Clinton announces her universal healthcare plan

TheProwler said:

Just curious - do you guys think that Medicare/Medicaid should pay for liver transplants for alcohol-induced liver damage?

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Damn, thats a great question. If they made it on the list and they are next in line then I guess someone feels that they deserve a new liver so ya, medicare and medicaid should be used to help those who can't afford the treatment otherwise. I guess what I'm trying to say is that whether or not meidcare/medicaid should be used isn't the issue to begin with for alcohol related liver transplants, the patients are. Placing a penalty on the medicare and medicaid from alcohol/drug related liver problems might help to sway some patients from pickling their livers but in the end I don't think it would be enough motivation for them not to drink/use in the first place.

Does anybody actually think she can pull this off?

TheProwler said:

Just curious - do you guys think that Medicare/Medicaid should pay for liver transplants for alcohol-induced liver damage?

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how about for people who want boob jobs? Braces? laser eye surgery? Oh I see, you'd pay those out of your own pocket lol

hows it working out in Massachusetts?
Do doctors have any sort of private practices? or is everyone working for state-run clinics?

Just a lil thing about the rich paying for everyone thing. I read Hillary's proposal and she only suggests letting the Bush tax cuts for salaries over 250,000 expire. So this wouldn't really be asking the rich to pay more, it would just mean going back to their previous taxes.

Also since alot of general practitioners don't even make that much, it means that a large portion of the health care community would not be affected.

What I see as a prob with Hill's proposal however is,

-weak plan for negotiating with pharm companies. Obama has a much better plan for this, he wants to allow Americans to purchase drugs from countries where prices are lower for the same pharmaceuticals (like where the gov't is not being screwed like a little school girl by the pharm companies, unlike our own). Obama, like Hillary also suggests increase avail of generics.

-No plan for protecting MD salaries. Doctors work really hard for what they earn, much harder that probably the average corporate executive, and they deserve to have large salaries. Being a doctor is also one of the few jobs in biotech/science with very high compensation; most labs top out around 100,000 for ppl with PhD's. Because medicine is considered an altruistic profession, many people (prolly politicians included) think its okay to make them work for less, a fallacy which is eating away at doctors' compensation. With increasing levels of mid level providers and declining reimbursements , we need a politician who will protect our future.

-lots of other problems too, but post is already too long...

The biggest problem with doctor's compensation is... who the hell is going to want to be a doctor if they really cut doctor's compensations to the point where they can't even payback thier medical school loans?

If they do make serious cuts to doctor's compensation, don't be surprised to see the number of doctors(mostly primary care) slowly decline over the next 20+ years

I think doctors are going to get reamed with UH.

Everyone else has strong lobbyists...except doctors. The State is a beautiful thing...

Maybe its time for doctors to start an angry letter writing campaign to our politicians...

Also, doctors should chill their fingers on ice-cubes before every rectal exam performed on a congressman, senator, or presidential hopeful as a poetic expression of how doctors get screwed by them every day.

But seriously, doctors really do need a lobby. Although people like Clinton and Obama who claim to be so idealistic and concerned for the middle class should be protecting MD salaries (and other professionals in the technical field) without having to be pressured...

On that note, how badly do you guys think doctors are going to be screwed by universal health care? Are physicians going to be looking at working even more to compensate for crappy reimbursements? Specifically, does anyone have any clue how this will affect reimbursements (federal and private)?

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LodiDodi said:

Maybe its time for doctors to start an angry letter writing campaign to our politicians...

Also, doctors should chill their fingers on ice-cubes before every rectal exam performed on a congressman, senator, or presidential hopeful as a poetic expression of how doctors get screwed by them every day.

But seriously, doctors really do need a lobby. Although people like Clinton and Obama who claim to be so idealistic and concerned for the middle class should be protecting MD salaries (and other professionals in the technical field) without having to be pressured...

On that note, how badly do you guys think doctors are going to be screwed by universal health care? Are physicians going to be looking at working even more to compensate for crappy reimbursements? Specifically, does anyone have any clue how this will affect reimbursements (federal and private)?

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its nice to think there is a "system" that will help "all".... but lets be realistic, if such thing was to happen, it woun't last long.....
Think about it, would you like to be a Family Doctor who makes 60k a year? and has maybe over 200k in school debt? and have huge malpractice insurance premiums? The answer to these questions is a big NO.... Primary care (internal medicine, family practice, peds, etc) will drop within 10-20 years after this new "system" is implemented..... Then theyr going to realise "oops... we were so worried about the middle class that we kinda screwed over the medical practitioners" ~ who by the way are above ANY class, since without too many of them, you'll end up with a 300-350 million population country and huge waitlists for anything

Nasem said:

hows it working out in Massachusetts?
Do doctors have any sort of private practices? or is everyone working for state-run clinics?

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Yes, Communist Governor Mitt Romney got together with those pinkos at The Heritage Foundation and abolished private practices.

TheProwler said:

Just curious - do you guys think that Medicare/Medicaid should pay for liver transplants for alcohol-induced liver damage?

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Yeah it should.

Gut Shot said:

Yes, Communist Governor Mitt Romney got together with those pinkos at The Heritage Foundation and abolished private practices.

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Are you being serious or just joking?

As much as everyone would like to believe we do not have unlimited resources. It won't take long for people to get pissed that they are paying for a chronic smoker's chemo for lung cancer or boob jobs for self esteem. Same goes for lasik when a cheap pair of glasses would suffice.

My point is if you want the best care you have to pay for it.

People getting government handouts did not make this country what it is today. If we expect to be able to help the less fortunate in society for the foreseeable future people need to stop being motivated to remain in that less fortunate group.

Progress of a society is inherently tied to personal progress.

If your sitting around sad because someone took your job overseas because a different man/women can do it faster and cheaper then you i say get off your a$$ and go do something better and faster then the next guy. It's called natural selection its how the world works. Wow I've gotten off topic.

end rant

badasshairday said:

Are you being serious or just joking?

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http://www.heritage.org/Press/Commentary/ed012806a.cfm

I'm not a fan of Hillary's (and many other proposed) universal health care "plan" (if it can be called one, as undeveloped and vague as it is). I'll first state my problems with it and thoughts about universal health care in general, and follow it up with a post of what I think should be the model on which to base health care reform.

First, Hillary follows the standard line, and assume that the "ideal" universal healthcare models the communist approach - equal coverage and benefits for everyone. My biggest issue (and obviously most other people as well) is who pays for the cost if there is a substantial increase in health care utilization?

If it is income based then you have the rich shouldering the burden (a huge one, mind you), in turn suppressing the economy, leading to fewer people whose incomes are high enough to contribute to the system. End result is huge income tax alterations and increased unemployment rates. This is a redistribution from rich to poor. In the truest of socialistic spirit, I think this may have the best intents but still poor results. I think we can find example countries for this case.

If it is not income based then everyone pays the same premium for their "government policy." Young, old, sick, poor, man, woman. This is a redistribution from healthy to unhealthy. Not too different from a controlled standardization of private insurance with no exclusions or adjustments allowed at all (currently private insurance can alter your premium based on certain things - age, sex, smoking, some previous illnesses, but not others - genetics, family history, race). But what about those too poor to afford this standardized policy? Are they shut out of the healthcare system for good? Or are their policies picked up by the government (i.e., the rich taxpayers)? If so, this reduces to the first option with a different income/payment schedule.

What about having doctors foot the bill? We all know they make ****loads of money, only work four days a week, and have too many sports cars, boats, or leer jets already. Well, there is already a shortage of physicians in the US, and if you increase healthcare utilization and decrease net salaries you will find way fewer people willing to go through ten years of grueling education and go hundreds of thousands in debt to enter the field. Either the government would step in and increase salaries, or the laws of supply and demand would kick in and attempt to return the system to equilibrium (most likely by physicians simply demanding higher pay for services to offset the "healthcare tax" on them). This would be a bad, bad situation, because as service fees increased so would the expenses of the government healthcare policies, meaning an increase on the healthcare tax of physicians, with increased fees to compensate, etc. A type of healthcare hyperinflation. Either that, or just settle for affordable universal policies that are of no benefit because there are no doctors and the waiting line at the ER is six weeks long. No, you can't have the people paying for this coverage being directly in the feedback loop of market economics. Physicians footing the bill is a no go.

So where does that leave us? I seems clear to me that a true socialized system just isn't practical, which isn't surprising as decades of experience has taught us that socialized economics aren't very efficient.

So what does capitalism have to tell us? We must be careful here, too. It might seem natural to think that the person who is strong, healthy, exercises, eats right, and has no significant disease risks and no significant medical history should benefit from his "hard work" with reduced premiums. But where to draw the line? What about his family medical history? Any early heart attacks, diabetes, hypertension? What about genetic testing for predisposition to cancer, cardiovascular disease, etc.? Should he be equally rewarded for his good fortune as well as his hard work?

And where do private insurance policies fit in? Seems to me they are a mild form of socialism. Instead of each person paying for his own medical expenses as they occur, people group together to collectively (communistically) shoulder the cost burden so that the individual risk is reduced. This is a redistribution of income from healthy to unhealthy as well, but on something of a voluntary basis. If you are healthy enough, you can opt out of the system (not sure how wisely), removing yourself from shouldering a heavier portion of the burden relative to your own healthcare expenses. This brings us back to the question of how far this grouping should go... should the government mandate that everyone be covered under a standardized policy if they choose and are able to buy it (or go without insurance if not) that spreads costs equally for everyone? Is that fair, to be a man and pay for women's deliveries? Is it more or less fair than being rich and paying for the poor? I don't know for sure.

I do know that I'm not a big believer in me paying for your bad habits. Or, as cruel as it sounds, past the way private insurance currently works, me paying for your misfortune. But I do believe that "universal healthcare" should start at the most basic levels, and that we should pay for that as a society just as we pay for roads and bridges that everyone uses essentially equally. I honestly believe that that average cost for healthy people would remain very close to what it is today, and we could pick up the basic preventative and primary care for everyone that doesn't currently get it by simply halting disease progression and increasing the net health of the country. How do I think that is possible? Next post...

So what do I think is a reasonable model for serious, thoughtful, and radical reform? I'm not an economics major by any means, and I haven't attempted to work through these ideas fully, but here are my gut feelings about what is both workable and ethically sound under a variety of models.

1. Universal government coverage (paid for by either income or sales taxes) that provides free routine checkups by both doctors and dentists, including preventative and screening procedures and labs (regardless of cost) if recommended by the AMA/AOA, such as PSA/rectal exams for men starting at 50, colonoscopy/sigmoidoscopy/fecal occult blood for men starting at 50, mammograms and pap smears for women, etc.

2. Free primary care visits excluding procedures and labs, other than say basic wound care and stitches, rapid strep tests, and maybe basic blood and/or urinalysis. Primary care physicians still get paid per procedure etc. similar to today, but in only the primary care fields we move to a single payer system where the government holds the checkbook. Some people will instantly assume that reimbursement cuts would be inevitable (they probably would) and harm physicians in those areas, but that shouldn't be the case. If you actually collect on every patient and procedure you bill for, reimbursement per unit can go down substantially.

3. Some form of support for programs like Wal-Mart's $4/prescription program so that routine prescriptions for routine problems are affordable for everyone. This program should cover the majority of people that go to the clinic or ER for sinus infections, ear infections, arthritis, viral infections, stumped toes, etc. Medications to prevent progression, such as asthma meds, antibiotics and antifungals, medicine for diabetic and cardiovascular problems (anti-hyperlipidemics, diuretics, alpha/beta/calcium channel blockers, ACE inhibitors/ARBs, etc.) should also be affordable. This isn't a huge challenge when you realize that this whole list could probably consist of generic medications that have been one the market for many years. If you need vancomycin or chemotherapy, of course, that may not be so cheap, and electing for the newest diabetes medication may cost more out of pocket.

The routine care alone (including basic dental cleanings) would lower total healthcare expenditure in this country like you wouldn't believe. It is amazing how people are too poor to go see a doc about a cough, and a month later are costing "the system" (docs and hospitals short term, everyone else eventually as costs are offset) thousands of dollars to treat pneumonia. Or not getting an annual fecal occult blood test or sigmoidoscopy every few years, and later needing tens of thousands of dollars to get the colon resection surgery and chemotherapy for colon cancer. If people knew that a trip to the family doc to get some antibiotics for their laryngitis was almost free (other than the $10 prescription) then people would stay much, much, much healthier. And free access to good doctors telling them about the risks of bad lifestyle habits, and how to change them, and even reasonably priced medications to help lower cholesterol or blood pressure if needed? Priceless.

Now, the poor person that needs a heart transplant still wouldn't have that covered by the government, and though it may still seem cruel to some that we would let people with the most serious (and costly) diseases die without picking up their bill through socialized medicine (unworkable as described above), I would rather see a system in place that is workable and provides the most benefit possible.

Along with the above, I believe a shift from elderly-centric government coverage to young and preventative-centric government coverage must eventually occur. We can't improve the health of the country if we are spending all of our collective revenue resources paying for the least healthy. I'm not saying let them all die... I'm saying that implementing a preventative approach to universal care will significantly reduce the geriatric burden on the system. There would likely be a couple of decades of growing pains as the current approach is phased out and a new approach phased in, but I think the problem is tractable.

Beyond the outline above, there would still be a place for private health insurance. People are still going to experience trauma, or rare illnesses that preventative medicine can't always stop. There will always be expenses to great to cover with universal care without the burden on the economy making it a net loss for the nation.

HMO's, most health insurance, and the whole managed care bull**** sucks. This country's healthcare is doomed. There is too much power held by drug companies and insurance companies, they own our freakin congress.

armybound said:

I sure don't.

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Why not?

badasshairday said:

HMO's, most health insurance, and the whole managed care bull**** sucks. This country's healthcare is doomed. There is too much power held by drug companies and insurance companies, they own our freakin congress.

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Meh....everyone owns Congress. And by everyone I mean powerful multinationals.

You'll get Universal Healthcare when the business interests favor it and can bend it to their advantage. Until then you get what you have now. Gotta love the American political system. Pick your poison.

osli said:

First, Hillary follows the standard line, and assume that the "ideal" universal healthcare models the communist approach - equal coverage and benefits for everyone.

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Hmmm, where does she say this, exactly?

osli:

Im sure that was an awesome post, but could you condense it into a shorter 10-20 line post?


Anecdotal evidence contrary to universal health care:
Friend A from Canada tears ACL --- 2 months for MRI, 6 months after that for surgery
Friend B from USA tears ACL ---- Calls doctor and asks for MRI, 3 DAYS later MRI confirms tear, less than a month later goes under the knife

Which system is better?

francisco84 said:

osli:

Im sure that was an awesome post, but could you condense it into a shorter 10-20 line post?


Anecdotal evidence contrary to universal health care:
Friend A from Canada tears ACL --- 2 months for MRI, 6 months after that for surgery
Friend B from USA tears ACL ---- Calls doctor and asks for MRI, 3 DAYS later MRI confirms tear, less than a month later goes under the knife

Which system is better?

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Based on this, neither. You can pull up examples like this to support the canadian system as well. For example, in Sicko when Moore points out how a guy in Canada gets two of his fingers chopped off and gets both put right back on for free versus the guy in the US who gets his two fingers chopped off and has to choose to get only one put back on for $12000 since getting both would be $60000.

Your friend has kickass top notch insurance that most people don't have.

badasshairday said:

Based on this, neither. You can pull up examples like this to support the canadian system as well. For example, in Sicko when Moore points out how a guy in Canada gets two of his fingers chopped off and gets both put right back on for free versus the guy in the US who gets his two fingers chopped off and has to choose to get only one put back on for $12000 since getting both would be $60000.

Your friend has kickass top notch insurance that most people don't have.

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Nothing is free. It's paid through taxes......or loans from the Chinese government most likely.

An empire based on debt. Fantastic welfare-warfare state we have here.

armybound said:

I sure don't.

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Hasn't alcoholism been medicalized...If so and is considered a disease then how can you deny them coverage especially if their pre-existing genetic "disorder" cannot be treated.

Medicare/Medicaid also pays for weight loss surgery (in some cases)...so how do you decipher between the two isses?...transplant for alcoholic vs. bariatric (type) surgery for the food-a-holic.

I'm just playing devil's advocate

TheProwler said:

Just curious - do you guys think that Medicare/Medicaid should pay for liver transplants for alcohol-induced liver damage?

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Hasn't alcoholism been medicalized?...If so and is considered a disease then how can you deny them coverage especially if their pre-existing genetic "disorder" cannot be treated before the damage is done?

Medicare/Medicaid also pays for weight loss surgery (in some cases)...so how do you decipher between the two isses?...transplant for alcoholic vs. bariatric (type) surgery for the food-a-holic.

I'm just playing devil's advocate

M.Furfur said:

I am not asking that they get naturalized. The jobs held by those immigrants are mostly in agriculture and those jobs are very necessary for the american economy since it is very hard to find anyone with legal status who is willing to perform any of those duties. So Maybe those people can come to the states for the season they are needed in, make some money that can both contribute to the american system and to the life in Mexico. Alberta started this model and so far it is very successful.

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The only problem is that many WILL NOT leave.

And, in many ways, the presence of illegal immigrants in this country is more of a detriment than a benefit...The amount/cost of services they use (read steal) greatly outweighs the low wage service they provide in labor intensive jobs (i.e. jobs most Americans feel they are above).

Sweenracer said:

BRAVO!!! When will YOU be running for president Rose??? You got my vote.

A few things to think about:

You get what you pay for... and when you enter a hospital you get a whole lotta education, experience, overhead... it ain't cheap because it CAN'T be! What people expect is impossible.

People need to be responsible FOR THEMSELVES... If you smoke, you will most likely die at a yonger age and require more the medical attention and more cost... it only makes sense that you pay more for healthcare... or maybe put a levy on cigarettes to help pay for increased healthcare. If you are obese, drink heavily, do drugs, don't exercise, etc., etc. Why should I pay for your healthcare??? An incentive/penalty program needs to be initiated that assesses an indiviuals actual risk.

Americans are some of the fattest, laziest people on this planet... Not only will the RICH be paying to cover the holes... I think it is the HEALTHY people's pockets that will suffer the most.

This is the real world, nothing is free... And until "shooting the lazy" is legalized, then socialized healthcare is just medical communism and is doomed to fail... (unfortunately doc's will be the first to suffer in it's demise).

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I think that would work in an ideal situation where everyone is provided the knowledge of how to ensure that one does not consume food that will make him/her/his or her family fat (obese). Also, part of the problem is that access to healthier foods is limited in lower-income communities...and let's not even mention the fact that these foods are much more expensive than your round-the way McDonald's hamburger. Fast food companies know this...and know that these families are on a very strict budget that prevents them from being able to purchase those foods...Soooooooooooooooo it only makes sense that these people are very overweight.

Take the WIC program, for instance. This program is provided to low-income mothers who live around the established poverty line. It basically provides them with coupons that allow them to purchase specific food types. However, these coupons are limited to covering starchy/high calorie (low in nutrition) foods. Initially the overseers of the program were seeking to expand this program to cover access to fruits and veggies. However, with looming cuts in the budget (thank George Bush and company...the best president we have ever had), the expansion of such a program is unlikely. If anything, much of the progress that has been made will fall by the wayside.

What many don't realize is that when addressing the shortcomings of healthcare (coverage/access/etc) we must consider addressing both the proximal and distal issues (which are usually a contributing factor to the formation of these proximal issues). If we choose to ignore the latter, it is best to assume that things will remain the same (for the most part)

foreverLaur said:

i vote to regulate the insurance companies. they are the ones screwing patients and doctors by charging more and more and more to have insurance and reimbursing less and less. this problem did not exist in the past. the problem revolves around the insurance companies. why not regulate how much they can charge and how much they have to reimburse?

I'm basing this off of what my family has to pay for insurance through my dad's work (and how much it is changing) and how the income of the doctors my mom has worked for for 11 years has changed as a result of health care.

The OB that delivered me has started doing a lot of side work unrelated to OB/GYN because he was actually losing money from reimbursements.

One insurance company (United?) was dropped by my moms work because they reimburse less than the actual costs, but they were forced to pick them back up because so many people use them.

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Well, you can thank the AMA (major Unions and powerful advocacy grps...hahaha like the AARP) for the this current healthcare system.

I agree - Insurance companies should now be given a free-pass in Washington. Just remember that $$$$$$ talks....and it always will...b/c that's one of the characteristics of the human condition

It would be great if we could somehow manage to implement an overarching lobbying reform policy that SEVERELY limited the monetary influence these major companies could have on governmental/social policy. I think we just took a step back due to Justice Roberts ability to utilize a major loophole in the McCain-Feingold Act to re-allow (hahaha is that a word)...I hate that man!!!!!....he is soooooooooooo smart...and just as evil as Sr. Bush.

francisco84 said:

Anecdotal evidence contrary to universal health care:
Friend A from Canada tears ACL --- 2 months for MRI, 6 months after that for surgery
Friend B from USA tears ACL ---- Calls doctor and asks for MRI, 3 DAYS later MRI confirms tear, less than a month later goes under the knife

Which system is better?

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You're forgetting Friend C, who is uninsured, and limps on torn ACL until turning 65.

Gut Shot said:

Hmmm, where does she say this, exactly?

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It isn't explicit in her "new plan" it is just an inference based on years and years of her ramblings on "how things ought to be." I guess I could find specific examples, but I don't think that is necessary.

I guess I poorly worded it, but my point is that I assume her new healthcare "plan" is the best politically non-suicidal solution she could come up with when trying to take her ideology to an actual implementation.

badasshairday said:

HMO's, most health insurance, and the whole managed care bull**** sucks.

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Not that I agree whole heartedly with the power insurance companies have in making medical decisions for their patients, but I think it is worthwhile to remember that in the 70's, before managed care was implemented, people routinely died in hospitals while doctors and administrators screwed around with giving them the most procedures and medications they could instead of maximizing the patient's health. In some cases, that meant severe complications from unnecessary "treatments" and in others it meant sacrificing the patients quality of life for more money (i.e., not sending someone home to die in a dignified way, or continuing treatments on a brain dead or untreatable patient).

francisco84 said:

osli:

Im sure that was an awesome post, but could you condense it into a shorter 10-20 line post?

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I can't summarize my ramblings on healthcare policy in general, but here's the gist of my proposed alternative for universal care:

- free coverage for delivering mothers, infants, and children up to a certain age
- all immunizations free
- free regular "well patient" checkups, until death, including AMA/AOA recommended screening procedures and labs, and regular dental cleanings
- free primary care visits for a large class of illnesses, such as sinus/ear infections, chest pains, asthma, headaches, etc. (the stuff that makes up the bulk of a PCP's practice)
- heavily discounted generic drug plan that offered at least one suitable drug for every major treatable, preventable, and/or controllable illness (antibiotics, cholesterol meds, hypertension meds, diabetes meds, asthma meds, etc.)

- less coverage for the sickest and the oldest - phased in as the nation's health rises as a result of better preventative medicine
- every thing else handled by private insurance

osli said:

It isn't explicit in her "new plan" it is just an inference... ...but my point is that I assume

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Yeah, you might want to do a little less inferrin' and assumin' and a little more readin' about what she has actually proposed rather than what you think she has proposed.

osli said:

I can't summarize my ramblings on healthcare policy in general, but here's the gist of my proposed alternative for universal care:

- free coverage for delivering mothers, infants, and children up to a certain age
- all immunizations free
- free regular "well patient" checkups, until death, including AMA/AOA recommended screening procedures and labs, and regular dental cleanings
- free primary care visits for a large class of illnesses, such as sinus/ear infections, chest pains, asthma, headaches, etc. (the stuff that makes up the bulk of a PCP's practice)
- heavily discounted generic drug plan that offered at least one suitable drug for every major treatable, preventable, and/or controllable illness (antibiotics, cholesterol meds, hypertension meds, diabetes meds, asthma meds, etc.)

- less coverage for the sickest and the oldest - phased in as the nation's health rises as a result of better preventative medicine
- every thing else handled by private insurance

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Ok so what about people who are born with debilitating (and often eventually fatal) illnesses, such as muscular dystrophy (etc...)?

How do you appease the various patient advocacy groups?

Gut Shot said:

Yeah, you might want to do a little less inferrin' and assumin' and a little more readin' about what she has actually proposed rather than what you think she has proposed.

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Erm, dude, if it doesn't smack you in the face that many facets of her plan are centered on wealth redistribution, then I guess I can't help you. That part isn't up for debate. What I inferred was that her motivation for including such facets is that she believes that fundamentally a socialistic distribution of work and reward is an ideologically sound system. I can't say that with certainty. Perhaps there is some other motivation, such as she actually believes that it is the best teleological distribution of available resources. I doubt it, based on her previous history and health care proposals, hence I assume that her motivations are as stated.

But regardless of her motivations, it is fact that her current proposal does attempt to implement such ideals.

- health care coverage for a lot of the current poor uninsured, paid for by "shared responsibility" and "tax relief." i.e., the rich pay for the poor. Redistribution of income. It doesn't take reading between the lines, just open eyes.

- preventing discrimination based on certain health risk factors. i.e., from each according to his ability, to each according to his needs. She's stripping capitalistic principles out of insurance policy and replacing them with socialistic ones.

Now, I'm not trying to argue that socialistic ideals have no place in medicine, or that capitalistic ideals make for the perfect insurance system. But I am calling a spade a spade, and proposing that her plan may not be the best solution.

My biggest problem is that the bulk of expenditure for this plan falls on the shoulders of tax payers. It doesn't make a serious attempt at rebalancing the equation so that new expenses are offset by new savings. It is democratic through and through, and like most such programs it ignores the fact that at best this is a zero sum economy. Putting greater burden on the wealthy impacts the economy, which hurts the very poor you are attempting to help.

You must start from the teleological perspective that we have a fixed pool of resources with which to support public health programs. The goal should be finding the best distribution of those fixed resources to do the most good. Finding economically sound ways to motivate the development of increased resources is a worthy, if peripheral goal. Deontological models that assume everyone is entitled to perfect health, and set forth with the goal of figuring out how to pay for that, are doomed to failure.

riceman04 said:

Ok so what about people who are born with debilitating (and often eventually fatal) illnesses, such as muscular dystrophy (etc...)?

How do you appease the various patient advocacy groups?

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Short answer is that initially, just as you do today. I'm proposing a short term increase in government provided health care, with a planned and carefully monitored reduction in existing expenditures as the financial benefits of preventative medicine are realized. "Special cases" can be handled much like they are today, which seems to vary wildly depending on just what the case is and just what the lobbying group is. Later reform can begin to address more specific issues.

Example: free routine checkups and dental cleanings initially cost money; savings are realized later down the road as colon/breast/skin cancer (for example) are found early and treated before more expensive radical surgeries are required, or leukoplakia is found early, or a dental abscess is prevented saving a tax payer sponsored trip to the ER.

Example: free primary care visits for sinusitis or bronchitis initially cost money; savings are realized conditions are treated by the less expensive PCP and with fewer medications required, saving the tax payer sponsored trip to the more expensive ER for treatment of full blown pneumonia.

osli said:

Not that I agree whole heartedly with the power insurance companies have in making medical decisions for their patients, but I think it is worthwhile to remember that in the 70's, before managed care was implemented, people routinely died in hospitals while doctors and administrators screwed around with giving them the most procedures and medications they could instead of maximizing the patient's health. In some cases, that meant severe complications from unnecessary "treatments" and in others it meant sacrificing the patients quality of life for more money (i.e., not sending someone home to die in a dignified way, or continuing treatments on a brain dead or untreatable patient).

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I get your point, but now a days it seems like it is on the opposite spectrum now where the insurance company has way more say in what the doctor's can decide for their patients. There should have been a middle ground instead of what it is today.

badasshairday said:

I get your point, but now a days it seems like it is on the opposite spectrum now where the insurance company has way more say in what the doctor's can decide for their patients. There should have been a middle ground instead of what it is today.

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Absolutely! I probably should have added that while I think the pendulum was swung way too far in that direction in the 70's, it has reciprocated its swing too far in the other direction. Good intentions then, bad situation now. There was some good middle ground in the mid-late 80's and earlier 90's, and I do believe that the momentum has once again shifted back towards the center.

Hopefully. I pray. Please.

TheProwler said:

your username is composed of four words....I'm hoping the first two go together and not the middle two. Care to clarify?

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If I get to go to medschool with you man at MCW, we have got to hang out and enjoy some dank.

j/k

But there is nothing like being burnt the day before your MCAT.

osli said:

What I inferred was that her motivation for including such facets is that she believes that fundamentally a socialistic distribution of work and reward is an ideologically sound system.

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I have no f*cking idea what you're talking about. I chimed in because you were rambling on about Hillary's proposal without any apparent clue that you even knew what her proposal entailed. It reminded me of Mitt Romney's bizarre criticisms of Hillary's proposal, which bears eerie similarities to his the one he enacted in Massachusetts. Like you, he apparently went on the offensive based on assumptions rather than facts. Sweet Jesus, mandating health insurance (with subsidies when necessary) is the least radical path to universal coverage that I can think of.

Oh, and while you're at it, you should probably read Capitalists for Hillarycare. (although it predates the current debate)

Someone care to summarize the 298 replies in this thread for me?