For all those in favor of a "single-payer" healthcare system....

[Dr. J?]

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Please consider these short films before you support the single-payer system...

http://www.onthefencefilms.com/video/brainsurgery.html

http://www.onthefencefilms.com/vide...at=QuickTime&quality=low&width=320&height=196

The problems that exist in Canada are not uncommon in these systems, just ask any Brit.

Why in the world would we want to emulate these systems with all of their associated problems?

Discuss (seriously).

 

[flighterdoc]

Well, the totalitarians who go for this sort of program will tell you that THEY can do it right.


Sure they can.....


Never mind that there is no example of any single-payer system that works correctly.

Never mind that it will be a huge boondoggle for bureaucrats and petty little people who revel in denying lifesaving care to those who need it....and if you don't like it, you can 'appeal' just as Mr. McCreaith was 'able' to.

Never mind that since an ever increasing percentage of allocated health care dollars will go to overhead (petty bureaucrats et al) there will be less money for actual, you know, patient care.....

Between Canadian health care denying people the immediate treatment they deserve and the NHS in Britain deciding that they can replace physicians with 'nurse specialists' who get a 3 week specialty course, single payer is a great system. As long as you don't actually get sick, or hurt, or care where your tax money goes.

 

[Miami_med]

Without a free market, there is no basis by which to determine whether the investment amount is correct or not. You end up with shortages or an excess of funding, which will hurt other sectors of the economy due to the diversion of resources. In the case of healthcare, it is such an expensive commodity, that shortage is the way it usually goes. This doesn't even tackle the question of proper resource distribution within the healthcare system.

 

[genesis09]

A true single payer system in the U.S. is unconstitutional. If the government was to try to implement a federal health insurance, you would see a two tiered health care system evolve. One for people just with the public insurance, and the other for people with private insurance or could afford to pay. They tried to implement a true single payer system in Canada, but their courts ruled it illegal.
The medium size city of Rochester, on the U.S.-Canadian border, has more MRI machines than the entire country of Canada. A city of a few hundred thousand has more MRI machines than a country of about 40 million. That is sad. A lot of those MRI clinics in Rochester, regularly see people from Canada.

 

[misfit]

Uh, genesis09:

The city you refer to is Rochester, Minnesota-- the location of the original Mayo Clinic. Minnesota as a STATE is on the U.S.-Canadian border, but the city is not by a long shot. The city is located in southeastern Minnesota and is approximately 370 miles from International Falls, Minnesota which IS on the U.S.-Canadian border.

And yes, between the Mayo Clinic and other hospitals/clinics in the Rochester area, there are many MRI machines.

The city only has a population of about 98,000 as of year 2005, not "a few hundred thousands."

misfit

 

[flighterdoc]

There are probably a few MRI's in Rochester and Buffalo, NY too - taking care of the Canadians trying to get decent medical care, even when it doesn't fit into the Ontario Ministry of Health's schedule or budget.

And the population of Canada is around 32.6 Mil (http://www.statcan.ca/menu-en.htm), or somewhat less than that of California at 36.1 million (http://quickfacts.census.gov/qfd/states/06000.html)

There are more MRI's in Los Angeles County, California than in all of Canada.

 

[Dr. J?]

There are probably a few MRI's in Rochester and Buffalo, NY too - taking care of the Canadians trying to get decent medical care, even when it doesn't fit into the Ontario Ministry of Health's schedule or budget.

And the population of Canada is around 32.6 Mil (http://www.statcan.ca/menu-en.htm), or somewhat less than that of California at 36.1 million (http://quickfacts.census.gov/qfd/states/06000.html)

There are more MRI's in Los Angeles County, California than in all of Canada.

So, just how many MRI's are there in Canada? I'm curious.

 

[FoughtFyr]

And yes, between the Mayo Clinic and other hospitals/clinics in the Rochester area, there are many MRI machines.

The city only has a population of about 98,000 as of year 2005, not "a few hundred thousands."

misfit

Couple of small points (just for fun). There is only one other hospital in Rochester, MN. It does not have an MRI. The Mayo Clinic itself has (reportedly - per MC patient handouts) more MRIs than the country of Canada - but that is a bit of a miscue. Several of them are used for research only. Lastly, while Rochester has a population of ~100K, the clinic has a catchment area for primary care of 2.5 million persons and there are more than 1 million tourists that visit Rochester annually (most to come to the clinic).

- H

 

[flighterdoc]

So, just how many MRI's are there in Canada? I'm curious.

4.2/million, according to the OECD as reported by the Fraser Institute
http://www.fraserinstitute.ca/admin/books/files/HowGoodIsCanHealthCare2005.pdf

Appendix B

 

[Dr. J?]

Couple of small points (just for fun). There is only one other hospital in Rochester, MN. It does not have an MRI. The Mayo Clinic itself has (reportedly - per MC patient handouts) more MRIs than the country of Canada - but that is a bit of a miscue. Several of them are used for research only. Lastly, while Rochester has a population of ~100K, the clinic has a catchment area for primary care of 2.5 million persons and there are more than 1 million tourists that visit Rochester annually (most to come to the clinic).

- H

OK, Fought Fyr does have some points about Mayo, however, even taking these points into account Canada's system is still ridicuously outgunned by only ONE of the USA's medical centers:

Pop. of Rochester: 100,000 potential pts
Regional area: 2,500,000 potential pts
Tourists to Rochester: 1,000,000 potential pts
Total potential pts: 3,600,000 (perhaps a slight overestimate given the other medical centers nearby in the Twin Cities)

Number of CLINICAL MRI's at Mayo: 20 (this number does not include research MR's) http://www.mayo.edu/msgme/rad-cardiacimg-rch-faculty.html

MRI's per million pts: 5.6 / million pts

Seems small, but it is actually a large difference.

 

[dry dre]

Canada has been debating switching to a two-tier system (like Australia and elsewhere) for some time now. The basic structure of a two-tier system is that everyone is granted basic services with queues for more advanced/elective services (as with the single payer system) but individuals have the right to pay extra for extra/faster service should they choose.

A couple points: Anyone who has studied (I mean read books, examined the history in detail, not postulating based on superficiai readings) will appreciate that the US is heading towards a two-tier system. Anyone who denies that this is so is simply ignorant to the facts. Politically, both sides of the isle at root recongize the need for universal coverage, how it is to be providing will take forever to figure out.

On "free markets": The healthcare system is a failed market. The supplier tells you what you will buy, when you will buy it, at what costs, and with little/no options. Regina Hertzlinger, a market-based (free-market, as used here) proponent has written extensively to support her cause. She invisions well-informed patients making educated healthcare decisions. These are the same people who demand to see specialists without indication, who demand to be prescribed the pills they saw advertised with the nightly news, and who want an MRI because their toe hurts. Refusing to grant these wishes (while economically and scientifically sound) will result in you losing patients in our "market driven system."

"Well-informed" patients often have irrational desires for studies/treatment that our system simply can't afford. MRIs? Patients often expect an MRI for their musculoskeletal complaint, even if not medically indicated (I'm an orthopod). The cost of two MRIs is equal to the annual healtcare premium of at least one young individual. MRIs, for ortho complaints, are entirely overutilized. A $75 textbook and some reading will usually confirm/rule-out the diagnosis in question, but there is no incentive for physicians to take up this offer. Moreover, physician kick-backs from the studies may increase the tendency to over-utilize the scanner. HMOs in the US (our equivalent of the single-payer system) provide incentives to not over-utilize (you eat what you kill system).

Fact is, physicians across the board in the US are "eating what they kill" when it comes to declining physician payments for servces. Say it isn't so? Most of the "economic growth" in the past ~5 years is in the healthcare industry. So why haven't physicians seen such growth in wealth?

Those opposed to a ~single-payer system in the US point excessively to Canada for anecdotes of how that system doesn't work. These people are not physicians (or at least are unwilling to debate the grossly larger failings of the US system). Any American physician could on a weekly basis cite a dozen or more failures of the US system that they've witnessed (failures that happen less frequently in Canada or elsewhere). It comes down to choosing the lesser of evils. So how does one decide? Healthcare statistics. In short, the US lags behind the industrialized world. Lies, damned, lies, and statistics you say? Ask, really ask, how many Canadians would be willing to trade in their healtcare system for the US system.

As a final note, a point of non-debate, the US spends a greater precentage of its GDP on healthcare than any other industrialized country. We are the only first-world country that does not provide healthcare to all of our citizens. In short, we spend more (in the future approaching twice as much as other countries), but don't even cover 25-35% of the population. Yes, a "free market" system that delivers 33% less goods at 150% the price. And you say the government is inefficient. Please.

 

[Miami_med]

I don't think that both sides recognize "universal" coverage as good at its root at all. If they do, I must be a third side.

By the way, the government is inefficient. Comparing our current system to others isn't remotely comparing capitalism to socialism. The government pays for 50% of care in the US, they heavily regulate everyone else, and the medico-legal environment is an outright disaster. These are all government intrusions into OUR system. We haven't seen true capitalism in healthcare since the early part of the 20th century.

 

[dry dre]

I don't think that both sides recognize "universal" coverage as good at its root at all. If they do, I must be a third side.

I wouldn't confuse "good" with "needed" in this context.

 

[Miami_med]

I wouldn't confuse "good" with "needed" in this context.

I'm not sure how something could be both "not good" and "needed." If something is actually needed, it would by definition be good.

 

[dilated]

Politically, both sides of the isle at root recongize the need for universal coverage, how it is to be providing will take forever to figure out.

This statement seems ... false. The Democrats certainly support it, but there is no way the Republican party will. Mitt Romney did, but he was one R in one of the most Democratic states in the US, so he had very little choice.

There is no free lunch. If you are going to cover more people with the same amount of money and reduce the barrier to getting care, you are going to get rationed care and waiting lists, just like everywhere else. I wish the Democratic party the best of luck in the 20xx elections when Grandma and her boomer buddies realize she now has to wait 3 months for her hip replacement.

 

[dry dre]

This statement seems ... false. The Democrats certainly support it, but there is no way the Republican party will. Mitt Romney did, but he was one R in one of the most Democratic states in the US, so he had very little choice.

There is no free lunch. If you are going to cover more people with the same amount of money and reduce the barrier to getting care, you are going to get rationed care and waiting lists, just like everywhere else. I wish the Democratic party the best of luck in the 20xx elections when Grandma and her boomer buddies realize she now has to wait 3 months for her hip replacement.

Typical. The above implies that we currently don't have rationed care and waiting lists in the US. We do, it's just structurally different, and getting worse. What do you call it when an employer, because of increasing healthcare premium costs, reduces benefits? Drops children from coverage? How is this not rationing? This speaks nothing to the uninsured. Waiting lists? In the US, if you need a rotator cuff repair and don't have insurance, depending on where you live, it will never be fixed. Have any idea what this costs society (not to mention the whole patient suffering bit)? At least in Canada you'd be in a line somewhere. I don't know if you meant to, but you illustrate the point of the irrational consumer: generally speaking, if Grandma's hip can make it another 3 months, she should wait.

When I say support on both sides of the isle I mean to state that it is universally recognized that our system is broken and needs an overhaul. Intrinsic in a repair is an addressing of the uninsured problem.

No free lunch. You have to clean up your practice. You can't replace a hip just because it hurts, has radiographic evidence of arthritis, and the patient has insurance, you have to start replacing them when they don't work any longer. You have to start prescribing omeprazole instead of Nexium. You have to provide primary care/screening exams to mitigate dialysis costs. You have to get rid of the myriad of insurance companies, all of their lackies, and all the associated lawyers. You can't have 2 MRI matchines running at half capacity across the street from one another. You have to be accountable for the tests that you order (i.e. if they are unwarranted), you have to be somehow accountable...change your practice, or have your privileges restricted.

 

[dilated]

Typical. The above implies that we currently don't have rationed care and waiting lists in the US. We do, it's just structurally different, and getting worse. What do you call it when an employer, because of increasing healthcare premium costs, reduces benefits? Drops children from coverage? How is this not rationing? This speaks nothing to the uninsured. Waiting lists? In the US, if you need a rotator cuff repair and don't have insurance, depending on where you live, it will never be fixed. Have any idea what this costs society (not to mention the whole patient suffering bit)? At least in Canada you'd be in a line somewhere. I don't know if you meant to, but you illustrate the point of the irrational consumer: generally speaking, if Grandma's hip can make it another 3 months, she should wait.

There is the idealist response: you have simply decided that it's better to make everyone wait the same amount of time to get health care rather than segregate by willingness to pay. Since the truly poor are covered by medicaid, an economical approach might suggest that willingness to pay allows people to weight how bad they want certain health care items versus how bad they want other consumer items. Ideally that would be a better reflection of consumer desires than an arbitrary government imposed cap. In any case, you are making a value judgment on what type of rationing is "right" that many others disagree with, so it's hardly a universal agreement.

And there's the simple realist response: your system will cause the elderly to go from health care on demand to waiting lists and queues. They are the largest, most powerful voting bloc and get bigger every year. GOOD LUCK.

 

[Miami_med]

Typical. The above implies that we currently don't have rationed care and waiting lists in the US. We do, it's just structurally different, and getting worse. What do you call it when an employer, because of increasing healthcare premium costs, reduces benefits? Drops children from coverage? How is this not rationing? This speaks nothing to the uninsured. Waiting lists? In the US, if you need a rotator cuff repair and don't have insurance, depending on where you live, it will never be fixed. Have any idea what this costs society (not to mention the whole patient suffering bit)? At least in Canada you'd be in a line somewhere. I don't know if you meant to, but you illustrate the point of the irrational consumer: generally speaking, if Grandma's hip can make it another 3 months, she should wait.

When I say support on both sides of the isle I mean to state that it is universally recognized that our system is broken and needs an overhaul. Intrinsic in a repair is an addressing of the uninsured problem.

No free lunch. You have to clean up your practice. You can't replace a hip just because it hurts, has radiographic evidence of arthritis, and the patient has insurance, you have to start replacing them when they don't work any longer. You have to start prescribing omeprazole instead of Nexium. You have to provide primary care/screening exams to mitigate dialysis costs. You have to get rid of the myriad of insurance companies, all of their lackies, and all the associated lawyers. You can't have 2 MRI matchines running at half capacity across the street from one another. You have to be accountable for the tests that you order (i.e. if they are unwarranted), you have to be somehow accountable...change your practice, or have your privileges restricted.

Why? This is exactly why there are no real waits for MRIs in this country.

I'll say what I've said before. EVERYONE can get care in this country. The difference is, that they are expected to pay for it after they get it, rather than contributing to some giant tax pool their entire lives for the privelege of waiting after they get sick. Try actually being sick without insurance and showing up to ANY ED in the country. You'll be seen. There were a myriad of public EDs before the era of EMTALA that would have even seen you then.

As to "no free lunch," what do you think Universal Coverage is? Take money from the people who could already afford health insurance and use it to provide "free lunch" for people who couldn't or wouldn't. Then, make those that are now paying for two people wait in long lines for procedures that they could have paid for without you taking their money.

The communist model of economics has been an abysmal failure in all places that it has been tried. Economic prosperity is almost directly inversely proportional to the level of government intervention in markets. In this country, we understand the value of free markets in most things, and I can go to the store and buy incredibly complex items that didn't even exist 30 years ago on my student's budget. For some reason, we take things that are most important, and treat them like they are too good for the capitalist model that did the best job of providing services in the first place.

Things like Healthcare and Education, where the government is heavily involved in the market, are persistently falling apart, while personal computers and DVD players become forever cheaper. Every technological advance in video games creates a larger variety and lowers the price of all previous advances in games. Every technological advance in medicine strike fear into the hearts of everyone, because it raises costs trying to provide it to everyone. Rather than subjecting medical advances to market forces, which drive prices down in order to be able to make the produce affordable to a decent market size, socialism drives prices up. People want to keep technology expensive, because the incentive is to draw more money from the government. We already see this in Medicare and Medicaid. Why do we think that it will improve if we make the government even more involved in healthcare?

The only "universal coverage" that I support, is a free market on medical services that people can universally choose to access based on market conditions..

 

[dry dre]

While I'm just a young physician, it's grand to hear non-physicians describe the realistic state of health care in the US, no less elsewhere. Have you lived in Canada? I have, stationed there in the Marines. Have you used their system? I have. Have you used the US system? Do you have any family members with medical problems? Have you taken care of any American patients with insurance to realize what they deal with? Have you tried to bill for services and realize the reality of what physicians deal with?

Pure capitalism in health care? Even intellectuals who are proponents of market driven health care (i.e. who make better points to the ends you seek), who are experts/PhDs etc in their fields, who are conservative in nature, do not support this. Why not? Because it costs the society too much (oh yeah, you and your children are part of society). They (unlike the non-docs here) recognize that, financially (and for varying amounts of good to mankind kind of thing) we can not afford to. Penny-wise and pound foolishness has gotten us far enough. American industries are tied to the anchor of near double-digit annual increases in healthcare costs which, in the aggregate, is stiffling American economic competetiveness and growth across the board.

Talk of waiting lines and queues... They exist today in the US for people with insurance. Specialists are over-utilized. Have you done any primary care work in the US? Tell me what happens when you deny patients the workup or medication that they desire. You lose patients. They seek out a provider that will give them what they want. This is typically neither scientifically or economically sound, but it the nature of a free market system. Is this what you seek?

It all comes down to what you see the purpose of the healthcare system to be. If you see it as a place to make money, then state such and advocate for a purely capitalistic model. Make sure you have the character and fortitude to let all of your collegues and patients know that this is how you see the role of medicine in the world. Alternatively, if you see to goal of the healthcare system to maximize public health, wake up and smell the coffee.

I assume some here are not familiar with where the advances (science and technology) in healthcare are coming from. They assume that the US leads the world. Practically, this is not so. Someday you folks might read some medical journals and/or look at the citations in your textbooks and realize that a disproportionate amount of advances come from outside the US. Other countries (i.e. the rest of the industrialized world) have an economic incentive to maximize public health. Our system has no incentive (particularly for people with insurance) to provide preventative medicine, the area that is proven the world over to maximize health and reduce healthcare costs.

Is the relationship of a healthy population and economic/historical strength so difficult to appreciate and accept? Yes, let's get away from public healthcare concerns, do away with mandatory vaccinations, not treat people with disease if they don't have money. We'll send the diseased/disabled to Wyoming or somewhere and make them become economically self-sufficient amongst themselves. Alternatively, let's get everyone out of healthcare who isn't a nurse, doctor, scientist, patient aide...

 

[MountainPharmD]

If you really want something screwed up get the government involved. Medicare part D(iaster) is a prime example. I have nightmares at the thought of single payer government run healthcare. God helps us all....

 

[sdn1977]

Both Miami & dry dre make good & valid points. However, each has points which can be argued.

I agree - currently there is a two or even three tiered system within the US with regard to access & actual care given. If you have money, you can get your MRI, hip replacement, proton pump inhibitor of choice. Likewise, if you're a provider, you can set up your own MRI or CT scanner & advertise like crazy for full body scans to appeal to those who are continually fearful of anything & everything. Is this a good thing or not - it can be argued both ways.

I can't comment on medical insurance as a provider - only a consumer. But, my own, which is excellent, discounts my providers billing by about 2/3rds - but that original bill was as artificial as the 2mg morphine I billed out in the hospital - its all "funny money" and doesn't reflect actual costs at all. However, the way the reimbursement structure is set up, we have to bill for all sorts of things in 2007 that would have not been billed for in 1977 since insurance companies determine how payment is made.

I can comment on drug coverage since I am a provider for that & as Mountain alluded - it is absolutely insane & without cohesive thought nor based on rational medicine. The Part D insurers hold all the cards & can change their plans - and do change their plans - without notice & as often as they want.

Dry - your comment was prescribers should be prescribing omeprazole rather than Nexium makes good sense to you since in a logical fashion, one would think the generic with is as close to a first cousin as a drug could be, would be less expensive. However, in the fantasy world of drug coverage - that is not always the case. The reason is - drug insurance companies are OWNED by drug companies - Paid Prescriptions is owned by Merck-Medco - which owns Merck Pharmaceuticals....if you go far enough back in the corporate structure. This is why I dispense as much Zocor as simvastatin & Wellbutrin SR as buproprion sr....the hand that is feeding you is also the hand that is making the food - it is self serving & the "self" is the drug companies.

I agree there needs to be a huge overhaul, however, having individuals pay full price, as Miami suggests, is unrealistic. Few of us could afford one major illness let alone many in a lifetime. I'm not sure a single payer system is the answer either - especially if its the government. After all - Bush came right out & said pharmacists are to blame for drug prices & we have absolutely no control over drug prices - they are set by insurance companies. So....if you have a idiot who doesn't understand the current system, why would that same individual be smart enough to set up a better system. Fortunately, he won't be around long enough to do so, but there are a whole lot more of them in Washington who have about the same amount of smarts when it comes to healthcare.

One thing I do feel strongly about - there needs to be less control by the insurance industry on coverage - from MRI's to proton pump inhibitors. I see no reason why someone who works for Ford Motor Company in Detroit should have better or worse coverage than someone who works for Intel in Santa Clara or Hyatt Hotels in Miami or New York.

Personally, I feel there should be a standard we set that we decide on as a society that we feel all individuals should have as the bottom, acceptable coverage which is available to everyone - not necessarily paid for by the govt, but shared by all 3 - the individual, the govt & the employer. Beyond that....I'm not sure how I feel....I still have to think about it.

 

[Miami_med]

Pure capitalism in health care? Even intellectuals who are proponents of market driven health care (i.e. who make better points to the ends you seek), who are experts/PhDs etc in their fields, who are conservative in nature, do not support this. Why not? Because it costs the society too much (oh yeah, you and your children are part of society). They (unlike the non-docs here) recognize that, financially (and for varying amounts of good to mankind kind of thing) we can not afford to. Penny-wise and pound foolishness has gotten us far enough. American industries are tied to the anchor of near double-digit annual increases in healthcare costs which, in the aggregate, is stiffling American economic competetiveness and growth across the board.

So? Society is comprised of individuals. What is bad for individuals is bad for society. This whole argument that we should tax and take freedom away from individuals to feed "society" is ridiculous. It is however, the intellectual mainstream.

By the way, I can quote a number of phDs who do agree with me. I also think that it is irrelevant. The truth is not defined by who has more "intellectuals" on his side.

Talk of waiting lines and queues... They exist today in the US for people with insurance. Specialists are over-utilized. Have you done any primary care work in the US? Tell me what happens when you deny patients the workup or medication that they desire. You lose patients. They seek out a provider that will give them what they want. This is typically neither scientifically or economically sound, but it the nature of a free market system. Is this what you seek?

It is perfectly sound in a free market system, because the patient has to pay for treatment. Patient's won't want unlimited workups if they come out of the patient's pocket. Primary care will be cheaper than specialty care, and a free market might actually fix part of the over-utilized specialist problem. If a patient pays for too much treatment, it is a personal choice, and it won't hurt anyone, because the money will come from the patient.

It all comes down to what you see the purpose of the healthcare system to be. If you see it as a place to make money, then state such and advocate for a purely capitalistic model. Make sure you have the character and fortitude to let all of your collegues and patients know that this is how you see the role of medicine in the world. Alternatively, if you see to goal of the healthcare system to maximize public health, wake up and smell the coffee.

This is a false dichotomy. I've been arguing the whole time that capitalism provides the greatest amount of healthcare just like it provides the cheapest DVD players. Don't accuse me of not wanting to provide good care because I think that money is a legitimate reward for providing better care. I believe that it creates the best incentives for good care, and that capitalism would provide good care. We don't have capitalism now.

I assume some here are not familiar with where the advances (science and technology) in healthcare are coming from. They assume that the US leads the world. Practically, this is not so. Someday you folks might read some medical journals and/or look at the citations in your textbooks and realize that a disproportionate amount of advances come from outside the US. Other countries (i.e. the rest of the industrialized world) have an economic incentive to maximize public health. Our system has no incentive (particularly for people with insurance) to provide preventative medicine, the area that is proven the world over to maximize health and reduce healthcare costs.

This is just blatantly wrong. I'll find the statistics, but I think that we had ~50% of the advances last year. It also doesn't take into account difference in government research dollars. If a government put taxes at 50% and put it all towards research, you'd probably have a number of advances. You'd also kill most of your economy. There is a maximum amount of money that can be spent on healthcare to provide maximum efficiency within the economy as a whole. You've put a spotlight on healthcare and divorced it from the economy as a whole as an end unto itself.

Is the relationship of a healthy population and economic/historical strength so difficult to appreciate and accept? Yes, let's get away from public healthcare concerns, do away with mandatory vaccinations, not treat people with disease if they don't have money. We'll send the diseased/disabled to Wyoming or somewhere and make them become economically self-sufficient amongst themselves. Alternatively, let's get everyone out of healthcare who isn't a nurse, doctor, scientist, patient aide...

I've always argued that the ONLY role of government in healthcare is the control of infectious disease. This is because infectious disease directly infects innocent people, and its control can be seen as a police function (self-defense). This is different than diabetes or CV disease.

 

[Miami_med]

I agree there needs to be a huge overhaul, however, having individuals pay full price, as Miami suggests, is unrealistic. Few of us could afford one major illness let alone many in a lifetime. I'm not sure a single payer system is the answer either - especially if its the government. After all - Bush came right out & said pharmacists are to blame for drug prices & we have absolutely no control over drug prices - they are set by insurance companies. So....if you have a idiot who doesn't understand the current system, why would that same individual be smart enough to set up a better system. Fortunately, he won't be around long enough to do so, but there are a whole lot more of them in Washington who have about the same amount of smarts when it comes to healthcare.

I've never said that insurance shouldn't exist. I've only argued that it shouldn't be controlled by the government. People can choose to buy it in order to protect themselves from catastrophes. If the money train dried up however, or the government let go of the pseudo-monopolies that individual hospital districts have, prices would *gasp* drop. Medicine is only as expensive as it is now BECAUSE there is basically a limitless amount of money feeding it.

One thing I do feel strongly about - there needs to be less control by the insurance industry on coverage - from MRI's to proton pump inhibitors. I see no reason why someone who works for Ford Motor Company in Detroit should have better or worse coverage than someone who works for Intel in Santa Clara or Hyatt Hotels in Miami or New York.

An insurance plan is something to consider when choosing a job. This is like arguing that all workers should be paid the same. It is a perk, and it is part of the package. I insure a family of 3 with a completely independent policy that is in no way linked to my job.

Personally, I feel there should be a standard we set that we decide on as a society that we feel all individuals should have as the bottom, acceptable coverage which is available to everyone - not necessarily paid for by the govt, but shared by all 3 - the individual, the govt & the employer. Beyond that....I'm not sure how I feel....I still have to think about it.

And therein lies the root of the problem. This is a socialist statement at heart, and with this as the ideal, the system will never be fixed. Minor reallocations of who pays what will do NOTHING to stop the spiraling healthcare monster. Right now, the amount of money paid out of pocket accounts for something like less than 10% of all healthcare expenditures. The higher this number goes, the better things will be.

I'm tired of watching middle class and working families getting squeezed out of any health coverage in the name of universal coverage. In the 60s, there was really a minimal problem with healthcare access. As we've progressively tried to cover people through the government, people who are more and more better off are losing their coverage. I'm sick of screwing the average middle class american and also the most productive people in the country in the name of the poor. Someone always pays as long as the government is involved.