can you explain the health care concerns?

[batista_123]

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I dont understand the health care situation. I am not into politics so I haevnt read much about it, but I keep hearing this thing about health care reform and obama?? can you explain why some are worried?

 

[jvesco22]

You want to be spoon fed?...

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No hard feelings!

 

[LizzyM]

Many Americans are uninusured because they can not buy health insurance (too expensive) or because they don't believe it is worth buying (usually young & healthy). Some Americans have health conditions that are so profound that no insurance company will sell a policy to cover what they need or will sell a policy that excludes their pre-existing condition. Some people can not get into see a doctor because they are uninsured. Many people wait until they are very sick and then go to the Emergency Department. Hospital emergency departments are required by law to provide enough emergency care to stabilize a patient regardless of that patient's ability to pay. Some hospitals are having financial difficulties because they care for many patients who are uninsured.

Many Americans have health insurance but are required to pay some money out of pocket before the insurance compay will cover any bills (the out of pocket is called the "deductable") and many people divide the cost of care with the insurance company (these folks pay a "co-pay", often 10-30% of the bill or a flat payment per visit or per prescription). Some folks are charged so much for health care due to injury or illness that they can't meet their financial obligations and they file for bankrupcy.

Many employees receive insurance thorugh their employers and there are tax incentives for businesses to do this. However, the cost of insurance premiums is rising and hurting businesses who need to compete in global markets.

Medicare covers Americans 65 and older as well as some disabled Americans. Medicaid covers many poor Americans including some people who live in nursing homes. Both programs are (under) funded with our state and federal tax dollars and both are headed for trouble.

No politics.... just the situations of different groups of Americans (for those who are in the US without documentation it is another story with differences of opinion).

Like several previous admininstrations, the current administration wants to solve some of the problems with health care financing and access to care. How to solve the problem is where politics and opinions about the role of government comes into play.

 

[mrmilad]

Not to be an ass, but people like you annoy me.... If you are genuinely not interested in the future of what you're going into, then why should I spend the time to make you interested.

Sorry for that in advance!

 

[batista_123]

Many Americans are uninusured because they can not buy health insurance (too expensive) or because they don't believe it is worth buying (usually young & healthy). Some Americans have health conditions that are so profound that no insurance company will sell a policy to cover what they need or will sell a policy that excludes their pre-existing condition. Some people can not get into see a doctor because they are uninsured. Many people wait until they are very sick and then go to the Emergency Department. Hospital emergency departments are required by law to provide enough emergency care to stabilize a patient regardless of that patient's ability to pay. Some hospitals are having financial difficulties because they care for many patients who are uninsured.

Many Americans have health insurance but are required to pay some money out of pocket before the insurance compay will cover any bills (the out of pocket is called the "deductable") and many people divide the cost of care with the insurance company (these folks pay a "co-pay", often 10-30% of the bill or a flat payment per visit or per prescription). Some folks are charged so much for health care due to injury or illness that they can't meet their financial obligations and they file for bankrupcy.

Many employees receive insurance thorugh their employers and there are tax incentives for businesses to do this. However, the cost of insurance premiums is rising and hurting businesses who need to compete in global markets.

Medicare covers Americans 65 and older as well as some disabled Americans. Medicaid covers many poor Americans including some people who live in nursing homes. Both programs are (under) funded with our state and federal tax dollars and both are headed for trouble.

No politics.... just the situations of different groups of Americans (for those who are in the US without documentation it is another story with differences of opinion).

Like several previous admininstrations, the current administration wants to solve some of the problems with health care financing and access to care. How to solve the problem is where politics and opinions about the role of government comes into play.

thanks, very informative, but i dont understand why doctors are worried about their income going down. is the current administration trying to pass a law that would require doctors to work for free? why do doctors think their income will decrease as a result of obama?

 

[Caprica6]

Not to be an ass, but people like you annoy me.... If you are genuinely not interested in the future of what you're going into, then why should I spend the time to make you interested.

Sorry for that in advance!

I think this statement is unfair. Healthcare reform, insurance, etc. is confusing. If it wasn't there wouldn't be an ongoing debate over it.

 

[doctor2014]

You want to be spoon fed?...

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No hard feelings!

Love it!!!!

 

[mrmilad]

I think this statement is unfair. Healthcare reform, insurance, etc. is confusing. If it wasn't there wouldn't be an ongoing debate over it.

Confusing yes, but you'd expect some effort rather than asking someone to summarize the debate so you don't have to read through it yourself.

 

[Instatewaiter]

thanks, very informative, but i dont understand why doctors are worried about their income going down. is the current administration trying to pass a law that would require doctors to work for free? why do doctors think their income will decrease as a result of obama?

Because a doctor will bill X amount but the medicare will only pay Y. For instance, a doctor may charge 4,000 for a given operation but medicare will only pay that doctor $800 and the doc must just suck it up or not see medicare pts.

Medicare has 2 major reimbursement issues when compared to insurance: 1) it pays ~80% of what insurance pays the doctor.
2) There are automatic cuts to reimbursement when medicare overspends (ie every year). So the extra money comes out of the doctor's pocket to make up the deficit that congress was too stupid to fix. For instance next year there is a scheduled 20% decrease in reimbursement across the board for medicare. So while inflation has gone up and overhead has gone up, medicare reimbursement has gone DOWN. The doctor still has to pay for the nurses, receptionists, office managers, the supplies and the office space. As it stands many doctors refuse to see new medicare pts because they lose money. Most keep on their old medicare pts because they have a relationship. However, if the cuts go through, you will see docs dropping medicare pts like it is their job.


Much of the reform debate centers around expanding medicare. Doctors fear that that will mean the reimbursement schedule will entirely switch to what medicare pays. That means seeing more patients, spending less time with them and working longer hours.

 

[LizzyM]

thanks, very informative, but i dont understand why doctors are worried about their income going down. is the current administration trying to pass a law that would require doctors to work for free? why do doctors think their income will decrease as a result of obama?

A physician's income can decrease even if the physician is being paid for services provided.

First of all, taxes on high income individuals may rise to cover health care coverage for all Americans. Docs might be expected to be among those who would feel that pinch.

Insurance companies often "negotiate" to direct patients covered by their plans to "preferred providers" who will accept a negotiated rate for services. If you don't accept the negotiated rate you won't have many patients (the insurance company will direct them to go elsewhere). The negotiated rate may be less than you'd like to be paid. There is the possibility that these negotiated rates will drop as insurance companies try to reduce their costs (Medicare and Medicaid often pay less than insurance companies pay -- in some cases it is too little to cover the cost of providing the care and patients with private insurance pay a little more than their share. ) A doctor or hospital with a good "case mix" has enough patients with private insurance to cover the costs of providing care to the patients with government coverage.

Some physicians provide services of limited benefit to patients. Some of these can be big ticket procedures. Limiting reimbursement (Medicare, Medicaid and private insurance payments) to those services that have been proven to be the most cost effective might cut the income of the providers of those procedures. It may also reduce innovation and new treatments for difficult medical problems.

Doctors are leaders and they like to make decisions in consultation with the patient. They don't like playing "Mother, may I?" with the insurance companies and they fear even more of the same (more phone calls, more forms, more roadblocks and speedbumps) that keep them from doing what they want to do which is to take care of patients.

 

[Chronicle]

A physician's income can decrease even if the physician is being paid for services provided.

First of all, taxes on high income individuals may rise to cover health care coverage for all Americans. Docs might be expected to be among those who would feel that pinch.

Insurance companies often "negotiate" to direct patients covered by their plans to "preferred providers" who will accept a negotiated rate for services. If you don't accept the negotiated rate you won't have many patients (the insurance company will direct them to go elsewhere). The negotiated rate may be less than you'd like to be paid. There is the possibility that these negotiated rates will drop as insurance companies try to reduce their costs (Medicare and Medicaid often pay less than insurance companies pay -- in some cases it is too little to cover the cost of providing the care and patients with private insurance pay a little more than their share. ) A doctor or hospital with a good "case mix" has enough patients with private insurance to cover the costs of providing care to the patients with government coverage.

Some physicians provide services of limited benefit to patients. Some of these can be big ticket procedures. Limiting reimbursement (Medicare, Medicaid and private insurance payments) to those services that have been proven to be the most cost effective might cut the income of the providers of those procedures. It may also reduce innovation and new treatments for difficult medical problems.

Doctors are leaders and they like to make decisions in consultation with the patient. They don't like playing "Mother, may I?" with the insurance companies and they fear even more of the same (more phone calls, more forms, more roadblocks and speedbumps) that keep them from doing what they want to do which is to take care of patients.

I heard a surgeon's 300K annual income could likely be reduced to a pathetic $80K in the long run.🙁🙁

 

[docboo83]

Not to be an ass, but people like you annoy me.... If you are genuinely not interested in the future of what you're going into, then why should I spend the time to make you interested.

Sorry for that in advance!

Do you always begin a degrading comment with an apology as if it negates the rudeness of the statement?

Is this how you plan to react to your future patients who are not "genuinely interested" in their health? Patients that smoke and drink alcohol even against your advice? Is this the attitude that you are building as a foundation for future encounters in your career?

Take a moment to educate initially, and then direct someone to more resources. As a physician, you are an educator, and your students/patients are likely to be much less informed than you are. Such a negatively opinionated reaction is completely unnecessary.

 

[bannie22]

thanks LizzyM that was really enlightening. i see why doctors are specifically anti-medicare now.

i never liked the idea of being controlled by teh government in terms of my pay because it really restricts what you want to do with your occupation.

and having lived in a few countries, canada, singapore, hongkong, malaysia... i feel that free health care in canada is perhaps the worst policy i have experienced. but there are also disadvantages to a primarily private health care system too!

 

[jvesco22]

I heard a surgeon's 300K annual income could likely be reduced to a pathetic $80K in the long run.🙁🙁

and I heard Michael Jackson faked his death...

 

[Mesokun]

i never liked the idea of being controlled by teh government in terms of my pay because it really restricts what you want to do with your occupation.

and having lived in a few countries, canada, singapore, hongkong, malaysia... i feel that free health care in canada is perhaps the worst policy i have experienced. but there are also disadvantages to a primarily private health care system too!

So if the government limits physician income will you have second thoughts about being a physician? That's what England does I believe, where many physicians are basically government employees. Would you change your practice or only accept a particular populations because you don't make as much as you thought?

I thought most of us decided to go into medicine because it was the most interesting, most meaningful thing to do? There are plenty of careers out there that makes way much more income such as executives and management without the exposure to all kinds of health hazards and the physical stress in a medical setting. Why not do that instead?

I apologize in advance if I sounded interrogative or condescending as I have no intention of doing so. I also apologize if I have wrongly taken your opinion of context.

It's just that I really believe in government regulation of health care. Having worked as a state employee for years and having family members working for the federal government I know that, yes, there are a lot of hoops to jump through, a lot of bureaucracy and inefficiencies to deal with when it comes to government involvement, in ANYTHING. But isn't it the same, or worse with private insurance companies? They can decide, at whim, whether a patient gets reimbursements for health care; and they can change the rules and the monthly premiums at any time when they feel it is no longer profitable. At least with government you get consistency.

I lived in Taiwan for the first half of my life, and the US for my second half. Taiwan offers universal healthcare. Do you know how much an average middle class Taiwanese pays a month? About $24, adjusted by income. It covers just about everything except special cases like some cancer for which it has other mandates. Average copay is about $2 for clinics and $3 for hospitals. Everyone pays directly to government without any private companies taking up profit in the middle. Although people still complain whenever they raise premium it is often a small amount that just get some rants here and there. Subscribers can see any doctor they want without referral by a primary care physician, thus they don't have to pay for the additional, practically useless clinical visit.

In comparison, my father, who works as a technician for a small company here in the State of Washington. He makes less than $20,000 a year. Right now his monthly health insurance premium is all paid by his job. But in the 10 years he has worked, the coverage has been shrinking and his out of pocket responsibility has been increasing steadily every year. But at least he has still got vision and dental coverage, even with the restrictions that got tighter every year and limited his clinical visits. Now he can only see specific doctors at specific medical facilities in order to get reimbursement. He has to go to a Group Health Hospital instead of going to the UW Hospital, which was easier for him to get to and had very consistent and integrated patient services. Thanks, HMO!

And for me? Well, I have been on the Washington State sponsored Basic Health plan for 4 years. I pay $17 per month for the most basic things - primary care clinics and the more commonly used generic prescription drugs. I still have to pay out of pocket for most specialist visits. I have been going without any vision of dental coverage for the same 4 years. I am lucky that the UW Medicine system accepts Basic Health coverage, but there are still lots of procedures that I need to pay out of pocket.

Sorry for going on a tangent about my personal situation...what I really want to say is that I believe it is ok for doctors to make a bit less (if things really turn out that way) because they will still make way more than the majority of the Americans anyways. I know there are specialist physicians who are single and complain about their inability to keep more than $5,000 in their bank account, and there are primary physicians with family and make about $80,000 yet still live a happy life. Government regulation of health care coverage is necessary because it makes sure people get treated fairly in the vast majority of the cases. The rules are there to be followed to ensure the lease abuse possible, so that we have less waste and become more efficient than we are now.

But, if I am too naive and needs to be more realistic, please let me know. I welcome any corrections and opinions. After all I am not a doctor and I don't know everything that goes on in a doctor's life.

 

[LizzyM]

It is very hard to compare between countries....

who pays for medical education and what is the average debt of medical school graduate in Taiwan?

are physicains salaried employees or self-employed? Who pays to furnish outpatient facilities/doctor's offices (e.g. medical equipment, rent, utilities, furnishing, supplies)

what are the laws in Taiwan concerning malpractice? What do physicians pay for malpractice insurance?

what is the typical annual income of a physician?

In a country where medical education is provided at little or no cost to studetns, where health care facilities are gov't owned or subsidized, where malpratice suits are rare, and/or physician incomes are low in comparison to US income, insurance costs are going to be lower than in the US. Costs would be lower, too, if many high tech /high cost items are in short supply (defacto rationing) and unaviailable to many who need them.

 

[Mesokun]

Hmm... I failed to think about the cost of health care from the point of the physician's burden. Unfortunately I don't have the answers to LizzyM's questions.

I don't know if Taiwanese doctors pay for their own education. But they would furnish their offices if they own their clinics. I know that the physicians are paid like those in the US; as employees (hospitals) or self-employed (self-operated clinics). I don't know about the malpractice laws but I do know that they exist because Taiwanese doctors get sued just as often as American doctors. I don't know how much the Taiwanese doctors get paid annually though.

All I was told by my parents is that the government pays for 80% of the cost and the subscriber pays for about 20%. The main factor for the affordability is the lack of private insurance companies meddling in the middle to take up profits.

The average cost of living is indeed lower in Taiwan as well in terms of food, housing, etc. That also contributes to a overall lower amount of physician salary.

But I do not think there are rationing in Taiwan. At least if there is any I do not know about. I personally know very many Taiwanese (especially seniors) who live in the US and visit Taiwan frequently simply to get health care because a CT scan, for example, is going to be cheaper in Taiwan no matter how you cut it. I personally don't really like people doing this because it kind of feels like they are cheating the system...but they did pay for the insurance so I can't say anything about it. If there really is rationing I think many of these seniors' trips would be rendered ineffective as rationing can be applied to them as well. Again, so far I haven't read or heard about rationing.

And while it may be very hard to compare between countries...if it is that hard to do so, why so many comparisons to Canada and other advanced democratic countries in the health care debate? I think there is still a lot to be compared with.

I did not mention this before, but some Taiwanese people have said years ago that their universal healthcare is going to run out of money in a few decades, much like our own Social Security Program. I don't know how they will raise the necessary funds to drive the program, but I doubt they would simply let the program die. Most likely they will increase taxes gradually to pay for the deficits. But that's in the future. Right now we need to get our healthcare costs under control. And isn't it the lack of regulation and oversight that got us here in the first place?

I really would like to see LizzyM's response because I used her (her, right?) medical school spreadsheet and saw some very insightful comments on SDN. If you really are a school admin, please enlighten me, Ms. LizzyM. (I hope I am correct in my salutation.)

 

[armybound]

I heard a surgeon's 300K annual income could likely be reduced to a pathetic $80K in the long run.🙁🙁

Rumor has it the sky is falling.

 

[mrmilad]

Hmm... I failed to think about the cost of health care from the point of the physician's burden. Unfortunately I don't have the answers to LizzyM's questions.

I don't know if Taiwanese doctors pay for their own education. But they would furnish their offices if they own their clinics. I know that the physicians are paid like those in the US; as employees (hospitals) or self-employed (self-operated clinics). I don't know about the malpractice laws but I do know that they exist because Taiwanese doctors get sued just as often as American doctors. I don't know how much the Taiwanese doctors get paid annually though.

All I was told by my parents is that the government pays for 80% of the cost and the subscriber pays for about 20%. The main factor for the affordability is the lack of private insurance companies meddling in the middle to take up profits.

The average cost of living is indeed lower in Taiwan as well in terms of food, housing, etc. That also contributes to a overall lower amount of physician salary.

But I do not think there are rationing in Taiwan. At least if there is any I do not know about. I personally know very many Taiwanese (especially seniors) who live in the US and visit Taiwan frequently simply to get health care because a CT scan, for example, is going to be cheaper in Taiwan no matter how you cut it. I personally don't really like people doing this because it kind of feels like they are cheating the system...but they did pay for the insurance so I can't say anything about it. If there really is rationing I think many of these seniors' trips would be rendered ineffective as rationing can be applied to them as well. Again, so far I haven't read or heard about rationing.

And while it may be very hard to compare between countries...if it is that hard to do so, why so many comparisons to Canada and other advanced democratic countries in the health care debate? I think there is still a lot to be compared with.

I did not mention this before, but some Taiwanese people have said years ago that their universal healthcare is going to run out of money in a few decades, much like our own Social Security Program. I don't know how they will raise the necessary funds to drive the program, but I doubt they would simply let the program die. Most likely they will increase taxes gradually to pay for the deficits. But that's in the future. Right now we need to get our healthcare costs under control. And isn't it the lack of regulation and oversight that got us here in the first place?

I really would like to see LizzyM's response because I used her (her, right?) medical school spreadsheet and saw some very insightful comments on SDN. If you really are a school admin, please enlighten me, Ms. LizzyM. (I hope I am correct in my salutation.)

Well I think you haven't really answered the real questions from a physicians side in Taiwan. If the government isn't paying for their eduction then there should be a very high rate of debt among physicians in Taiwan. I highly doubt medical students would be willing to take on 300k debts ( if it is even close to that high in Taiwan) in a field that they would be over worked and under paid.

Another point about innovation and technology. Taiwanese medicine and med-technology is probably hindered due to a system where the government regulates the medical field so closely. Poor patients and most everyone will be exposed to mediocre immediate care, but solutions and development and research is probably not lead in Taiwan. In order for innovation and progress to occur doctors need to be able to dictate their own world and not have to worry about paying the rent rather than the intricacies of a certain disease.

Yes, going into medicine isn't about money, but doctors like any other person want to have good lives and provide for their family, and if you aren't thinking about the finances of any career you wish to follow, then you are gravely mistaken.

In either case, I am no expert as you said, but I hope that someone finds a solution to this mess.

 

[rdr44bb]

... Taiwan offers universal healthcare. Do you know how much an average middle class Taiwanese pays a month? About $24, adjusted by income. It covers just about everything except special cases like some cancer for which it has other mandates. Average copay is about $2 for clinics and $3 for hospitals. Everyone pays directly to government without any private companies taking up profit in the middle. .....


.Universal Healthcare in Taiwan was launched in 1995 so it is too young to be labeled as the world leading model despite what Paul Krugman hinted. (http://select.nytimes.com/2005/11/07/opinion/07krugman.html) The three things that Krugman praised were 1) true universal coverage, 2) low cost (5% of GDP vs. 17% in the US), 3) healthier population. While those were definitely true statistically, deep beneath the surface the picture is simply not as pretty. A simple google search (unfortunately in Chinese) using keywords such as Taiwanese healthcare bankruptcy, abusive behaviors, distorted incentives will reveal far more than the statistics..

.Like LizzyM suggested, the cost of medical schools in Taiwan is dirt cheap (lowest being $1100/yr for National Taiwan Univ.) when compared against the US by not by much against other countries. Nevertheless, by adding the cost-of-opportunities of medical education and limited financial rewards introduced by the Universal Plan, the economy of medical training is distorted. For the uninitiated, Taiwanese Universal Healthcare pays a flat rate regardless of specialties or difficulties based. The more patients a doctor see, the more he makes. Within a few years since new the plan’s inception, no self-respecting med students would voluntarily choose specialties that are perceived high-risk/low-return such as OB/GYN or general surgeon. Instead, everyone wants to become ophthalmologist or dermatologist. While the same phenomenon/trends are observed elsewhere, this distortion is exceedingly obvious in Taiwan..

.Krugman’s dream for the US healthcare system reform is to drive the cost down to the bare minimum perhaps towards Taiwan’s 5~6% GDP. This number is amazing particularly if you take into the account that average Taiwanese visits doctor 12 times/year compared to ..average American’s 7. Use super crude calculation (please don’t debate about my methodology) based on Wiki numbers of GDP and population (US$14T vs US$400B, 2000M vs 30M population), each US visit would be $160 while each Taiwanese visit would be $5.60. Voila, it’s a patient’s heaven as long as he or any of his child is not a physician since a lot of this cost-reduction is absorbed by doctors..

.Make a note that the high visit rate doesn’t mean Taiwanese are sicker than the average American. By paying close to US$1.50 out of pocket each visit, a lot of Taiwanese (mostly elderly) literally choose hospital-visit as their favorite passtime. Furthermore, just about every my Taiwanese friends who moved to the US in the 70s, 80s and 90s all plan to move back to Taiwan when they retire. That is a clear sign that the healthcare cost is artificially low in Taiwan..

.Krugman also believes that Taiwanese are healthier than the Americans based on life-span without any studying or mentioning of genetics and dietary differences. If you take into the account of Taiwan’s neighboring countries all have similar life expectancies or longer, one should take the comparison with a grain of salt. In fact, one should look at all health outcome comparison with a grain of salt..

.I was an expat living in Taiwan for a few years and had the (mis)fortune to visit some hospitals in recent years. Each month my payroll was automatically deducted to cover healthcare but it was too small for me to feel. Each visit would cost me less than my gasoline to get there. Sure the lines were long but the waiting wasn’t bad since on average the doctors spent no more than 2 minutes with each patients and that includes questioning, diagnostics, and prescriptions. The experiences were similar to my visit to the Ford assembly line except that I was on the conveyer belt. .

.It would be a complete eye-opener for the 75% of the average American who are currently insured. Some might even considered it a disgrace for modern medicine. But I bet that the remaining uninsured population wouldn’t mind paying $25/month plus $1.50/visit by trading in some quality for the peace of mind..

.Consumer survey showed Taiwanese extremely enjoyed their health plan. Complain was minimal. From the consumer perspective, the plan was a great success. But the opinions of the doctors/hospitals would be the overwhelmingly negative since they felt the new system robbed them. The new system altered the economic incentives of doctors and patients and induced massive behavioral changes. If a reciprocal system such as healthcare that relies on the balance between givers and takers is distorted based on government mandate, this system is simply unstable and certainly unsustainable. .

.Currently in the US, this possibility of doctors becoming the whipping boy of any healthcare reform is what causing a lot of the “thinking” doctors or doctors-to-be sick to the stomach. Those that are not thinking and wish to be spoon-fed on sites such as SDN may not even know or care what hit them if they weren’t preparing for the interviews. .

.Taiwan’s healthcare plan was a bold and noble attempt from a socialist’s perspective. However, it doesn’t take a genius to figure out that it will not last in its current form. Anyone who idolizes it is putting his own foot in the mouth..

 

[Mesokun]

rdr44bb,

Thank you for the clarification on the healthcare system in Taiwan. Like I have mentioned before, I know that their system is unsustainable and definitely not something to be worshipped. There are definitely flaws and abused as I have noted as well.

I probably did sound like I was idolizing it...and yes I admit I was looking at it purely from a consumer's viewpoint. I live in a low-income family where my parents face the fear of unemployement daily. Thus any discussion about health care with them is likely to bring up the Taiwanese system. I do have to say that I have not been using their system for the last 12 years I lived here in the US, only my parents had each utilized it once. I am humbled by your post. I realized that it was the only example where I had some superficial knowledge. I apologize to anyone who thought I sounded like an expert.

Your post does reinforce the idea in my mind that Taiwan's health care is definitely not something that the US should try to emulate. I agree completely. In that case, could you share your opinion on the health care debate in this country? What are some of the things we can do to fix this problem, or is there really a problem? It looks like you do not support healthcare reform of any kind, and you intend to go status quo on our current system.

Again, I apologize if I misinterpret anyone in any way. I am merely here to seek enlightenment and knowledge. I have no role or intention to incite any feelings or convince anyone of my stance.

 

[Blesbok]

You want to be spoon fed?...

Click Here

No hard feelings!

Health care for dummies sites = one sided sites attempting to sway dummies one way or another.

 

[BlueFoxAZ]

http://www.bdt.com/pages/Peikoff.html

Why Health Care is not a right

 

[teenmachinery1]

I heard a surgeon's 300K annual income could likely be reduced to a pathetic $80K in the long run.🙁🙁

Nope. You're wrong. It's going to be reduced to $80.00 annually in the long run. Please get your facts straight before you regurgitate them on forums.

thanks.

👍

 

[teenmachinery1]

thanks LizzyM that was really enlightening. i see why doctors are specifically anti-medicare now.

i never liked the idea of being controlled by teh government in terms of my pay because it really restricts what you want to do with your occupation.

and having lived in a few countries, canada, singapore, hongkong, malaysia... i feel that free health care in canada is perhaps the worst policy i have experienced. but there are also disadvantages to a primarily private health care system too!

I don't know about doctors being "specifically anti-medicare" but the majority favor a public option.

Health care in Canada may indeed be the worst health care you experienced, but you should know by now not to generalize on specific instances. How about looking at different health care systems systematically?

And as for your "there are also disadvantages to a primarily private health care system"... thanks for enlightening us- that must be why we're trying to fix our health care system or something... LizzyM also just mentioned A LOT of problems with our health care system. #1 cause of bankruptcies, unfunded mandates, oh... people DYING B/C THEY'RE UNINSURED.

Thanks for opening our eyes with that pedestrian, asinine observation.

👍

 

[Blesbok]

I don't know about doctors being "specifically anti-medicare" but the majority favor a public option.

Health care in Canada may indeed be the worst health care you experienced, but you should know by now not to generalize on specific instances. How about looking at different health care systems systematically?

And as for your "there are also disadvantages to a primarily private health care system"... thanks for enlightening us- that must be why we're trying to fix our health care system or something... LizzyM also just mentioned A LOT of problems with our health care system. #1 cause of bankruptcies, unfunded mandates, oh... people DYING B/C THEY'RE UNINSURED.

Thanks for opening our eyes with that pedestrian, asinine observation.

👍

Most do? Because most doctors I know think obama is a *****.

 

[teenmachinery1]

Most do? Because most doctors I know think obama is a *****.

Yes. Most doctors favor the public option.

New England Journal of Medicine: Doctors on Coverage - Physicians' Views on a New Public Insurance Option and Medicare Expansion. September 14th, 2009.

63% of physicians wanted a public and private option. 10% of physicians surveyed wanted a system with ONLY the public option available. So, 73% of physicians wanted a system where the public option is included.

Oh, and just because most doctors you know think obama is a *****.. Why was this point valid again?

 

[rdr44bb]

rdr44bb,

Thank you for the clarification on the healthcare system in Taiwan. ........ Your post does reinforce the idea in my mind that Taiwan's health care is definitely not something that the US should try to emulate. I agree completely. In that case, could you share your opinion on the health care debate in this country? What are some of the things we can do to fix this problem, or is there really a problem? It looks like you do not support healthcare reform of any kind, and you intend to go status quo on our current system.....


No apology needed. Reading your arguments leave one an impression that the US system is inferior to the Taiwanese one which is simply not the case unless you only look at it from a cost perspective as a consumer. And you’re wrong about my stance since I definitely support a drastic reform in the US. However, true reform is never possible unless a true crisis demands one. The reason is simple – you cannot avoid damaging the benefit of the status quo and merely pleading their sense of human decency. As far as I can see, just about all the current reform bills are full of compromises and failed to address all three issues of healthcare; i.e., access, cost, and moral hazard that is embedded in any 3rd party paying system. From where I sit, with some modifications (read more compromises) the Baucus bill appeared to be the most hopeful one but it still lack some elements required by a true reform; i.e. changing the pay-by-service model. But then again, it is such a touchy issue I doubt that it could be changed unless, of course, the pain and the price/cost for not doing it is absolutely unbearable.

In other words, I don’t have an answer and I don’t believe there is one.

 

[redsquareblack]

http://www.bdt.com/pages/Peikoff.html

Why Health Care is not a right

Awww, that's sweet. How is the little Objectivist Campus Club, anyway?

 

[BlueFoxAZ]

Awww, that's sweet. How is the little Objectivist Campus Club, anyway?

Awesome! 😍 Thanks for asking

 

[teenmachinery1]

http://www.bdt.com/pages/Peikoff.html

Why Health Care is not a right

Horrible article! I highly recommend it. It's a little dated though, from 1993.

Some of the greatest hits:

Peikoff needs a dictionary: "Of course, it (socialized medicine) is impractical -- it does not work -- but I hold that it is impractical because it is immoral."

"socialized medicine" is not a right and he appeals to the constitution: "According to the founding fathers, we are not born with a right to a trip to Disneyland, or a meal at McDonald's, or a kidney dialysis."

There's also some great paragraphs on american exceptionalism that I won't quote.

Mmm Mmm, delicious straw man: "You are entitled to something, the politicians say, simply because it exists and you want or need it -- period."

Slippery slope: "Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory? Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations..."


But can people afford health care on their own?: "Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all -- where does the government get its fabled unlimited money?"

What about the small minority that certainly can't pay for health care?: "As to this small minority, in a free country they have to rely solely on private, voluntary charity." He goes on: "And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity."

be scared: The clinton plan will finish off quality medicine in this country -- because it wil finish off the medical profession. It will deliver doctors bound hands and feet to the mercies of the bureacracy."

Then he quotes: "Doctors, she wrote, are not servants of their patients. They are "traders, like everyone else in a free society, and they should bear that title proudly, considering the crucial importance of the services they offer."

This part is my favorite: "The battle against the Clinton plan, in my opinion, depends on the doctors speaking out against the plan -- but not only on practical grounds -- rather, first of all, on moral grounds. The doctors must defend themselves and their own interests as a matter of solemn justice, upholding a moral principle, the first moral principle:self-preservation. If they can do it, all of us will still have a chance. I hope it is not already too late."

Quoting myself from above now: Yes. Most doctors favor the public option.

New England Journal of Medicine: Doctors on Coverage - Physicians’ Views on a New Public Insurance Option and Medicare Expansion. September 14th, 2009.

63% of physicians wanted a public and private option. 10% of physicians surveyed wanted a system with ONLY the public option available. So, 73% of physicians wanted a system where the public option is included.

I hope Peikoff is right.

👍

 

[caniac]

Yes. Most doctors favor the public option.

New England Journal of Medicine: Doctors on Coverage - Physicians’ Views on a New Public Insurance Option and Medicare Expansion. September 14th, 2009.

63% of physicians wanted a public and private option. 10% of physicians surveyed wanted a system with ONLY the public option available. So, 73% of physicians wanted a system where the public option is included.

Oh, and just because most doctors you know think obama is a *****.. Why was this point valid again?

way to be combative. That was the Sinai study, right? 633,000 practicing docs in the US in 2006, and they surveyed 5,157 of which only 2,130 responded (the rest I guess took the $2 bill and ran with it). They say they took into account the reasons for non-response of 58.6% of their sample pool, but they don't say specifically what the effects of that narrowed sample size were.

Now, I never took statistics, but in writing my senior thesis, I had to anticipate and explain every doggone thing that my readers could possibly ask themselves regarding my work, as I wasn't there to defend it. I don't think they did an adequate job in their supplementary materials defending their analysis. The results should not be taken as the Bible.

http://content.nejm.org/cgi/content/full/NEJMp0908239v1 if you want to read it for yourself and not trust the analysis of NPR, huffingtonpost.com, or this (admittedly statistics-ignorant) pre-med who had an extra 15 minutes at work.

let's get along guys 🙂

 

[teenmachinery1]

way to be combative. That was the Sinai study, right? 633,000 practicing docs in the US in 2006, and they surveyed 5,157 of which only 2,130 responded (the rest I guess took the $2 bill and ran with it). They say they took into account the reasons for non-response of 58.6% of their sample pool, but they don't say specifically what the effects of that narrowed sample size were.

Now, I never took statistics, but in writing my senior thesis, I had to anticipate and explain every doggone thing that my readers could possibly ask themselves regarding my work, as I wasn't there to defend it. I don't think they did an adequate job in their supplementary materials defending their analysis. The results should not be taken as the Bible.

http://content.nejm.org/cgi/content/full/NEJMp0908239v1 if you want to read it for yourself and not trust the analysis of NPR, huffingtonpost.com, or this (admittedly statistics-ignorant) pre-med who had an extra 15 minutes at work.

let's get along guys 🙂

😴