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Socialized Medicine and its consequences

Discussion in 'Healthcare Improvement' started by Shah_Patel_PT, Jan 21, 2007.

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  1. random-dude

    random-dude

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    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.
  2. random-dude

    random-dude

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

    random-dude

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    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.

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

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

    Instatewaiter Octogenarian with a Cr of 3... send a troponin

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    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.
  5. OncoCaP

    OncoCaP

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    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).
  6. Thomasss

    Thomasss New Member

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    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.
  7. Shah_Patel_PT

    Shah_Patel_PT MD

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    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?
  8. Thomasss

    Thomasss New Member

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    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.
  9. foo

    foo Junior Member

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    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?
  10. thewebthsp

    thewebthsp Shoobeedoowap

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    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.

  11. Thomasss

    Thomasss New Member

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    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.
  12. Thomasss

    Thomasss New Member

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    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.
  13. foo

    foo Junior Member

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    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).
  14. foo

    foo Junior Member

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    Perhaps I was wrong? :oops:

    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."
  15. OncoCaP

    OncoCaP

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    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.
  16. EctopicFetus

    EctopicFetus Keeping it funky enough

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    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.
  17. Shah_Patel_PT

    Shah_Patel_PT MD

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    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!!!!
  18. OncoCaP

    OncoCaP

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    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.
  19. Shah_Patel_PT

    Shah_Patel_PT MD

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    encouraging indeed!
  20. Jadyn

    Jadyn

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    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.
  21. OncoCaP

    OncoCaP

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    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
  22. OncoCaP

    OncoCaP

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    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.

    [​IMG]
  23. dilated

    dilated Fought Law; Law Won

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    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?".
  24. OncoCaP

    OncoCaP

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    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).
  25. Rzrbker

    Rzrbker

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    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.
  26. EctopicFetus

    EctopicFetus Keeping it funky enough

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    $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.
  27. EctopicFetus

    EctopicFetus Keeping it funky enough

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    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?
  28. dutchman

    dutchman

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    $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.
  29. EctopicFetus

    EctopicFetus Keeping it funky enough

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

    Qafas Jarhead

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    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.
  31. dynx

    dynx Yankee Imperialist

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    :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.
  32. Willard

    Willard Member

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  33. EctopicFetus

    EctopicFetus Keeping it funky enough

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    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.
  34. Willard

    Willard Member

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    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."
  35. Qafas

    Qafas Jarhead

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    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
  36. Willard

    Willard Member

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    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.
  37. EctopicFetus

    EctopicFetus Keeping it funky enough

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    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.
  38. MJB

    MJB Senior Member Moderator Emeritus

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    Extremely well said.
  39. Instatewaiter

    Instatewaiter Octogenarian with a Cr of 3... send a troponin

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    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
  40. Willard

    Willard Member

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    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.
  41. Willard

    Willard Member

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    So why have PCPs at all?
  42. EctopicFetus

    EctopicFetus Keeping it funky enough

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    Wow what a post. How about you find me the stats. Im a resident which means I dont have time to find useless facts. As I mentioned your article was weak in regards to the evidence they found. I have been in multiple cities including chicago, tucson, and orlando working as a student or resident and everywhere I have been have basically told me that kids can get free care.

    Here in tucson we have family practice clinics who make people pay based on their income, these are subsidized by the federal government. There was a similar program in chicago when i was a student.

    Lets not confuse adults with kids for now. As I am sure you know since you are so bright, annual visits do not make any measureable difference in healthcare outcomes. Seeing a doc for the sake of seeing a doc is a waste of resources. Now if you have a problem then there is a reason to see a doc if you are a kid. This is not the case for some adult issues. After the age of 1 a kid only needs to be seen by a health care person for their vaccines if nothing else is bothering them. Go on and find me data to the contrary. It seems like you have enough time on your hands.
  43. QuikClot

    QuikClot Senior Member

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    So you're too busy and important to support your arguments with facts, although you clearly have the time to bang out thousands upon thousands of SDN posts? That has to be the most pathetic excuse for being caught out that I've ever heard.

    No one cares you're a resident, except to say a prayer for the poor innocent souls in your care.
  44. EctopicFetus

    EctopicFetus Keeping it funky enough

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    Look little fella you dont know the first thing about medicine or me. nice try.. go back to your game of dungeons and dragons. Unless you are bringing some info.
  45. polofanPKP

    polofanPKP Fear the Vest

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    I honestly could not have said this any better, bravo.
  46. QuikClot

    QuikClot Senior Member

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    See, in the time you took to craft that trollish post, you could have been supporting your argument with facts. Piss and moan all you want, you got smoked and you don't have an answer. If anyone should retire, it's you. After all, you are a resident. Busy, busy, busy, except when it comes to whining and making excuses.
  47. EctopicFetus

    EctopicFetus Keeping it funky enough

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    I know someone as ignorant as you could not possibly know how to do an EBM search. If I cared more I would, but I just dont. Your silliness is amusing to say the least. Somehow you have to continually point out that I am a resident. Are you jealous? Sure seems like it..

    Me smoked? I dont think so little fella. Did I hurt your feelings in my last post?

    Here is something to warm your heart.:laugh: :smuggrin:

    [​IMG]

    Later tool.
  48. QuikClot

    QuikClot Senior Member

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    You care enough to hunt down an image that bears no relationship to anything, to try and insult me, but not to support your argument with facts? That's absurd. If you could produce the facts, you would; SDN is obviously the only social life you have.

    You coming out with that image reminds me of the old saw about the two men offered French perfume. The one, disgusted, says "I can't wear that! My wife will think I spent the day in a French whorehouse!" To which his companion replies: "To be sure, my wife does not know what a French whorehouse smells like."

    Moral; if you're a compulsive forum poster with an image of a D&D game on his computer, you're in no position to be calling someone else a geek. You're projecting, my friend; turn off the computer and go talk to a girl, you'll be better for it.[/engaging of troll]
  49. EctopicFetus

    EctopicFetus Keeping it funky enough

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    You got me.. ouch the truth hurts... Its been a while refresh my memory of what being a pre-med is like...:laugh: :smuggrin:
  50. Miami_med

    Miami_med Moving Far Away Moderator Emeritus

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