inequality, especially income, is unaviodable and in fact beneficial. Society of course needs economic winners and loser to create incentives. But there are basic things that as a rich nation many agree we should all have, for the best functioning society. Excessive inequality leads to crime, prejudices, addictions, and more. You're a bunch of docs and should stop pretending to be economists. Adam Smith was 1776, hopefully we come up with something better since then. And if any of you had actually read him, you would find that he actually is not for "unrestricted" capitalism (an oxymoron because capitalism is in fact a system, so of course is made of rules and restrictions) and has some support for socialism practices.
The fact is, we are have some socialism, which as we all should know is what brought us out of the great depression (i'd call this better for society, wouldn't you?)
The Canadian is in fact being very polite. He is correct when he states that different countries are different and placing some other country's system plop right on top of another country's system. But he was too nice to press for the fact that the US can and should devise its own universal system for its citizens.
I also doubt the statistics of the fact that half can afford it. I have many friends working hourly jobs that can't afford healthcare. If you have a pre-existing condition, be it even just OCD or irritable bowel syndrome, then health care can be out of reach on a waitress' salary. Even if it is "within reach" we all have a cost-benfit system, and many choose to gamble rather than use the small amount of disposable income on health. To force everyone to pay into this system is needed? If it can be made affordable for everyone, then yes. Even if this means that some may only be able to afford a 55 inch TV instead of a 70 inch plasma screen.

Dr. Roket

02-07-2007, 03:43 PM

Certainly then access to food, water, shelter and clothing are rights. Afterall, these are certainly much more necessary for survival than healthcare.

The idea that healthcare is a right is patently absurd and speaks to a fundamental misunderstanding of the idea of a natural right.

How does it go, Life, liberty, and the pursuit of happiness? I would say these three things imply certain rights to all members of society if not implicitly. I would further say that healthcare is a greater fundamental necessity than say education, but we all agree that all americans have a right to an education.
It also seems to me that there is most likely more to this story than the film makers let on. Is there a shortage of medical facilities in canada capable of performing MRI's, why the long wait time? Why is it that there is so much crowding in the MRI system in canada but not the U.S.? Clearly the U.S. has the capacity to treat all the individuals who need MRI's if we are able to handle the canadian overflow in a month, maybe it's the 40 million uninsured that have no access that are freeing up the system but I doubt it.
Honestly I see this problem as not a fault of the program, but a problem of the implementation strategy which can easily be resolved by structuring facilities to handle the greater demands for MRI. This may mean more to the canadian taxpayer but when stretched over the entire population, and if it really is as a big problem as they make it seem, one I am sure they can easily tolerate.

random-dude

02-07-2007, 06:25 PM

Thomasss,

Your right my money is not mine, just like my medical degree (hopefully in 6 months) will not be mine. Just as my state license is not mine because all of these things are part of systems. In fact by that logic nothing is mine or yours or anybodies. If that is true then why do we need police, judges, courts or anything. Since nothing belongs to anyone then anyone has a right to it (money, property, ideas) why do we get upset when someone robs a bank, or steals a car, or kills someone.

That sounds like anarchy to me.

People will pay for services such as police, firefighters, courts, military, even roads if there is incentive to do it. Owning property is an incentive to pay for most of these things.

But since I don't own property by your logic then your right, f*** it I don't need to pay for anything because I can't benefit from it in anyway. If my house burns down I'll steal my neighbors since he doesn't own his house and I have a right to it.

thewebthsp

02-07-2007, 09:42 PM

Thomass, (funny name heh) think about what you're saying for a moment. Think hard. I'm a libertarian not an anarchist!

Fortunately we don't live in a country that says individuals have no right to property. My parents fled that kind of crappy system. No one said we need to abandon the dying on the streets. This country does need to fix a horribly broken health care system; and the fact is, there does seem to be a need for some kind of basic covered care for everyone. Besides which, the overhead alone is sucking 10% of our GDP.

But that doesn't mean everyone should get the same care, or that everyone _deserves_ the same thing. Obviously if a person is acutely ill/near death, as a physician it is ethically obligatory to treat the person. But at the same time physicians are people too; and our work and our innovation should be fairly rewarded.

Anyway, this is a moot point. The US is a mostly capitalistic country, and not a socialist nor communist one. We have the right to property, free speech and ownership of firearms because the founding fathers determined individual liberty > communal well being in most cases during peacetime. The tide was somewhat turned in the 30s but we are not Sweden, Israel or Belarus. For better or worse. I'm still against the horrendous taxes on investment and estate taxation. (since you're getting taxed twice or three times for the same income!)

By the way, the notion of a strong state trumping individualism is the hallmark of a fascist society (not necessarily nazi though).

Thomasss

02-08-2007, 10:20 AM

I like my name Thomasss, I use it in a few different forums. It gives people a cheap shot at me. Everyone loves cheap shots, so I like to provide to them. That way I can take em as well! ;)
I have thought about this. A lot. I understand a lot about foreign societies and governments. What Americans don't realize is that WE are the extreme, not those with socialist practices. Any thought that carries a trend towards socialist or the idea of the common good occasionally having an effect gets tarred as facist and communist in the US. This is a lack of understanding.
Actually, absolute individualism would be anarchy. If anybody could do as they please, this is lack of anything.
There is plenty of accountability in the US. Many people that don't pursue a practical path to a more stable and productive life do so because of inequity, lack of perceived opportunity and such. Sure there are rich and middle income kids that do nothing, but higher incomes aren't gonna motivate them, they're dissillusioned and/or spoiled.
A lack of a nuanced picture leads to extremeness and fundamentalism. Think hard. Any extreme form of government and economic system has its faults. What should be done is to uphold that system, but have a damage control to minize the negatie effects of the system. Capitalism is the best we have and for all its faults provides pretty darn well. But socialist interventions can help pick up where the system lacks. Our capitalist system would even be supported by some interventions. One of the many reasons our auto companies are dying and creating large pockets of crime and poverty-- expensive healthcare. A social network of healthcare would move away from emplyee-based care that is a burden on our businesses. One reason why China is as well of today is due to providing (for its income level) decent healthcare and education. Interventions like this are a far cry from anarchy or fascism, two completely opposing ideologies which my thoughts simultaneously somehow got accused of.
To say nothing should belong to anyone is indeed an extreme view, and I admit I don't truly advocate that. I also took an extreme side, but it was to show that you DO owe society something for where you are today and are not completely justified in no paying back for where you are today.
Now as for choosing where your money, I suppose we could each have on our taxes box to check which program our money goes to. Sounds pretty scary and inefficient to me though.

random-dude

02-08-2007, 08:24 PM

I have thought about this. A lot.
So have I.

I understand a lot about foreign societies and governments. What Americans don't realize is that WE are the extreme
There is nothing wrong with being "the extreme" if you are right (and I believe we are)

Actually, absolute individualism would be anarchy. If anybody could do as they please, this is lack of anything.

Individualism is not anybody doing as they please, or at least not the way that I mean individualism. You can be an individual and still respect the rights of other individuals. In this type of society the individuals recognize that others have the same rights to life, liberty, property that you have.

Think hard.
I'll try. Also you alluded earlier that we are doctors not economists. Well some of us were workin' stiffs before medical school and were economists, philosophers ("do you want fries with that?"), and read books by Adam Smith/John Locke/Fredrick Bastiat/and here it comes Ayn Rand. Just because I'm going to be a doctor doesn't mean I don't know what I'm talking about.

you DO owe society something for where you are today and are not completely justified in no paying back for where you are today.
Look I'm not saying that people don't rely on each other. I rely on others all the time. What I am saying is that I never force someone to give me something that they do not want to give me. I don't cheat/steal/use force first. And no I don't feel I owe society anything.

I believe taxing = stealing. At least the way we do it in this country right now. Programs like social security/welfare/medicaid are wrong and I don't want to see any more of my earned money stolen to pay for services I don't use.

I love this discussion by the way...

thewebthsp

02-08-2007, 10:41 PM

The philosophy of state before individual is acutely demonstrated in Starship Troopers-- I'd advise you to see it Thomas, if you haven't already. Its genius is not the action movie quality of the film, but the satire of fascism -- albeit in a state of war against...er alien bugs. But it's effective. Also in the film you see a tearing down of ethnic and gender roles, the president is a black woman, the best pilots women (not to mention that men and women do everything together, infantry). But the society/government is inherently fascist-- military service for citizenship etc etc. The bugs are actually responding to the colonization of their space by humankind... It's a fascinating movie.

Much of Chinese government economic strategy is likewise fascist-- the government is highly involved in many stages of its "capitalistic" framework. And it also downgrades individual rights and bans people from freely associating (Falun Gong).

e_phn

02-09-2007, 05:38 AM

The impact of socialized medicine:

http://www.youtube.com/watch?v=X_Rf42zNl9U&eurl

If I were the Canadian govt., I would change their health care system...

Also, I heard somewhere that lots of Canadian docs come to the US to practice medicine....not sure if that's true or not...

Thomasss

02-09-2007, 08:48 AM

thewebthsp: I've already stated that I am not into the extreme gov't of fascism. I need not state this again and will no longer respond at attempts to tar me as supporting fascist and communist regimes. The world is not black and white. Every gov't chooses to sometimes put the good of the many above the good of the individual. It is simply where the balance lies that we differ. I am for a free scoiety, but occasionally yes, these freedoms must be restricted in order for the good of society. They already are in the US. You need a driver's liscense to drive, you can't support a terrorist organizations, you can't just build a house wherever you like. DO you really even believe the right to bear arms should be totally unrestricted? How about small independent organisations getting WMDs? As bad as the gov't has acted lately, I trust them above individuals in usage of those!

Thomasss

02-09-2007, 09:09 AM

Randomdude:
I'm truly glad you're here to kick me off my soapbox. It needed to be done. My thinking statement was more directed towards someone else who told me to "think hard", but you are correct in nailing me on my assumption that I'm smarter than everyone else, cuz I'm not.
And congra-rats on your soon-to-be medical degree. Your a smartie and should do well.
And while you are more well read than me on Western philosophy I'm sure (never read Bastiat), I will note that everything you've noted is within the same liberatarian category. Other influence should hopefully be included. Even when I read the daily news, I read alternet and the national review online to get opposing POVs (however, most extreme news sources like both of those are 80% ideological garbage). I'll go ahead and say it: even read *gasp* Marx. Believe it or not, he was also a smart cookie and has a lot of interesting things to say. It's those lousy Lenin and Mao characters that screwed everything up into the extreme socialist ideologies that the US sees Marxism as these days.
Anyway, the discussion is fun, but both of our minds are essentially closed. The differences come from a difference of basic world view which lead to a difference in morals and ethics. The same fact can be seen in different ways by both of us. Say if both of us have a poor childhood and arrived to the success of where we are today (which may we be the truth for both of us). You would take the POV that an extreme individualist and capitalist system led you to work hard and take the opportunities that drive to a greater productivity. However I would say productivity in not the ends, but a means, and that I should not have been put as such a large disadvantage (and continue to be) because I was born in such an unfortunate situation.
I believe that you know that the system provided you for your success, but I don't believe you truly feel it. I believe this very strongly to the core, down to the fact that free-will in actually an illusion. But lets not get into that.
What are the purposes or rights and freedoms? It is not some absolute right or wrong, cuz there is no such thing. All rights are actually determined by human societies. It was (correctly) determined by modern Western societies that many individual rights need to be protected. This is actually done because it is best for all the individuals in that society. However, occasionally the common good must take precedent for the common good of society. The individual must pay back for what has been given AND earned by him in order for the betterment of society as a whole. I could go on and on, but its gotten out of hand...

Thomasss

02-09-2007, 09:11 AM

oh and if you wanna get into falun gong and the western misconceptions about that situation, we would need to start a new thread. they are not simply a "freely associating" organization.

Shah_Patel_PT

02-09-2007, 03:38 PM

If I were the Canadian govt., I would change their health care system...

Also, I heard somewhere that lots of Canadian docs come to the US to practice medicine....not sure if that's true or not...

I personally have lots of friends who are personally trying to get out of Canada.

Lot of medical students are desperately trying to match in the USA.

EctopicFetus

02-11-2007, 12:20 AM

Nationalized healthcare is bad.. unless you think the guy flipping burgers should outearn you.

If you do get to it.. when it happens Ill be lining up for a job at Wendys.. The fringe benefits are better..

EctopicFetus

02-11-2007, 12:21 AM

OncoCaP

02-12-2007, 12:14 AM

I personally have lots of friends who are personally trying to get out of Canada.

Lot of medical students are desperately trying to match in the USA.

I heard it's because it's too tough to get into medical school in Canada. What I have read is that a U.S. student has almost no chance of getting in with a Canadian med school.

OncoCaP

02-12-2007, 12:16 AM

Or maybe walmart.. when the govt is done with them they will become a big slumbering wasteful corp who will be wasting money.

Hmm sounds like the government we have now..

I guess our Congress doesnt want to be shown up..

Hi Ectopic: I'm pro single-payer myself. Will it make medicine unbearable? I doubt it. It might even raise our pay for a while.

thewebthsp

02-12-2007, 12:35 AM

Likely pay would become more uniform.. instead of 300-1,000 K for specialists and 120K for generalists, pay would be 160-180K for everyone. SOunds very communistic.

OncoCaP

02-12-2007, 12:40 AM

Likely pay would become more uniform.. instead of 300-1,000 K for specialists and 120K for generalists, pay would be 160-180K for everyone. SOunds very communistic.

Seems like it would be difficult to predict the future precisely. It would be a good idea for physicians to participate in the political process as much as they can given their limited time.

Why do you think pay would become more uniform? Why do you think pay is not more uniform now and what do you expect will change this?

OncoCaP

02-12-2007, 12:50 AM

http://www.pnhp.org/
The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 46 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment though a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

*********

http://www.pnhp.org/news/2007/february/migration_of_canadia.php
Over the past five years, the proportion of Canadian physicians moving in and out of the country has decreased by 30.6%. While both the number leaving and the number returning to the country are on the decline, Canada has seen a larger decrease in the number of physicians leaving the country. As a result, the proportion of physicians returning to the country is now greater than the proportion leaving.

tantrum

02-12-2007, 08:32 AM

Even in countries with nationalized healthcare like Canada, pay scale will NEVER be uniform. It's still procedure-oriented but they used different codes (not CPT codes). The surgical fields still come on top but some family practitioners can make as much money (especially those trying to kill themselves working) as some non-surgical specialists. I've worked there, and there is just too many burnouts (especially FPs and Emerg. Meds). You have to work a LOT harder to get the same income.

thewebthsp

02-12-2007, 10:13 AM

In other words, while the income disparity isn't totally reduced, it is much reduced...

I can see this being good in some ways, with docs choosing fields based more on their love of the specialty than on money... but the problem is that it still causes a disincentive for quality, and innovation that a more free market system encourages. Medicine I agree isn't exactly amenable to a purely supply and demand system. Still I'd like to avoid the Canadian system, wherein some doctors actually have a "salary cap."

kugel

02-12-2007, 12:27 PM

Stealing is wrong.

Correct, stealing is wrong.
Taxes are not stealing.
We all have a choice. We are free to opt out of the system and renounce citizenship in order to live elsewhere.

You make a choice to belong to a system that includes requirements you don't like (US citizenship, hospital bylaws and policies, union membership, homeowners' association, church or temple, etc.). Don't just complain. Have the courage to do what you think is right: either comply with the rules to which you agreed, work to change them, or drop out of that system. If you choose to attempt to change the rules by defying them, have the courage to do it openly and accept the consequences.

Thomasss

02-12-2007, 12:35 PM

As much as I disagree with random-dude, I don't think that is really relevant either. He has a right to try to stay in the US and vote for changes in the system that follow his ideology. Everyone has things they don't like about where they live, it doesn't mean they should all just leave. Dude will vote for conservative of the liberatarian flavor leaving the underprivelaged to rot and I will vote for a bunch of fascist commies to come and support deadbeats and criminals and decrease the productivity of our capitalist society. Criticism from all sides is necessary on issues, not kicking out the dissenters.

thewebthsp

02-12-2007, 12:57 PM

taxation isn't per se stealing, but uncontrolled government spending usually is...

Basically -- people in the government --> friends of these people --> get massively inflated contracts and sometimes do a decent job, and sometimes a terrible job...

For example --> outsourcing of "rebuilding" in Iraq --> billions of dollars missing

That's why so many republicans are in arms about how massively the executive branch expanded the government

social security and medicare are in theory good systems, but highly inefficient

random-dude

02-12-2007, 09:27 PM

Correct, stealing is wrong.
Taxes are not stealing.
We all have a choice. We are free to opt out of the system and renounce citizenship in order to live elsewhere.

You make a choice to belong to a system that includes requirements you don't like (US citizenship, hospital bylaws and policies, union membership, homeowners' association, church or temple, etc.). Don't just complain. Have the courage to do what you think is right: either comply with the rules to which you agreed, work to change them, or drop out of that system. If you choose to attempt to change the rules by defying them, have the courage to do it openly and accept the consequences.

Yeah.....your right we all have a choice and currently I'm choosing to stay in the most free country in the world and try to spread the word about liberty being better than dependance. By that I mean dependance on the government to provide healthcare/education/social security. Right now I am abiding by the current laws and working to change them for what I believe to be better. If the country became less free than any other country in the world then I'd seriously consider leaving.

random-dude

02-12-2007, 09:30 PM

He has a right to try to stay in the US and vote for changes in the system that follow his ideology. Everyone has things they don't like about where they live, it doesn't mean they should all just leave. Dude will vote for conservative of the liberatarian flavor leaving the underprivelaged to rot and I will vote for a bunch of fascist commies to come and support deadbeats and criminals and decrease the productivity of our capitalist society.

I agree with the fascist commie on this one. Free thought by the individual is what makes this country great and leads to change.

random-dude

02-12-2007, 09:37 PM

taxation isn't per se stealing

When money is taken from a productive person (taxation) and given to another person without allowing the productive person to designate where the funds go, it is stealing. It is completely black and white to me. taxation=stealing currently. If I could say I want my tax money to go to defense/police/courts (services I use) then it would not be stealing. But because my tax money goes to programs like social security/medicaid, programs which I will never use, taxation = stealing.

That's why so many republicans are in arms about how massively the executive branch expanded the government

I am not a fan of this president for that reason and a few others.

social security and medicare are in theory good systems, but highly inefficient

I disagree for the above reason. Stealing = bad system.

Instatewaiter

02-13-2007, 09:17 AM

Yeah.....your right we all have a choice and currently I'm choosing to stay in the most free country in the world and try to spread the word about liberty being better than dependance. By that I mean dependance on the government to provide healthcare/education/social security. Right now I am abiding by the current laws and working to change them for what I believe to be better. If the country became less free than any other country in the world then I'd seriously consider leaving.

I think its funny how much the words 'freedom' and 'liberty' have been cheapened by the current administration. I just laugh now when people say stuff like 'I am for liberty' and this 'I love our free country.'

As to the whole socialized medicine thing, I don't think anyone is saying that in theory it is not an excellent idea. On paper it looks great but I think people have issues with how it will be carried out and the implications of deriving your pay check from the Govt. The Gov'ts track record is not exactly strong when it comes to managing money or social programs.

OncoCaP

02-13-2007, 01:27 PM

I think its funny how much the words 'freedom' and 'liberty' have been cheapened by the current administration. I just laugh now when people say stuff like 'I am for liberty' and this 'I love our free country.'

As to the whole socialized medicine thing, I don't think anyone is saying that in theory it is not an excellent idea. On paper it looks great but I think people have issues with how it will be carried out and the implications of deriving your pay check from the Govt. The Gov'ts track record is not exactly strong when it comes to managing money or social programs.

Hi Instatewaiter: I think the system might be similar to education or public works (roads). These aren't perfect systems, but they do work. No one goes without the opportunity for education or has to drive around in dirt and rocks (unless they choose to live in the countryside, perhaps).

Thomasss

02-14-2007, 01:06 PM

Instatewaiter:
Read the whole thread again. There is very much a resistance to socialized medicine whether it works or not. Just as there is a resistance to the existing welfare even though it currently works. Due to following reasons:
1) People don't want to give money they feel they earned and others didn't. This was what much of my previous posts were regarding
2) In every system there are cheaters and inefficiencies. Of course in increasing socialism, there will inevitably be more cheaters in the system and people focus on this (see #1, heh).
3) There is often a lack of real debate on socialized medicine because of the previous 2 reasons.

You have to convince people its morally acceptable to have something before you even discuss whether its viable. Is it viable? Of course it is! Why wouldn't it be, we're the richest country in the world. Yes, you need a functioning system. Throwing money at something doesn't always improve it or make it workable. But if a real honest and open effort were made and thoroughly discussed, There would definitely be a workable system. Its just whether we would find and implement it.

Shah_Patel_PT

02-14-2007, 01:11 PM

The impact of socialized medicine:

http://www.youtube.com/watch?v=X_Rf42zNl9U&eurl

I am so glad my post led to so much discussion.

So in the end....do you think the democrats (hilary/edwards) are going to socialize medicine in the USA if they get to the White House?

Thomasss

02-14-2007, 01:27 PM

I have a question for everyone: child healthcare. This has been increasingly in the spotlight and the previous arguments seem not to hold up as well regarding children. Society obviously believes that children are less responsible for their actions and should not be held as accountable (different jails and sentencing, fewer individual freedoms, more legal and financial responsibility, etc...) Should children pay the price for their parents sins? Should parent lack healthcare because their parents can't or won't pay for adequate healthcare?
In other words, would people be opposed to a socialized healthcare providing for all up to the age of 18. I can at least see the argument that once one is an adult they should be held more accountable for their choices, actions, and destiny, but I strongly believe children should not pay the price. Many states and cities are approaching this viewpoint as well.

As for any dems, I think a discussion about socialized healthcare will begin, but I can't see a full scale socialized medicine come into place. And unfortunately, the idea of employer-paid healthcare seems too embedded in the system to have what would require either baby steps of change, or essentially a minor revolutiion.

But the currently practicing docs'd prolly know better than me about that.

foo

02-15-2007, 10:07 AM

The impact of socialized medicine:

http://www.youtube.com/watch?v=X_Rf42zNl9U&eurl

The video tells the story of an individual that had extreme difficulties obtaining urgently needed health care in Canada.

The video implies that this is probably not an exception case but it does not provide any statistics as to how often this is happening in Canada.

It clearly demonstrated an instance of a very serious problem and raised the following questions:

- Is there a shortage of MRI scanners in Canada?
- Are there sufficient neurosurgeons in Canada?
- Are there problems prioritizing who gets scheduled at the front of the queue to have an MRI study in Canada?
- Are there problems prioritizing who gets scheduled for urgently needed neurosurgery in Canada?

It looks like the creators of the video decided to use this very compelling story to lobby for their cause, which seems to be, to make private health insurance legal in Canada. They did not discuss the obvious possible shortages, insufficiencies, or scheduling questions, or discussed specifically how the current health care system should be improved. Instead, they jumped to a conclusion based on their agenda.

The Canadian health care system in my opinion is less broken than the system in the US. I am sure Canadians will focus on needed improvements, most people in Canada seem to prefer their simple but flawed system over our complex, expensive, and flawed system in the US.

Since the topic seems to be private health care insurance, and since we are jumping to implications for how to improve the health care system in the US, I ask SDN readers to please take a look at the following relevant article in the NY Times ("A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It", By ROBERT H. FRANK, Published: February 15, 2007): http://www.nytimes.com/2007/02/15/business/15scene.html?ref=health

I like the idea of a single payer system that reduces our out of control overhead costs, from 31% to 17% (saving a substantial amount of money, without affecting actual care). Most of the savings would be the result of eliminating the cost for rooting out insurance candidates that are a poor risk so that the insurance companies can deny coverage.

I agree with the article, I don't believe private insurance companies are evil (please browse the discussion in links in the article for an excellent discussion); I like the idea of health care vouchers that would keep private insurance companies healthy and in business under a single payer system in the US.

What do you think?

thewebthsp

02-15-2007, 12:04 PM

Well like I posted in some other threads earlier, maybe a "one health service, two systems" might be the happy medium. Sounds like China when it took over Hong Kong, but basically we keep private insurance as is and we fund everyone with some level of basic coverage...

I am still highly skeptical of government "efficiency"; at least this government.

The video tells the story of an individual that had extreme difficulties obtaining urgently needed health care in Canada.

The video implies that this is probably not an exception case but it does not provide any statistics as to how often this is happening in Canada.

It clearly demonstrated an instance of a very serious problem and raised the following questions:

- Is there a shortage of MRI scanners in Canada?
- Are there sufficient neurosurgeons in Canada?
- Are there problems prioritizing who gets scheduled at the front of the queue to have an MRI study in Canada?
- Are there problems prioritizing who gets scheduled for urgently needed neurosurgery in Canada?

It looks like the creators of the video decided to use this very compelling story to lobby for their cause, which seems to be, to make private health insurance legal in Canada. They did not discuss the obvious possible shortages, insufficiencies, or scheduling questions, or discussed specifically how the current health care system should be improved. Instead, they jumped to a conclusion based on their agenda.

The Canadian health care system in my opinion is less broken than the system in the US. I am sure Canadians will focus on needed improvements, most people in Canada seem to prefer their simple but flawed system over our complex, expensive, and flawed system in the US.

Since the topic seems to be private health care insurance, and since we are jumping to implications for how to improve the health care system in the US, I ask SDN readers to please take a look at the following relevant article in the NY Times ("A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It", By ROBERT H. FRANK, Published: February 15, 2007): http://www.nytimes.com/2007/02/15/business/15scene.html?ref=health

I like the idea of a single payer system that reduces our out of control overhead costs, from 31% to 17% (saving a substantial amount of money, without affecting actual care). Most of the savings would be the result of eliminating the cost for rooting out insurance candidates that are a poor risk so that the insurance companies can deny coverage.

I agree with the article, I don't believe private insurance companies are evil (please browse the discussion in links in the article for an excellent discussion); I like the idea of health care vouchers that would keep private insurance companies healthy and in business under a single payer system in the US.

What do you think?

Thomasss

02-15-2007, 02:50 PM

Thomasss

02-15-2007, 03:03 PM

Oh, and HK wasn't more free and didn't have democracy when it was under the Brits either, so I suppose under them it was "one country two systems" as well.

foo

02-16-2007, 12:12 PM

Does anybody know anything about the swiss system? I looked it up real fast because I figured it might fit US values more (practioners remain private and aren't gov't employees, swiss customers expect cutting edge treatment).
I looked it up real quick and found this:
http://www.civitas.org.uk/pdf/Switzerland.pdf
If you look at the end it mentions the drawbacks. I put this up just as for a discussion and to point out the fact that through exploration we may find systems that retain some degree of competition. Health seems to be provided more through extensive regulations, rather than the government actually providing the care itself.
Again, I'm not claiming this is perfect (nothing is) or even that we should adopt this system either wholesale or even partially. Just for discussion for those who may have researched it more than I.

The Canadian system has more similarities, compared with the US system, than with the Swiss system (in my opinion)...

Canada's health care system is a publicly funded health care system, with most services provided by private entities... See: http://en.wikipedia.org/wiki/Health_care_in_Canada

Health care in the United States is provided by many separate legal entities... See: http://en.wikipedia.org/wiki/Health_care_in_the_United_States

A comparison of the health care systems of Canada and the United States... See: http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

I love wikipedia!

The French system is arguably "the best" at delivering good quality care at a reasonable cost, followed by the Italian. It depends of course on what criteria one thinks is important. (No system is perfect).

foo

02-16-2007, 01:14 PM

...I don't believe private insurance companies are evil...

Perhaps I was wrong? :o

The second largest US insurance company has been accused of "racketeering". See: http://select.nytimes.com/2007/02/16/opinion/16krugman.html

Looks like the government may need to change "the rules of the game" for insurance companies through legislation:

"...the larger problem isn’t the behavior of any individual company. It’s the ugly incentives provided by a system in which giving care is punished, while denying it is rewarded."

OncoCaP

02-17-2007, 09:07 PM

....

Since the topic seems to be private health care insurance, and since we are jumping to implications for how to improve the health care system in the US, I ask SDN readers to please take a look at the following relevant article in the NY Times ("A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It", By ROBERT H. FRANK, Published: February 15, 2007): http://www.nytimes.com/2007/02/15/business/15scene.html?ref=health

I like the idea of a single payer system that reduces our out of control overhead costs, from 31% to 17% (saving a substantial amount of money, without affecting actual care). Most of the savings would be the result of eliminating the cost for rooting out insurance candidates that are a poor risk so that the insurance companies can deny coverage.

I agree with the article, I don't believe private insurance companies are evil (please browse the discussion in links in the article for an excellent discussion); I like the idea of health care vouchers that would keep private insurance companies healthy and in business under a single payer system in the US.

What do you think?

I liked the concept of the voucher system overall. It leaves the door open to specialized government programs (people with certain disabilities, etc. that private insurance might not want to cover, people in regions that private insurers might not prefer to do business in, etc.). It makes use of private market and that could have customization, flexibility, as well as economic and innovation advantages. However, it would be a challenge to administer and implement because there would be potentially thousands of plans to choose from and consumers would struggle sorting it all out (what plan to pick, consumers rapidly switching plans as incentives like toasters are offered). Also, it might be difficult to detect and control fraud. People could also slip between the cracks (thought they transferred but something went wrong). On the billing side, I'm not how well that would work either. However, these issues can be overcome and could be weighed against other systems.

EctopicFetus

02-19-2007, 11:24 AM

I am so glad my post led to so much discussion.

So in the end....do you think the democrats (hilary/edwards) are going to socialize medicine in the USA if they get to the White House?

Yes, they have said so.. Of course Edwards would socialize medicine, and then encourage his fellow trial attorneys to sue us regardless and then we can sleep under bridges some some of our patients.

Shah_Patel_PT

02-19-2007, 11:32 AM

Yes, they have said so.. Of course Edwards would socialize medicine, and then encourage his fellow trial attorneys to sue us regardless and then we can sleep under bridges some some of our patients.

It's really sad how medicine in the USA has changed.

I still remember when I was in elementary school.....all the good things I heard about doctors in the early 1980s.

All of those peak years for physicians are gone....now the lawyers are taking over our noble profession and there is really NOTHING we can do as medical students!!!!

OncoCaP

02-19-2007, 02:50 PM

It's really sad how medicine in the USA has changed.

I still remember when I was in elementary school.....all the good things I heard about doctors in the early 1980s.

All of those peak years for physicians are gone....now the lawyers are taking over our noble profession and there is really NOTHING we can do as medical students!!!!

Ah yes, the 80s:

Ronald Reagan
Live Aid
J.R.
Madonna
Break-Dancing
Sweats
Geraldine Ferraro

To be honest: I'm glad they are over. They were nice for a while, but I'm not looking for a Groundhog Day (Bill Murray) experience.

Doctor is still one of the most admired & respected professions (for example #2 after firefighter on this list: http://www.forbes.com/leadership/2006/07/28/leadership-careers-jobs-cx_tvr_0728admired.html). Physician is still one of the most highly paid professions in the U.S. (if money floats your boat). Moreover, we have an aging population that is going to want us more than seniors did in the 1980s. There are still many good things about being a physician, and we're getting some attention (I guess it's positive) from certain TV programs.

Yes, we need to deal with lawyers, but we have defensive medicine to at least mitigate that. It's not that bad at the moment.

Shah_Patel_PT

02-19-2007, 03:05 PM

Ah yes, the 80s:

Ronald Reagan
Live Aid
J.R.
Madonna
Break-Dancing
Sweats
Geraldine Ferraro

To be honest: I'm glad they are over. They were nice for a while, but I'm not looking for a Groundhog Day (Bill Murray) experience.

Doctor is still one of the most admired & respected professions (for example #2 after firefighter on this list: http://www.forbes.com/leadership/2006/07/28/leadership-careers-jobs-cx_tvr_0728admired.html) (http://www.forbes.com/leadership/2006/07/28/leadership-careers-jobs-cx_tvr_0728admired.html)). Physician is still one of the most highly paid professions in the U.S. (if money floats your boat). Moreover, we have an aging population that is going to want us more than seniors did in the 1980s. There are still many good things about being a physician, and we're getting some attention (I guess it's positive) from certain TV programs.

Yes, we need to deal with lawyers, but we have defensive medicine to at least mitigate that. It's not that bad at the moment.

encouraging indeed!

Jadyn

02-19-2007, 04:35 PM

OncoCaP

02-19-2007, 05:52 PM

Is it even possible to aptly compare the US to other countries with socialized medicine. We have 10 times the amount of people Canada has, and no country with our resources even comes close to the immigration issues we face. I think some level of basic healthcare for children, regardless of immigration status, should be in place above what exists now, but comparisons to other countries are really limited.

Well, ok. If you hate working with large systems, then break it down by state. Start with Wyoming, population 506529 (2004), and work your way up.

http://wyominguninsured.state.wy.us/
"A comprehensive Wyoming study of the uninsured in Wyoming indicates that one in seven Wyoming citizens are uninsured and many of these citizens need help to obtain coverage. The cost of health insurance and the cost of health care coupled with low wages is seen as the major cause for folks being uninsured. The consequences to the individual, the family, the health care provider, and the community are high. Developing options to spend health care dollars proactively to expand health insurance to the uninsured will result in care being provided early when it is least expensive and most effective.

http://wyominguninsured.state.wy.us/WaiverStudy1.21.05.pdf
"The increasing lack of health care coverage
continues to affect access to care and place
financial stress on individuals, families and healthcare providers. Nationwide, the number
of nonelderly uninsured increased from 16.1 percent to 17.7 percent between 2000 and 2003.1
In Wyoming, the number of nonelderly uninsured has increased from 18.1 percent to 19.2
percent since 2000.2
The increase in the uninsured has been driven by the decline in employer-sponsored
insurance and the increase in the number of individuals below the poverty level.3 While
children s coverage has not declined nationwide over the same time period due to increases
in public healthcare coverage programs such as Medicaid and the State Children s Health
Insurance Program (SCHIP), this has not been the case for adult populations.4 The working
poor between the ages of 19 and 64 have the least number of options to obtain coverage as
they may earn too much to qualify for public health insurance programs and may not have
access to (or be able to afford) employer-based coverage.

********
Here is a story with a more national focus from the Wall Street Journal (reposted). It show how our current system results in extreme waste of $20 billion dollars to do nothing but deny claims as aggressively as possible on the one side and challenge denials on the other (each side spends about $10 billion apiece) -- great use of our healtcare insurance premiums -- we are paying for this junk. This of course the tip of the iceberg as hundreds of billions of dollars are wasted on administration that does nothing to provide more or better healthcare care.
http://www.pnhp.org/news/2007/february/excess_administratio.php
Fights Over Health Claims Spawn a New Arms Race
By Vanessa Fuhrmans
The Wall Street Journal
February 14, 2007

Doctors increasingly complain that the insurance industry uses complex, opaque claims systems to confound their efforts to get paid fairly for their work. Insurers say their systems are designed to counter unnecessary charges and help keep down soaring health-care costs. Like many tug-of-wars over the health-care money pot, the tension has spawned a booming industry of intermediaries.

It’s called “denial management.” Doctors, clinics and hospitals are investing in software systems costing them each hundreds of thousands of dollars to help them navigate insurers’ systems and head off denials. They’re also hiring legions of firms that dig through past claims in search of shortchanged payments and tussle with insurers over rejected charges. “Turn denials into dollars,” promises one consultant’s online advertisement.

The imbroglio is costing medical providers and insurers around $20 billion — about $10 billion for each side — in unnecessary administrative expenses, according to a 2004 report by the Center for Information Technology Leadership, a nonprofit health-technology research group based in Boston.

Some companies are profiting from arming both sides. Ingenix, a unit of UnitedHealth Group Inc., the country’s second-biggest health insurer, sells insurers systems to screen doctor’s claims while promising doctors its software for them will “help you take a more assertive stance on fair and accurate payment.”

The denial-management industry’s rise shows how much of medical spending is consumed by propping up and doing battle over an arcane patchwork of claims systems. Roughly 30% of physicians’ claims are denied the first time around. Sales of physician-billing and practice-
management technology grew 25% to more than $7.5 billion last year, estimates Jewson Enterprises, a health information-technology research firm in Austin, Texas.

Some doctors say they see insurers stepping up efforts to keep a lid on reimbursements. One increasingly popular tactic among health insurers is to hire “health-care claims recovery” teams or software to dig through claims, some as old as two years, to see if they overpaid and seek redress. That’s partly because more states have been adopting “prompt pay” laws that require health insurers to reimburse claims within 30 or 60 days, says UnitedHealth spokesman Tyler Mason, which sometimes doesn’t leave enough time to review them first. “We need to have a way to still thoroughly review whether a claim’s paid correctly or not,” Mr. Mason says. Some insurers demand the money back. More, though, simply deduct it from future claim payments. That forces doctors to appeal the claim all over again.

http://online.wsj.com/article/SB117141549626107896.html

OncoCaP

03-02-2007, 07:20 PM

It looks like Americans support raising taxes by $500 a year (per family or person?) to ensure that every American has access to health care. It seems like what this supports is coverage for those who don't have insurance now as opposed to a single-payer program, for example:

http://www.nytimes.com/2007/03/02/washington/02poll.html?pagewanted=2&_r=1
"The poll found Americans across party lines willing to make some sacrifice to ensure that every American has access to health insurance. Sixty percent, including 62 percent of independents and 46 percent of Republicans, said they would be willing to pay more in taxes. Half (49%) said they would be willing to pay as much as $500 a year more. Looks like we are seeing some shift on this issue toward providing universal healthcare even if it increases taxes.

http://graphics8.nytimes.com/images/2007/03/02/washington/0302-nat-webPOLLch.gif

dilated

03-02-2007, 07:26 PM

OncoCaP

03-02-2007, 08:54 PM

This is really a bizarre poll. Where did they get the $500 number? Also, I don't think the appropriate question to ask would be "Would you pay more in taxes" (since it's hard to say how much), it would be "Would you be willing to tolerate waiting lists and/or quotas in exchange for covering the uninsured?".

That's a good question. I think the $500 number (also per what? a family? an individual) is too low. It probably needs to be more like $850 for a family to provide coverage to the uninsured (assuming that employers kept providing coverage for employees as it stands today). This would mean that most Americans would still have to pay for coverage like to do today, but the uninsured would be paid for more directly than through property taxes and cost-shifting like they are today. In any case, what is significant that a majority of Americans would be willing to have their taxes raised by ~$500/yr. I see this as a shift in attitudes on the problem.

I'm actually in favor of a two-tier system. The "basic" coverage would cover everyone, and, as you say, could be underfunded and involve long waits or work well ... we simply can't predict the future. With private (additional) coverage of a two-tier system, you could get faster service and extra covered items.

That being said, it is my impression that what we will get is a combination of the private insurance that we have plus some medicaid/medicare type coverage for those who are not already covered (not the kind of two-tier system that I'm advocating).

Rzrbker

03-07-2007, 08:39 AM

The reason we shouldn't move towards socialized medicine is staring us right in the face...The Walter Reed debacle is a microcosm of the problems with military medicine - which is a single payer system form of socialized medicine (US Gov't)...ask any of the mil-med guys the system is absolutely terrible...

Also, ask yourself one question. Does anything the government run operate smoothly, "stream-lined", or fluid??? Hell no. They goof up everything they get their hands on. Stay away from medicine...why don't they socialize the legal system instead.

EctopicFetus

03-07-2007, 01:21 PM

$500 per person? What a joke. Insurance costs a min of 3-4K per yr. esp if we cut down on deductibles etc. Hell my employer tells me that they are paying something like $700 per month for just MY insurance and thats not including a family.

A complete joke. If you tell people that it would mean that they would increase their taxes by 1-2K the numbers would drop precipitously.

EctopicFetus

03-07-2007, 01:25 PM

Also a side note on this issue. Last time i checked its not like its easy to get in and see a doctor. Where is the supply going to come from?

dutchman

03-08-2007, 10:46 AM

It looks like Americans support raising taxes by $500 a year (per family or person?) to ensure that every American has access to health care. It seems like what this supports is coverage for those who don't have insurance now as opposed to a single-payer program, for example:
http://www.nytimes.com/2007/03/02/washington/02poll.html?pagewanted=2&_r=1
"The poll found Americans across party lines willing to make some sacrifice to ensure that every American has access to health insurance. Sixty percent, including 62 percent of independents and 46 percent of Republicans, said they would be willing to pay more in taxes. Half (49%) said they would be willing to pay as much as $500 a year more. Looks like we are seeing some shift on this issue toward providing universal healthcare even if it increases taxes.

http://graphics8.nytimes.com/images/2007/03/02/washington/0302-nat-webPOLLch.gif

$500/yr :laugh: :laugh: :laugh: . Do you think that is how we fund our healthcare system in Europe? Think again. Americans will at least expect 10% increase in taxes accross the board, plus an open end agreement that these taxes could be raised at any point. Trust me, there is no backyard way arround the issue. If you want it, you will have to pay for it.

EctopicFetus

03-08-2007, 11:33 PM

$500/yr :laugh: :laugh: :laugh: . Do you think that is how we fund our healthcare system in Europe? Think again. Americans will at least expect 10% increase in taxes accross the board, plus an open end agreement that these taxes could be raised at any point. Trust me, there is no backyard way arround the issue. If you want it, you will have to pay for it.

We dont want it.. At least those of us who are free to think for ourselves dont.

Qafas

03-13-2007, 09:38 AM

Great thread! I like the arguments on both sides. However, I stand with those who believe that healthcare is not a right. This is a generalization, but people in this nation have come to expect way too much. And they don't want to pay for it.
We all have access to emergency care, without regard to our ability to pay for it. And see how horrendously it is misused, even abused. The same drunks and junkies and non-compliant patients end up in the ED day after day, week after week. The story is the same across the country. Who here believes that people like these aren't responsible for significantly driving up the waiting times in ED, and the costs of healthcare in general? My favorite drunk-junkie-type-I-diabetic-standard-DKA lady had no less than 16 admissions last year alone; each time she was in the hospital for at least a few days, including days in the ICU. You think she's ever seen a bill? You think she gives a damn? Imagine her having the same access as the next guy to outpatient clinics and specialists. A socialized system would reward people like her at the expense of those who work hard to earn a living, and actually pay their dues.
Yes, she is probably an extreme example, but then her type isn't exactly rare. On the more moderate side, there are those who would rather spend their money on anything else but medical bills. Just a couple of weeks ago a patient in resident clinic had a heated argument with me over not having the funds to buy a freakin $4 medicine at walmart. He wanted the clinic's emergency funds used, just as they were used for his medicines the previous month. Where the hell is this expectation coming from? Would this sense of entitlement fly in the grocery store? Gas station? Lawyer's office? Auto dealership? Strip club? Did I mention he continues to smoke? It's 4 freakin dollars. Skip a meal.
Why can't a guy drive an old car, instead of a new one, and get health insurance with the savings? How about buying a house with 3 bedrooms, instead of 4? Or how about quitting smoking, or skipping holiday shopping, or that vacation, the new TV, or the trips to the bar each weekend, so that you can pay for insurance? I find it difficult to believe that the 40 million who don't have insurance are all truly so strapped that they can't afford it. Many of them choose not to do it, in favor of other things they think are more important for them. So be it. It is their decision. But then they should accept responsibility for not having the coverage when they need it.
Many patients don't even want to go on payment plans to pay what they owe the hospitals and doctors. They'll bitch and moan all the way to Cigarette Express or Tina's Nail Salon and Spa, or Exotica about how the doctors and hospitals are ripping them off.
I think our healthcare system is in trouble, but it's only trouble for those who cannot afford it. It is not now, nor will it ever be, a perfect system. There is no such thing. If you give to one group of people, you'll have to take from another. It's that simple. We talk about all kinds of possible changes and reforms for the system; but no one talks about personal responsibility. It is as if it doesn't exist any more. People's sense of entitlement keeps getting stronger and stronger, but there is no redress even though this sense is clearly misplaced. As with many thing in our society, we reward those who take no responsibility for themselves by giving them handouts under the pretext of charity, and punish those who work hard by making them pay for that charity.
To end my long-winded note, I'll relate a brief anecdote from last year, during my first month as an intern in the wards. One of the very first patient's I took care of was an elderly man with CHF. His sickness progressed over a few days, and he decided to forego all further treatment. On the day before he died, I asked him if there was anything I could get for him, and he half-jokingly said "yes, a bloody mary." He really wanted a last one, and I could sense the desire in his eyes and his voice. "What I wouldn't do for one right now." Needless to say, I couldn't very well arrange for a bloody mary for him in the hospital. Just a few days later, however, I ordered the first of a handful of beers to an alcoholic, just a few days out of rehab, who had relapsed. There was no point in withdrawing him, because he would just go out and drink again. What a shame.

dynx

03-14-2007, 05:11 PM

I find it difficult to believe that the 40 million who don't have insurance are all truly so strapped that they can't afford it. Many of them choose not to do it, in favor of other things they think are more important for them.

:laugh: My dad doesn't have health care insurance. But he owns 4 houses and a couple of apartment buildings, smokes every day. He got lung cancer. He picked up and moved to idaho, what the hell he can afford it...the state offers good medical insurance there which he never paid into. Over 100,000 in treatment. When he's done with treatment he'll sell the house there (maybe for a profit!) and move back. Thanks suckers, thats my inheritance that your good will is padding.

In all honesty I find his behavior abhorent, but if you're all gonna be such morons, I'll take the money.

Willard

03-14-2007, 08:06 PM

[QUOTE=Qafas;4883642]My favorite drunk-junkie-type-I-diabetic-standard-DKA lady had no less than 16 admissions last year alone; each time she was in the hospital for at least a few days, including days in the ICU. You think she's ever seen a bill? You think she gives a damn? Imagine her having the same access as the next guy to outpatient clinics and specialists. A socialized system would reward people like her at the expense of those who work hard to earn a living, and actually pay their dues.
QUOTE]

This story really illustrates perfectly one of the potential benefits of universal health insurance: better access to preventive care results in fewer crises. Imagine if your patient had had consistent access to a diabetes nurse-educator. Sure, it would cost more, but how much does a day in the ICU cost? Sure, maybe she won't show to her appointments, but maybe she will. And if she does, the cost/benefit analyses of this type of health maintenance work indicate that society will come out WAY ahead financially.

I understand people's frustration with freeloaders, with those who haven't paid their dues. I can certainly understand why health care should be considered a privilege rather than a right. But, if you are really concerned with building a system that will work, these considerations are irrelevant. Even if you don't think health care is a right, you have to admit that somehow, other countries with universal coverage achieve better health outcomes with much less spending. Isn't that our goal? Can you argue with that? Or is the goal to maximize the number of MRI machines per capita?

So, assuming the goal is "better outcomes for less money," how do we get there? Studies have shown consistently that lack of health insurance, even after controlling for other variables, is associated with poorer health. This suggests that one way to improve health outcomes is to insure more people...better yet, to insure everyone. So how do we do this while reducing costs? One source of savings is noted above: preventive care saves money. Another lies in the administrative costs of private insurers: the way these companies are able to make money is by insuring people who won't need health care, and denying coverage to those who will need health care. They spend a lot of money figuring out who is which, and this money represents potential savings in a universal system. Finally, a single-payer system can still borrow proven efficiencies from a "free-market" system: for example, I was impressed with a study in JAMA this week that showed significantly reduced low-priority outpatient visits by patients on a high-deductible health insurance plan; why not incorporate this into single-payer? Or a tax-credit system as an incentive for patients with fewer visits?

Final rant topic of the night: the despondency of many posters here. A lot of the criticism of universal health insurance in this thread arises from the assumption that the government can't get anything right. This is a lazy cop-out, and provably untrue in the case of health care: the VA system, for example, outperforms the average private system on most if not all outcome measures, and it manages this while spending significantly less than private systems. Why do other countries (France, Italy, Sweden for example) have single-payer systems that have superior outcomes at lower cost? Are they smarter than us? Are their governments somehow more responsive? It's true that if the people in charge of government think that government is worthless, then we are going to run into problems. Likewise, if you put some AIDS denialist in charge of NIAID or something then you're going to get some poor outcomes. But, and this is an admittedly big but, once we get past the question of whether we should have a single-payer system (which I think will happen in the next ten years) and we move on to a good-faith debate about HOW we should do it, I look forward to seeing a system emerge that is truly the best in the world.

EctopicFetus

03-14-2007, 11:11 PM

Willard

03-15-2007, 08:42 AM

If you believe that universal health care will get people to go to primary docs you are nuts.

On top of that we would need more primary docs and right now every IM doc I know is full, they arent dying for patients.

http://content.nejm.org/cgi/content/full/338/8/513

Note that table 5 controls for "the child's age, sex, race, family income, family structure, family size, region of residence, the population density of the area of residence, and several measures of health status."

Qafas

03-15-2007, 02:21 PM

Hi Willard. You raise good points. However, I think your faith in such measures as preventive medicine is misplaced. It is hard enough to get hard-working, conscientious people to do routine medical care so that they don't run into problems in the long run. With people like my patient, there is just no hope of getting anything done. In any case, this is exactly what I mean by a lack of personal responsibility in this country, especially when it comes to healthcare. Why should the government, or the insurance company, or the doctor have to come up with plans and programs to get people to care for their own health?!?! Why shouldn't they be the ones to take the initiative? I am happy to help out people who're trying to help themselves in any way I can. The irony is that there is hardly any help available for people like that. But the abusers and deadbeats have all kinds of help available. That is where the kink in our system is. As cruel as it sounds, I think that those who don't take any responsibility should be absolutely and totally cut off from any help at all.
Healthcare resources are limited; no one can argue against that. Why, then, do we waste them on undeserving people, and feel bad when we think that we ought not to do that? This is the same mentality that plagues us when it comes to crime in this nation. While no one thinks about the victims of crimes, the press and the lawyers and public have a field day if the criminals' 'rights' are trespassed.
The charity we provide to underserving people is not designed to solve any problems. All it does is mask the problem, and allow us to feel good about doing something. Well, in fact, we are making the problem worse by reinforcing the misplaced sense of entitlement; and wasting a lot of the resources that we pour into this senseless charity. I agree that every civilized society should provide some benefit to those who are less fortunate, and bear some of their weight. But, the simple fact is that the benefit goes mostly to those who choose to have bad habits and shun personal responsibility. And who can blame them? They have no incentive to earn a living, or have insurance, because then they'd be cut off from freebies. This is a lifestyle and attitude problem. You won't change it for the better by opening up more doors for the deadbeats; you'll only make it worse for those who're working hard to stay afloat.
Q

Willard

03-15-2007, 03:28 PM

Why should the government, or the insurance company, or the doctor have to come up with plans and programs to get people to care for their own health?!?! Why shouldn't they be the ones to take the initiative? ...The charity we provide to underserving people is not designed to solve any problems. All it does is mask the problem, and allow us to feel good about doing something. Well, in fact, we are making the problem worse by reinforcing the misplaced sense of entitlement; and wasting a lot of the resources that we pour into this senseless charity.
Q

I might not have made myself clear in my post, but this is exactly the sentiment I was hoping to dispel. The answer to your question is "because it saves money and improves health." Here's the thing: I don't think our society would tolerate all "undeserving people" being thrown to the wolves (i.e., being denied all care, emergent or not). Imagine the newspaper headlines. Agreed? So, how do we care for these individuals? Do we restrict their access to preventive care, then admit them to the ICU when they get really sick? Or do we try our best to provide them with basic primary care in order to avoid this outcome? As you say, adherence may be somewhat low. So what if it is only 50%? Or 25%? Won't we still save money and improve health significantly? As I said earlier, this calculation has nothing to do whatsoever with whether someone "deserves" health care or not.

Also, note that what you would call "undeserving people" probably represent a very small proportion of uninsured Americans.

EctopicFetus

03-21-2007, 08:17 AM

http://content.nejm.org/cgi/content/full/338/8/513

Note that table 5 controls for "the child's age, sex, race, family income, family structure, family size, region of residence, the population density of the area of residence, and several measures of health status."

Ok lets start by saying that this is only for kids. I dont know what your level of training is but if you critically appraise this very very old article you will note that it doesnt measure any outcome differences in kids. If you are a med student perhaps someone told you that the annual "school" physical is a complete waste of time and money. There have been NO studies showing that this has any impact on healthcare outcomes. Do not believe that more care is necessarily better care.

I looked at table 5 and I didnt see anything related to "measures of health status". All that article shows is that people SAID they would go to the doctor more if they had insurance.

Lastly, you may or may not know that basically ANY child can be seen by a doctor for almost no money. There are tons of underutilized programs and just about every state would cover every child in that state. The issue is that parents dont take the time to apply for these programs.

So the article you cite is weak evidence at best and it doesnt address my previous points.

MJB

03-26-2007, 08:45 AM

Instatewaiter

03-26-2007, 06:43 PM

You know I think it's funny how the different political movements point to two different groups of the poor: conservatives cite the lazy freeloading poor and their abuse of handouts while liberals talk of the hard working industrious poor who have just been dealt a crappy hand. Someone needs to do a study and find out which group is the majority and then we can once and for all decide whether have massive social programs or few at all.

Willard I think your system would work well with a fully compliant group of patients. However I think you give people too much credit. The public can't even keep themselves in shape. How is visiting a PCP going to change anything? The doc will skirt around the issue of the person's weight so as not to offend and the patient will probably not be compliant if it is too much of a hastle. Preventative medicine, especially in this country entails major lifestyle changes which I feel people just don't want to do. Remember it's their 'genetics.' It has nothing to do with the no exercise, crappy eating habits and numerous vices that they do on a daily basis. JMHO

Willard

03-28-2007, 11:36 AM

Ok lets start by saying that this is only for kids. I dont know what your level of training is but if you critically appraise this very very old article you will note that it doesnt measure any outcome differences in kids. If you are a med student perhaps someone told you that the annual "school" physical is a complete waste of time and money. There have been NO studies showing that this has any impact on healthcare outcomes. Do not believe that more care is necessarily better care.

I looked at table 5 and I didnt see anything related to "measures of health status". All that article shows is that people SAID they would go to the doctor more if they had insurance.

Lastly, you may or may not know that basically ANY child can be seen by a doctor for almost no money. There are tons of underutilized programs and just about every state would cover every child in that state. The issue is that parents dont take the time to apply for these programs.

So the article you cite is weak evidence at best and it doesnt address my previous points.

The article I linked to indicates that children with health insurance go to physicians more, not that they "SAID they would go to the doctor more." Your contention in your post was that "if you believe that universal health care will get people to go to primary docs you are nuts." Because health insurance is associated with increased physician contacts in kids, and because universal health insurance would insure more kids, it seems likely that universal health insurance, at least in kids, would in fact encourage more physician contacts. "Physician contacts" certainly doesn't necessarily equate to "primary care" visits, but as the authors note, kids don't go to many specialists, so it's a useful proxy measure.

My reference to "measures of health status" regarding table 5 was because I wanted to draw your attention to the factors that the authors were controlling for. "Controlling" in this case means using statistics to eliminate likely confounding factors, or bias. For example, since income is related to the likelihood that someone will visit the doctor, independently of insurance status, the authors adjusted their results to exclude the contribution of family income (the magnitude of which had been established by previous studies). "Measures of health status" was one such confounding variable that the authors controlled for.

As for your "previous points," do you mean the relative lack of openings in the schedules of primary care doctors? Maybe I'll leave it to you to think of a possible solution...does this really seem like such an enormous hurdle?

As you say, more health care isn't necessarily better. More to the point, though, are you taking the position that kids without health insurance are just as healthy as kids with health insurance? Or that adults without health insurance are just as healthy as adults with health insurance? Are you sure about this? As an exercise for you, I'll let you spend some time on Google and find some evidence for your position. I'd be surprised (but sincerely interested) if you can find some, but I'm pretty sure that several large analyses have come to the conclusion that health insurance results in better health outcomes. See the periodic Institute of Medicine reports for examples.

Finally, you claim that "basically ANY child can be seen by a doctor for almost no money. There are tons of underutilized programs and just about every state would cover every child in that state. The issue is that parents dont take the time to apply for these programs." This isn't exactly true; about two-thirds (~6 million) of presently uninsured children are probably eligible for SCHIP or Medicaid (I'm not aware of "tons" of underutilized programs - these are the only ones I have heard of). However, this leaves ~3 million kids. Moreover, it raises the question of why these kids remain uninsured. As you say, it is because their parents don't take the time, but why is that? And, having established that health insurance for kids (not to mention adults) is a good idea, how do we lower the barriers to getting coverage? I would suggest that universal coverage is an effective way of substantially reducing these barriers.

Willard

03-28-2007, 11:37 AM

EctopicFetus

03-28-2007, 06:31 PM

The article I linked to indicates that children with health insurance go to physicians more, not that they "SAID they would go to the doctor more." Your contention in your post was that "if you believe that universal health care will get people to go to primary docs you are nuts." Because health insurance is associated with increased physician contacts in kids, and because universal health insurance would insure more kids, it seems likely that universal health insurance, at least in kids, would in fact encourage more physician contacts. "Physician contacts" certainly doesn't necessarily equate to "primary care" visits, but as the authors note, kids don't go to many specialists, so it's a useful proxy measure.

My reference to "measures of health status" regarding table 5 was because I wanted to draw your attention to the factors that the authors were controlling for. "Controlling" in this case means using statistics to eliminate likely confounding factors, or bias. For example, since income is related to the likelihood that someone will visit the doctor, independently of insurance status, the authors adjusted their results to exclude the contribution of family income (the magnitude of which had been established by previous studies). "Measures of health status" was one such confounding variable that the authors controlled for.

As for your "previous points," do you mean the relative lack of openings in the schedules of primary care doctors? Maybe I'll leave it to you to think of a possible solution...does this really seem like such an enormous hurdle?

As you say, more health care isn't necessarily better. More to the point, though, are you taking the position that kids without health insurance are just as healthy as kids with health i