Health Care Reform

[ms2209]

The Kerry plan - What do you think?

NYTimes Op-Ed
Health Versus Wealth
By: Paul Krugman


Will actual policy issues play any role in this election? Not if the White House can help it. But if some policy substance does manage to be heard over the clanging of conveniently timed terror alerts, voters will realize that they face some stark choices. Here's one of them: tax cuts for the very well-off versus health insurance.

John Kerry has proposed an ambitious health care plan that would extend coverage to tens of millions of uninsured Americans, while reducing premiums for the insured. To pay for that plan, Mr. Kerry wants to rescind recent tax cuts for the roughly 3 percent of the population with incomes above $200,000.

George Bush regards those tax cuts as sacrosanct. I'll talk about his health care policies, such as they are, in another column.

Considering its scope, Mr. Kerry's health plan has received remarkably little attention. So let me talk about two of its key elements.

First, the Kerry plan raises the maximum incomes under which both children and parents are eligible to receive benefits from Medicaid and the State Children's Health Insurance Program. This would extend coverage to many working-class families, who often fall into a painful gap: they earn too much money to qualify for government help, but not enough to pay for health insurance. As a result, the Kerry plan would probably end a national scandal, the large number of uninsured American children.

Second, the Kerry plan would provide "reinsurance" for private health plans, picking up 75 percent of the medical bills exceeding $50,000 a year. Although catastrophic medical expenses strike only a tiny fraction of Americans each year, they account for a sizeable fraction of health care costs.

By relieving insurance companies and H.M.O.'s of this risk, the government would drive down premiums by 10 percent or more.

This is a truly good idea. Our society tries to protect its members from the consequences of random misfortune; that's why we aid the victims of hurricanes, earthquakes and terrorist attacks. Catastrophic health expenses, which can easily drive a family into bankruptcy, fall into the same category. Yet private insurers try hard, and often successfully, to avoid covering such expenses. (That's not a moral condemnation; they are, after all, in business.)

All this does is pass the buck: in the end, the Americans who can't afford to pay huge medical bills usually get treatment anyway, through a mixture of private and public charity. But this happens only after treatments are delayed, families are driven into bankruptcy and insurers spend billions trying not to provide care.

By directly assuming much of the risk of catastrophic illness, the government can avoid all of this waste, and it can eliminate a lot of suffering while actually reducing the amount that the nation spends on health care.

Still, the Kerry plan will require increased federal spending. Kenneth Thorpe of Emory University, an independent health care expert who has analyzed both the Kerry and Bush plans, puts the net cost of the plan to the federal government at $653 billion over the next decade. Is that a lot of money?

Not compared with the Bush tax cuts: the Center on Budget and Policy Priorities estimates that if these cuts are made permanent, as the administration wants, they will cost $2.8 trillion over the next decade.

The Kerry campaign contends that it can pay for its health care plan by rolling back only the cuts for taxpayers with incomes above $200,000. The nonpartisan Tax Policy Center, which has become the best source for tax analysis now that the Treasury Department's Office of Tax Policy has become a propaganda agency, more or less agrees: it estimates the revenue gain from the Kerry tax plan at $631 billion over the next decade.

What are the objections to the Kerry plan? One is that it falls far short of the comprehensive overhaul our health care system really needs. Another is that by devoting the proceeds of a tax-cut rollback to health care, Mr. Kerry fails to offer a plan to reduce the budget deficit. But on both counts Mr. Bush is equally, if not more, vulnerable. And Mr. Kerry's plan would help far more people than it would hurt.

If we ever get a clear national debate about health care and taxes, I don't see how President Bush will win it.

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[ms2209]

The Bush plan:

NYTimes Op-Ed
Medical Class Warfare
By: PAUL KRUGMAN

If past patterns are any guide, about one in three Americans will go without health insurance for some part of the next two years. They won't, for the most part, be the persistently poor, who are usually covered by Medicaid. They will be members of working families with breadwinners who have jobs without medical benefits or who have been laid off.

Many Americans fear the loss of health insurance. Last week I described John Kerry's health plan. What's the Bush administration's plan?

First, it offers a tax credit for low- and middle-income families who don't have health coverage through employers. That credit helps them purchase health insurance. The credit would be $3,000 for a family of four with an income of $25,000; for an income of $40,000, it would fall to $1,714. Last year the average premium for families of four covered by employers was more than $9,000.

A study by the Kaiser Family Foundation estimates that the tax credit would reduce the number of uninsured, 44 million people in 2002, by 1.8 million. So it wouldn't help a great majority of families unable to afford insurance. For comparison, an independent assessment of the Kerry plan by Kenneth Thorpe of Emory University says that it would reduce the number of uninsured by 26.7 million.

The other main component of the Bush plan involves "health savings accounts." The prescription drug bill the Bush administration pushed through Congress last year had a number of provisions unrelated to Medicare. One of them allowed people who purchase insurance policies with high deductibles, generally at least $2,000 per family, to shelter income from taxes by setting up special accounts for medical expenses. This year, the administration proposed making the premiums linked to these accounts fully tax-deductible.

Although the 2005 budget presents that new deduction under the heading "Helping the uninsured," health savings accounts don't seem to have much to do with the needs of the families likely to find themselves without health insurance. For one thing, such families need more protection than a plan with a $2,000 deductible provides. Furthermore, the tax advantages of health savings accounts would be small for those families most at risk of losing health insurance, who are overwhelmingly in low tax brackets.

But for people whose income puts them in high tax brackets, these accounts are a very good deal; making the premiums deductible turns them into a great deal. In other words, health savings accounts will offer the already affluent, who don't have problems getting health insurance, yet another tax shelter. Meanwhile, health savings accounts, in the view of many experts, will actually increase the number of uninsured.

This perverse effect shouldn't be too surprising: unless they are carefully designed, medical policies often have side consequences that worsen the problems they supposedly address. For example, the Congressional Budget Office estimates that one-third of the retirees who now have drug coverage through their former employers will lose that coverage as a result of the Bush prescription drug bill and will be forced to accept inferior coverage from Medicare.

In the case of health savings accounts, the key side consequence is a reduced incentive for companies to insure their workers. When companies provide group health insurance, healthier employees implicitly subsidize their sicker colleagues. They're willing to do this largely because the employer's contributions to health insurance are a tax-free form of compensation, but only if the same plan is offered to all employees.

Tax-free health savings accounts and premiums would provide healthier and wealthier employees an incentive to opt out, accepting higher paychecks instead, and would lead to higher insurance premiums for those who remain in traditional plans. This would cause some companies to stop providing health insurance, or raise employee contributions to a level some workers can't afford.

The difference couldn't be starker. Mr. Kerry offers a health care plan that would extend coverage to most of those now uninsured, paid for by rolling back tax cuts for those with incomes over $200,000. President Bush offers a tax credit that would extend coverage to fewer than 5 percent of the uninsured, plus a new tax break for the affluent that would actually increase the number of uninsured. As I said last week, I don't see how Mr. Bush can win this debate.

 

[g3pro]

Isn't Paul Krugman a declared socialist?


Anyways, people will have to make the decision between capitalism and socialism in this case. Either you can re-distribute wealth from the top 3% to the bottom 3% and hurt the country's economic growth, or you can get tax credits from the government which do not create incentives for unnecessary medical procedures, etc, and cost less for the whole government.


It's your choice, but keep in mind that Kerry is trying to lead the path towards socialized medicine.

 

[DoctorFunk]

It's your choice, but keep in mind that Kerry is trying to lead the path towards socialized medicine.

With the demonstrated link between low socioeconomic status and poor health, it seems that "socialized" medicine is the only plan that will increase out nation's general health. Only by recognizing the financial strain that lower and middle class uninsured place on our health care system and reallocating funds from the rest of society to fund greater access to insurance and public health education can we hope to improve overall public health. It seems to me that as future health professionals we should keep an open mind towards any political idea with the prospect of improving the health prospects of any underserved population.

 

[g3pro]

With the demonstrated link between low socioeconomic status and poor health, it seems that "socialized" medicine is the only plan that will increase out nation's general health. Only by recognizing the financial strain that lower and middle class uninsured place on our health care system and reallocating funds from the rest of society to fund greater access to insurance and public health education can we hope to improve overall public health. It seems to me that as future health professionals we should keep an open mind towards any political idea with the prospect of improving the health prospects of any underserved population.

No, socialized medicine is only one route to insuring the non-insured. Bush's plan, on the other hand, focuses less on socialism and more on the problems with socialized medicine. The government simple can not give free reign to almost anyone to rack up health expenses. The only way to curve the problem of being given incentives to go to the hospital whenever you want is to put a level of responsibility on the individual, which is exactly what Bush's plan is. When you take the concept of payment away from the individual, all hell breaks loose.

Socialized medicine will create far more problems than it will solve. I already noticed it when I worked with triage at my hospital's ED. You simply would not believe the number of parents who take their children to the ER because of "a runny nose". These visits cost at least $800. What is their rationale for doing this? "My husband's company health care will take care of it." There it is. Now just imagine that on the scale of the nation, and you have some serious problems. Would that parent take the kid to the ER when she has to use her "savings"? Almost certainly not.

As a physician, you need to understand the costs and benefits of the plans.

 

[flighterdoc]

Isn't Paul Krugman a declared socialist?


Anyways, people will have to make the decision between capitalism and socialism in this case. Either you can re-distribute wealth from the top 3% to the bottom 3% and hurt the country's economic growth, or you can get tax credits from the government which do not create incentives for unnecessary medical procedures, etc, and cost less for the whole government.


It's your choice, but keep in mind that Kerry is trying to lead the path towards socialized medicine.

Krugman is also an idiot. If you look at his articles over the years he's been pretty consistently wrong. And I certainly wouldn't depend on him to tell me what the Bush plan is.

 

[flighterdoc]

With the demonstrated link between low socioeconomic status and poor health, it seems that "socialized" medicine is the only plan that will increase out nation's general health. Only by recognizing the financial strain that lower and middle class uninsured place on our health care system and reallocating funds from the rest of society to fund greater access to insurance and public health education can we hope to improve overall public health. It seems to me that as future health professionals we should keep an open mind towards any political idea with the prospect of improving the health prospects of any underserved population.

There is no demonstrated link. Countries that have socialized medicine (Canada, for example) have people with poor health - the "First Nations", for one. Also, 25% of Canadians can't get access to a primary care provider, at all. Even though cost isn't an issue since the province pays for it.

 

[ms2209]

Krugman is also an idiot. If you look at his articles over the years he's been pretty consistently wrong. And I certainly wouldn't depend on him to tell me what the Bush plan is.

And the fact that you call someone an idiot simply because you disagree with his opinion makes your viewpoint so much more valid.

 

[medic170]

socialism, including socialized medicine, would be a big mistake and goes against everything this country was founded on. Just because someone is richer, regardless of whether they earned it or inheritied it, does not give you or I the right to take the money and redistribute it in any way. It is their money, not yours and not the governments. I do not agree with socialism in any form. The rich already pay their share. The top 10% of income earners pay roughly 60% of all federal income tax revenus already. I saw the funniest thing on TV the other day. They did a survey asking people their income level and whether or not they thought their taxes were too high. As you know, once you are below a certain income, your tax rate becomes 0 and you may even get extra money through earned income. 62% of respondants that had an income level at which their federal tax was 0%(they paid no taxes or received a 100%refund) said that their taxes were TOO HIGH!!!. I guess the rich should just pay everything. I could go on, but their is no convincing liberald of the obvious truth that capitalis equals equality of opportunity and socialism is an unfair system of unearned equality and decreased opportunity for everyone.

 

[DoctorFunk]

There is no demonstrated link. Countries that have socialized medicine (Canada, for example) have people with poor health - the "First Nations", for one. Also, 25% of Canadians can't get access to a primary care provider, at all. Even though cost isn't an issue since the province pays for it.

There is, in fact, such a correlation that has been demonstrated time and again in public health research. The problem comes from two main sources: problems with equal access to health care and a disparity in the health education offered to those of lower classes.

You cannot dispute that less access to health care will not affect the amount of preventive advice/care physicians can offer the lower socioeconomic class, leading to more occurrence of major preventable illnesses, for example lung cancer, sexually transmitted diseases, heart disease. This also directly ties into the lack of solid health education offered to the lower socioeconomic class due to the poor education received in high school and lesser chances of secondary education. These classes are therefore less likely to fully understand the risks of unhealthy behavior like smoking, unprotected sex, a McDonald's diet, etc. and thus cost the entire society more down the line when they have a massive heart attack, lung cancer, or require the newest AIDS drugs.

I agree with the previous poster, accountability is very important. But in the end would we rather punish the less fortunate for what may or MAY NOT be under their control, such as the education they receive, or would we prefer to live in a society in which we work to protect the less fortunate and work together towards more public health? Health is always going to be a problem, I guess I would prefer that we share that problem equally across the socioeconomic spectrum, rather than concentrating a great deal of the burden on those least able to deal with it.

*End bleeding heart liberal rant*

 

[flighterdoc]

And the fact that you call someone an idiot simply because you disagree with his opinion makes your viewpoint so much more valid.

As I said, if you look at his articles over the years he's been pretty consistently wrong. That is support for my opinion, which you're free to agree or disagree with. However, if you think that a notorious left wing columnist (no matter their academic qualifications) is a good place to find out about a conservatives political opinions, what does that say for your viewpoint?

 

[medic170]

There is, in fact, such a correlation that has been demonstrated time and again in public health research. The problem comes from two main sources: problems with equal access to health care and a disparity in the health education offered to those of lower classes.

You cannot dispute that less access to health care will not affect the amount of preventive advice/care physicians can offer the lower socioeconomic class, leading to more occurrence of major preventable illnesses, for example lung cancer, sexually transmitted diseases, heart disease. This also directly ties into the lack of solid health education offered to the lower socioeconomic class due to the poor education received in high school and lesser chances of secondary education. These classes are therefore less likely to fully understand the risks of unhealthy behavior like smoking, unprotected sex, a McDonald's diet, etc. and thus cost the entire society more down the line when they have a massive heart attack, lung cancer, or require the newest AIDS drugs.

I agree with the previous poster, accountability is very important. But in the end would we rather punish the less fortunate for what may or MAY NOT be under their control, such as the education they receive, or would we prefer to live in a society in which we work to protect the less fortunate and work together towards more public health? Health is always going to be a problem, I guess I would prefer that we share that problem equally across the socioeconomic spectrum, rather than concentrating a great deal of the burden on those least able to deal with it.

*End bleeding heart liberal rant*

Education can be obtained by poor people. I am living proof. Also, I have spent the majority of my life uninsured, and I would rather be a poor uninsured person in a capitalistic society where I have the opportunity to succeed as much as I want than in a socialist society where I have insurance, but why even try to succeed, the gov. will just take my hard earned money and give it to poor people to make it "fair". the idea of capitalism is not fairness, the idea is that even the poorest indigent person can rise to the top if they choose to do so. Sure, its harder than inheriting money, but this is as good as it gets.

 

[DoctorFunk]

I could go on, but their is no convincing liberald of the obvious truth that capitalis equals equality of opportunity and socialism is an unfair system of unearned equality and decreased opportunity for everyone.

I guess I fail to see how a national healthcare system is any more socialism than the other national systems that we pay taxes to fund, such as our national highway system, the national security programs we all fund, or our public education system. How are we able to place national healthcare under the d*mning umbrella of socialism (boo, hiss) when we all take advantage of, and fund according to our ability, the other national programs that are necessary for a successful society?

 

[medic170]

I guess I fail to see how a national healthcare system is any more socialism than the other national systems that we pay taxes to fund, such as our national highway system, the national security programs we all fund, or our public education system. How are we able to place national healthcare under the d*mning umbrella of socialism (boo, hiss) when we all take advantage of, and fund according to our ability, the other national programs that are necessary for a successful society?

Because highways, public education, and national security are NOT income redistributuion and therefore is not socialist!

 

[ms2209]

As I said, if you look at his articles over the years he's been pretty consistently wrong. That is support for my opinion, which you're free to agree or disagree with. However, if you think that a notorious left wing columnist (no matter their academic qualifications) is a good place to find out about a conservatives political opinions, what does that say for your viewpoint?

I didn't say that Krugman's opinion articles are good for finding out "conservative political opinions". Obviously Krugman is left-wing, and obviously the pieces I have added to this thread are expressions of his opinion. The only reason I started this thread with his op-ed articles was that I had read them this morning and thought it might be interesting to see what others thought, regardless of political affiliation. I don't pretend that Krugman's NY Times opinion section would provide conservative political opinions, but feel free (and this is for anyone) to post articles with the conservative viewpoints on this thread. I would be very interested to hear your thoughts on this matter.

 

[flighterdoc]

There is, in fact, such a correlation that has been demonstrated time and again in public health research. The problem comes from two main sources: problems with equal access to health care and a disparity in the health education offered to those of lower classes.

You cannot dispute that less access to health care will not affect the amount of preventive advice/care physicians can offer the lower socioeconomic class, leading to more occurrence of major preventable illnesses, for example lung cancer, sexually transmitted diseases, heart disease. This also directly ties into the lack of solid health education offered to the lower socioeconomic class due to the poor education received in high school and lesser chances of secondary education. These classes are therefore less likely to fully understand the risks of unhealthy behavior like smoking, unprotected sex, a McDonald's diet, etc. and thus cost the entire society more down the line when they have a massive heart attack, lung cancer, or require the newest AIDS drugs.

I agree with the previous poster, accountability is very important. But in the end would we rather punish the less fortunate for what may or MAY NOT be under their control, such as the education they receive, or would we prefer to live in a society in which we work to protect the less fortunate and work together towards more public health? Health is always going to be a problem, I guess I would prefer that we share that problem equally across the socioeconomic spectrum, rather than concentrating a great deal of the burden on those least able to deal with it.

*End bleeding heart liberal rant*

You stated

that "socialized" medicine is the only plan that will increase out nation's general health.

I pointed out that countries that have socialized medicine (I used Canada, but could have just as easily picked an avowedly socialist country like say Cuba) has much the same disparities that any other country has.

So, rather than support your thesis or attempt to disprove my point, you're changing the argument. Which is typical for a bleeding heart liberal ranter (your description of yourself).

Public health education is not dependent on socialized medicine (again, the point YOU were trying to make). The greatest strides forward in health, and public health, all happened absent socialized medicine (for example, what we would consider basic hygiene and sanitation), and there is no reason to assume that socialized medicine is necessary for future gains in public health.

 

[DoctorFunk]

Education can be obtained by poor people. I am living proof. Also, I have spent the majority of my life uninsured, and I would rather be a poor uninsured person in a capitalistic society where I have the opportunity to succeed as much as I want than in a socialist society where I have insurance, but why even try to succeed, the gov. will just take my hard earned money and give it to poor people to make it "fair". the idea of capitalism is not fairness, the idea is that even the poorest indigent person can rise to the top if they choose to do so. Sure, its harder than inheriting money, but this is as good as it gets.

I'm really not trying to argue the merits of socialism versus capitalism. I think that history has shown that socialism as a nationwide system of government is simply not functional at this time. I'd also like to congratulate you on the success that you have earned, clearly you are one of the success stories.

I simply think that in an advanced society such as ours, it is unfortunate that life and death decisions are often made by market forces out of the control of our patients and, far too often, the physicians charged with their care. I guess I'm surprised that my fellow future physicians are so concerned with market forces and capitalist theory over the (perhaps idealistic) greater health of everyone in America. I hope to fit my political idealogy around my overwhelming concern for my patients' health as I enter into medicine, not base my medical morals around my preexisting political opinions.

 

[flighterdoc]

Because highways, public education, and national security are NOT income redistributuion and therefore is not socialist!

Actually, I'd argue that highways and national defense are the only things that the federa government should be involved in since they're specifically mentioned in the Constitution (interstate highways were created as the "National Interstate Defense Highway System", or could be considered to be "post roads" which are also specifically authorized to the federal government.

And, the Tenth Article of Amendment says

The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.​

"public education" isn't in there anywhere. And, public education should be a states rights issue, without federal involvement or funding.

 

[DoctorFunk]

Because highways, public education, and national security are NOT income redistributuion and therefore is not socialist!

Sure they are. They represent resource reallocation, as higher income citizens fund these programs to a greater extent than the poor, yet both receive the same service in the end. I fail to see how this is fundamentally different than the idea of the richest in our country chipping in more of their resources for receiving the same amount of medical care that the poor would receive.

 

[CJMPre-Med]

Socialized medicine is not the answer imo, for a variety of reasons. One is that I feel that it isn't (or wouldn't) be as efficient with a larger population base; another is that we are not a socialist country, so until all those fat-cat businessmen decide to forgo their numerous hundreds of millions of dollars, we shouldn't be in the business of dictating how well-trained and dedicated professionals like physicians make a living. What's good for the goose is good for the gander, no? Contrary to popular "wisdom", health care is not a right. Find it in the Constitution. Try to defend such an assertion philosophically-- you can't. Try to invoke a broad interpretation of "the right to life" to cover "health care" and you'll fall flat, as it is not a tenable stance to hold.


Anyway, here's my opinion of the sort of system which should be implemented, and which would be best for the largest number of people (patients AND workers); this is re-posted from another thread where I got absolutely NO feedback on it either pro or con, which was disheartening, because it strikes me as fair:


People should still have health insurance, but it will be more akin to catastrophic coverage (which has largely been discontinued for single payers, iirc, due to its lack of profit margin for the insurance co's). I would propose a model whereby people would have to pay for their health services up until a pre-set deductible, which would be based upon their income bracket. After that amount, insurance would take over and (hopefully) cover the rest, or at least a reasonable amount (unlike what occurs presently).


So, for example, take the following income brackets and what I feel a reasonable deductible would be for people in said brackets to pay to their physicians:


$15-20K Income = $150-250 deductible
$55-60K Income = $1000-1400 deductible (it's not proportional to the previous case due to sustenance costs which more greatly affect those in lower income brackets)

$85K Income = $2000-2500 deductible
$120K Income = $4500 deductible


I feel that this would be a fair system for several reasons: first, it would allow primary care physicians to finally have fee-for-service again, benefitting their bottom lines and allowing them to give the sort of care that all patients desire, rather than having to rush through patients assembly-line style in order to keep their practices solvent; secondly, those who are earning $60K per annum can certainly afford to pay $1200 for their medical costs (realistically, the only time costs would ever get to that point would be the rare procedure or expensive diagnostic test, which would be needed perhaps once or twice per year if that). I say that they can afford it because these largely comfortable middle-class people don't hesitate in the slightest to shell out $400 for a battery of tests for their dog at the vet, or $800 for a new TV set, or $150 on a dinner, or $350 for their plumber, or $1000 when the coils blow on their car. Yet these same people, by and large, want to be able to go to their primary care physician and hand over the insurance card and a $10-15 co-pay. That is injustice right there, I'm sorry; it cannot be philosophically defended. A person's health is presumably more important than entertainment, or cuisine, or even their pet's health, yet they have no qualms in denying a physician, who is among the most skilled and dedicated of professionals, his due compensation. The sense of entitlement in this country is shocking, and that definitely contributes to this sentiment among the populace; also, however, I do not believe that the majority of people understand how primary care (and ER and other) docs are being squeezed at the moment-- if they did, I do believe that many of them would be more amenable to such plans, or at least with throwing some extra cash or a check their doctor's way after a visit.


It would also benefit insurance companies, as their payouts would decrease, if only due to the fact that they would no longer have to reimburse primary care physicians except in the most exceptional of cases where the cost of care ran over the pre-set deductible. Since the incidence of more expensive procedures such as surgery should remain relatively constant, insurance companies will be able to generate larger profit margins if they keep their premiums steady. However, what would most likely have to ensue is 1) sufficient education of the consumer/employee as to the reasons for the new cost structure, and 2) at least a slight reduction in premiums to account for the company's decreased financial liability for all sorts of primary care. I do honestly believe that most people would be accepting of such a system so long as they are comforted by the knowledge that their medical costs will never go beyond their reasonable means. For instances of extended hospitalization etc. (where costs would go quite far beyond the deductible, not merely a couple of thousand dollars), perhaps a system could be worked out where for every $X in costs incurred, the patient has to pay a certain amount. So, say, for every $10K in costs incurred above the deductible (but only once cost has gone above $10 beyond the deductible), the patient may have to chip in another $1000 or so (this would, ideally, also be tied to income bracket in my opinion, so the less fortunate pay less and the more well-off pay more).


Also, those who legitimately cannot afford to pay even for primary care service-- either because their income falls below the $15K level or they are currently unemployed-- should not be denied care despite their inability to pay. I feel that if all of the above policies (conceived in haste, but that's the general idea) were implemented, most, if not all, physicians would not have any problem with treating the occasional non-paying patient. Hell, in many cases, they do so now, and actually LOSE money on the transaction with the insurance company. The problem with the current system is that, since everybody is covered by these ludicrous plans, the physicians cannot recoup the costs anywhere else; in the proposed plan, they'd be able to recoup these costs from the people who can actually afford to pay.


I believe education is the key to this plan, and I've begun it in my own way by speaking to my family about the realities of the current system. My family's combined income is around $60-65K before taxes, and my mother is one of the aforementioned folks who will glady (well, not gladly, but she's done it) drop $600-1000 on my dog at the vet when he's sick, but still hands over a $10 co-pay at the doctor's office. Now, it's not because she's greedy, or feels entitled-- it's because she just doesn't know any better; I'd wager most people don't. I've already told my mother and father that it wouldn't kill them to throw another $20-30 (in addition to the $10 co-pay and the pittance the insurance co. reimburses the doctor) to the doctor when they have to see him once every 2-3 months. We're not going to starve. But medical professionals who've worked so hard for so long and are dedicated, caring (for the most part), and knowledgeable (and saddled with debt in many cases) deserve their due. I'm sorry.


Just my two cents.


EDIT: This is not to say that such a plan is perfect-- no plan is. One legitimate criticism of it would be that people would say "why should I pay twice for my medical care-- once to my insurance co. and once to the physician?" My short answer to that would be: People did that for decades. Catastrophic coverage was the dominant paradigm for health insurance up until the early-mid 90's. What, precisely, about human nature, the concept of service provider/consumer/payment for services rendered, or the expertise of doctors has changed in that time which now entitles you to essentially "free" care on the backs of physicians who are making less and less after having dedicated, in many cases, nearly a decade in post-graduate schooling to their profession? Answer: Nothing has changed except people's biases and expectations, which is why they have to be re-educated on such matters. When the catastrophic coverage model was dominant, self-reported customer satisfaction with the medical system was actually at an all-time high, especially as compared with today. But my above system is by no means perfect; then again, is our current system perfect? Hardly. Can anyone propose a flawless system? Doubtful, but I'd be quite open to hearing it if you can. What I've outlined above is simply the fairest system I can conceive of for all involved parties; I feel it strikes an appropriate balance where there currently is none. Obviously all notions of "fairness" are inherently subjective, and so I clearly leave myself open to charges of bias and/or skewed notions of propriety. But I would argue we all do to one extent or another.


I think that such a system would be INFINITELY better for all involved parties than pure socialized medicine. Sure, it may not be "better" for the patients, because they WILL have to pay something assuming they have the means to, but ISN'T THAT THE WAY IT IS IN EVERY OTHER SPHERE OF LIFE? I mean, this isn't rocket science-- people who provide services deserve to get paid commensurate with their abilities. Under socialized medicine, doctors would NOT be making what they are entitled to. I also feel that this plan addresses the single most pressing concern for the majority of people, which is how they will pay for catastrophic events where bills exceed their means to pay. As for other people who have the means to pay but just don't feel like doing so, a big middle-finger salute to them. That's a foolish attitude to have imo.

 

[flighterdoc]

I'm really not trying to argue the merits of socialism versus capitalism. I think that history has shown that socialism as a nationwide system of government is simply not functional at this time. I'd also like to congratulate you on the success that you have earned, clearly you are one of the success stories.

I simply think that in an advanced society such as ours, it is unfortunate that life and death decisions are often made by market forces out of the control of our patients and, far too often, the physicians charged with their care. I guess I'm surprised that my fellow future physicians are so concerned with market forces and capitalist theory over the (perhaps idealistic) greater health of everyone in America. I hope to fit my political idealogy around my overwhelming concern for my patients' health as I enter into medicine, not base my medical morals around my preexisting political opinions.

And what of the market forces and decisions that the sick and injured make? Are they responsible for them? Read this, and tell me that the poor uninsured who use the ED as their sole medical contact don't make choices that are poor (smoking, drinking) for their health, or make the economic and market choice to not have insurance so they can have new cars or cellphones

http://www.victorhanson.com/Articles/Private Papers/How_Bad_Is_It_In_America.html

 

[medic170]

I'm really not trying to argue the merits of socialism versus capitalism. I think that history has shown that socialism as a nationwide system of government is simply not functional at this time. I'd also like to congratulate you on the success that you have earned, clearly you are one of the success stories.

I simply think that in an advanced society such as ours, it is unfortunate that life and death decisions are often made by market forces out of the control of our patients and, far too often, the physicians charged with their care. I guess I'm surprised that my fellow future physicians are so concerned with market forces and capitalist theory over the (perhaps idealistic) greater health of everyone in America. I hope to fit my political idealogy around my overwhelming concern for my patients' health as I enter into medicine, not base my medical morals around my preexisting political opinions.

\

I just believe in personal responsibility. I am responsible for my health care, and you are responsible for yours. We have programs for indigents like medicaid, and every drug company has programs to give free drugs to low income folks, so beyond that little boost and volunteer organizations, i think you need to be responsible for your own well being. Why do I have to be responsible for paying for someone elses health care?

 

[IndyZX]

ms2209, thanks for the posts...

 

[ms2209]

ms2209, thanks for the posts...

You're welcome !

 

[velo]

God its always disgusting how these threads develop....ms2209 puts up some op-ed pieces looking to discuss health care reform (I presume civily) and what happens...

"Hey, what do you guys think about health care reform?"

The author's a socialist

Kerry's plan is socialist

What? I don't like socialists...they're idiots and so are you

Yeah! I don't like socialism either, I think capitalism is great

Yeah me too...how can you support socialisim you jerk

Wait what were we talking about....oh yeah...heath care reform....well this was productive

 

[ms2209]

God its always disgusting how these threads develop....ms2209 puts up some op-ed pieces looking to discuss health care reform (I presume civily) and what happens...

Indeed, that was my hope. I've been trying to read up on issues with health care, because admittedly, I'm not too familiar with the different proposals out there (other than a socialized system and what we have right now). After reading these opinion pieces, I thought that might be a good "start" for a discussion about health care reform, and to get a sense of what else is out there, but I guess I was wrong! LOL! Sorry for the degeneration of the thread...I certainly didn't mean for it to become an argument against/for socialism.

 

[flighterdoc]

God its always disgusting how these threads develop....ms2209 puts up some op-ed pieces looking to discuss health care reform (I presume civily) and what happens...

"Hey, what do you guys think about health care reform?"

The author's a socialist

Kerry's plan is socialist

What? I don't like socialists...they're idiots and so are you

Yeah! I don't like socialism either, I think capitalism is great

Yeah me too...how can you support socialisim you jerk

Wait what were we talking about....oh yeah...heath care reform....well this was productive

LOl, and then there's always some jackass who complains about the thread. Whats your point (if you have one, or can remember it)?

 

[velo]

Oh no point....this is the first I've posted to this thread...and I ussually just go for the joke instead of making a point that won't be listened to...people feel too strongly about these issues to have their opinions changed

I guess I was just musing on how you skillfully took a health care reform discussion and turned it into a vehement debate about the merits of capitalism vs. socialism

God I wish I could argue like that....i'd never lose.

Lets try...

"Why do you support school vouchers?"

Well school vouchers help children

Hey, I think we should help children!

Yes me too...children are special...like baby seals

You know some people club baby seals

They do!! those bastards! Well I'm against that

As am I...as am I...I think I'll answer your original question with another question, how can you OPPOSE school vouchers you evil baby seal clubbing monster!?!?!

haha...YEA! I win!!


On the issue of healthcare reform by the way...no point, I havn't looked into it enough to have an informed opinion, I'm just going for a cheap laugh and pointing out the ridiculous way you guys are debating this topic

 

[flighterdoc]

Oh no point....

On the issue of healthcare reform by the way...no point, I havn't looked into it enough to have an informed opinion, I'm just going for a cheap laugh and pointing out the ridiculous way you guys are debating this topic

So, you claim yourself you know nothing about the topic, but claim that the arguments are "ridiculous"?

Thanks for playing, here's your take-home version of SDN.

 

[velo]

So, you claim yourself you know nothing about the topic, but claim that the arguments are "ridiculous"?

Thanks for playing, here's your take-home version of SDN.

So reading comprehension isn't your strong suit eh? I said I thought the way you were debating the issue was ridiculous...quite skilled but rediculous. You took an debate that was diffucult to win "bush plan v. kerry plan" and boiled it down into a largly unrelated debate that's easy to win in this country "socialism v. capitalism"

I obviously know SOMETHING about the debate...you'd have to live in a bubble to know NOTHING about the health care reform debate....but I don't think i've learned enough to articulate exactly how I feel on the issue...I was hoping to learn more by reading this thread...but you and gp3pro hijacked it into an anti-socialism thread...plus you're always so hostile it makes it hard to read your posts, let alone absorb your "arguments"

thanks for playing yourself

 

[flighterdoc]

So reading comprehension isn't your strong suit eh? I said I thought the way you were debating the issue was ridiculous...quite skilled but rediculous. You took an debate that was diffucult to win "bush plan v. kerry plan" and boiled it down into a largly unrelated debate that's easy to win in this country "socialism v. capitalism"

I obviously know SOMETHING about the debate...you'd have to live in a bubble to know NOTHING about the health care reform debate....but I don't think i've learned enough to articulate exactly how I feel on the issue...I was hoping to learn more by reading this thread...but you and gp3pro hijacked it into an anti-socialism thread...plus you're always so hostile it makes it hard to read your posts, let alone absorb your "arguments"

thanks for playing yourself

Actually, my reading comprehension is apparently better than yours (and your short-term memory):

On the issue of healthcare reform by the way...no point, I havn't looked into it enough to have an informed opinion, I'm just going for a cheap laugh and pointing out the ridiculous way you guys are debating this topic

 

[velo]

but claim that the arguments are "ridiculous"?

here I'll put it in bold this time so you can't miss it.

I never claimed your arguments were ridiculous...I said the way you were debating was ridiculous. Your arguments against socialism are perfectly valid, and totally unrelated to the OPs thread...

As i said before...you took a difficult debate "bush plan v kerry plan" and generalized it into an easier general debate "socialism v capitalism"

I don't need to no ANYTHING about the topic to make this observation, I just have to know a bit about rhetoric.

Furthermore, I'm not totally ignorant about this issue as you have claimed. I said i havn't researched it enough to have an informed opinion...meaning I don't yet feel strongly enough about my position to articulate and debate it...MEANING I HAVN'T MADE UP MY MIND YET AND MAYBE YOU COULD CHANGE IT IF YOU'D STOP BEING SO HOSTILE....jesus christ, i hope its just the annonimity of the internet that makes you such a jerk flighterdoc

 

[DoctorFunk]

Actually, my reading comprehension is apparently better than yours (and your short-term memory):

I think there is a difference between an informed opinion and no opinion at all. Not having an informed opinion does not mean you are unable to read and comprehend at least the rudimentary details of either the Kerry or Bush plan, just that you do not know enough about the economic details of either plan, or even the moral implications, to bother putting your opinion out there.

You see, when people are unable to differentiate between simple kneejerk opinions and informed opinions, debates tend to get boiled down to good vs. evil, red vs. blue, or even socialism vs. capitalism.

 

[velo]

I think there is a difference between an informed opinion and no opinion at all. Not having an informed opinion does not mean you are unable to read and comprehend at least the rudimentary details of either the Kerry or Bush plan, just that you do not know enough about the economic details of either plan, or even the moral implications, to bother putting your opinion out there.

You see, when people are unable to differentiate between simple kneejerk opinions and informed opinions, debates tend to get boiled down to good vs. evil, red vs. blue, or even socialism vs. capitalism.

ahh...calm rational thought...where has it been all this time. Thanks funk, at least someone gets it.

"We want the Funk, give up the Funk"
George Clinton and the Parliament Funkadelic

 

[flighterdoc]

here I'll put it in bold this time so you can't miss it.

I never claimed your arguments were ridiculous...I said the way you were debating was ridiculous. Your arguments against socialism are perfectly valid, and totally unrelated to the OPs thread...

As i said before...you took a difficult debate "bush plan v kerry plan" and generalized it into an easier general debate "socialism v capitalism"

I don't need to no ANYTHING about the topic to make this observation, I just have to know a bit about rhetoric.

Furthermore, I'm not totally ignorant about this issue as you have claimed. I said i havn't researched it enough to have an informed opinion...meaning I don't yet feel strongly enough about my position to articulate and debate it...MEANING I HAVN'T MADE UP MY MIND YET AND MAYBE YOU COULD CHANGE IT IF YOU'D STOP BEING SO HOSTILE....jesus christ, i hope its just the annonimity of the internet that makes you such a jerk flighterdoc

OK, very simply.

You have admitted (not me) that you don't know what you're talking about, so your analysis of the debate is based in ignorance. I even quoted your own words showing where you said that (twice). Now you claim that you do know something.

BTW, the word you were searching for was "know".

 

[flighterdoc]

I think there is a difference between an informed opinion and no opinion at all. Not having an informed opinion does not mean you are unable to read and comprehend at least the rudimentary details of either the Kerry or Bush plan, just that you do not know enough about the economic details of either plan, or even the moral implications, to bother putting your opinion out there.

You see, when people are unable to differentiate between simple kneejerk opinions and informed opinions, debates tend to get boiled down to good vs. evil, red vs. blue, or even socialism vs. capitalism.

So, whats a "non-informed opinion"? Mindless gibberish?

 

[velo]

read doctorfunk's post, I said I didn't have an informed opinion....you over simplified that into "don't have a clue what I'm talking about" in much the same was as you turned the debate earlier "socialism v. capitalism"

if you STILL don't understand what i'm saying here...well i don't know what else to do for you.

 

[DoctorFunk]

So, whats a "non-informed opinion"? Mindless gibberish?

Rhetorical wanking, which is one step higher on the intellectual pursuits hierarchy than the search for misspellings/typos on the internet and the subsequent mocking of said misspelling/typo.

 

[flighterdoc]

read doctorfunk's post, I said I didn't have an informed opinion....you over simplified that into "don't have a clue what I'm talking about" in much the same was as you turned the debate earlier "socialism v. capitalism"

if you STILL don't understand what i'm saying here...well i don't know what else to do for you.

And again, what is a non-informed opinion?

 

[flighterdoc]

Rhetorical wanking, which is one step higher on the intellectual pursuits hierarchy than the search for misspellings/typos on the internet and the subsequent mocking of said misspelling/typo.

I didn't have to search for it. I read the post, and there it was. And, it was spelled correctly, it was just the wrong word, which is neither a typo or misspelling. It is carelessness, I think.

 

[velo]

And again, what is a non-informed opinion?

An opinion that is not based on research (reading articles, gathering stats, etc.) and is not yet set in stone in the person's mind. An opinion that is not yet worth sharing.

That's why I havn't shared my opinion on the kerry plan vs. bush plan issue.

I have, however, shared my opinion on your rhetorical style-- a subject on which I have an informed opinion. I observed the way you manipulated this debate, and commented on that...I won't rehash my observations, you can see them in my earlier posts.

Now please, someone un-hijack this thread and discuss the specific merits of the bush plan v the kerry plan in a civil manner so i can start forming an informed opinion (clear on what this is yet?) on that matter.

 

[gdk]

it's commendable to try to start honest discussion, but posting op eds by krugman (former enron advisor, keep in mind) is not really a good start. he's sloppy and ultra-liberal (probably plays golf with m.moore. i can pm some of his latest half-truths and incorrect writing upon request)

back on target a little bit, i think there needs to be some kind of system to provide support for routine checkups, etc, so stuff can get caught before it needs big cost treatment. that will take some government involvement (unfortunately - because it could mean a short sighted social program that is subject to abuse by politicans - see social security for more info) but also some changes in our culture.

however, i also believe historically the government has actually increased their revenue from tax payers after taxes were cut. it doesn't sound right, but check the data (i'll look for some supporting evidence to pm upon request). so i'm always suspicous of people that say "increase taxes to pay for my program." sounds like a politician... cut spending? no way, we'll increase taxes on a minority of voters.

so when do you expect krugman to write a column about health insurance reform for medical professionals under a vice president that got rich of suing doctors and hospitals?

if you want to learn more about krugman, subscribe to the wall street journal ,opinion journal's "best of the web". it's free, through email (you can read it from wsj.com also).

sorry for the rant/thread hijacking/etc, i just don't like that krugman guy

 

[DoctorFunk]

I didn't have to search for it. I read the post, and there it was. And, it was spelled correctly, it was just the wrong word, which is neither a typo or misspelling. It is carelessness, I think.

Using the spelling for a different word in place of the spelling of the word which you mean to use is, in fact, a misspelling. But again, pointing these things out is nothing more than whipping out your internet penis and grabbing the measuring stick.

I'm sure you treasure your role as the interpreter of the posts in this thread, but I will reserve my right to read into the posts what I will, and not resort to your conclusions of carelessness or intellectual inadequacy simply due to what could very well have been the result of a sticky keyboard and an itchy trigger finger to submit a post.

We're all obviously fairly intelligent individuals, and bring different viewpoints to this debate. I think it is unfortunate that this particular conversation has become a forum on internet spelling and proper message board debate, but so be it.

 

[Garuda]

Paul Krugman is a known liar and an idiot.

 

[DoctorFunk]

Paul Krugman is a known liar and an idiot.

I hear he clubs baby seals on the weekends.

 

[wends]

There is no demonstrated link. Countries that have socialized medicine (Canada, for example) have people with poor health - the "First Nations", for one.


i think you just demonstrated a link. the link is between socioeconomic status and health, the natives are poor and in poor health.

 

[velo]

Paul Krugman is a known liar and an idiot.

haha, almost back on track again with gdk's much appreciated post...and then right off the rails again

 

[gdk]

by the way, i don't generally think people with higher income should pay more for the same services. but the system already works that way in many places since firemen, police, public school teachers, etc. are paid by taxes. when i look at it that way, i'm surprised medical care isn't the same way. i can only think of medicaide/medicare as examples of where there is a similarity.

it doesn't seem to bother me that i pay more or less for the firetrucks down the street than my neighbor, so i guess that's a good example of how you can get used to a system once it's in place.

 

[Garuda]

I hear he clubs baby seals on the weekends.

Maybe I judged Mr. Krugman too harshly.

You know how us evil conservatives like seal clubbing.

 

[flighterdoc]

There is no demonstrated link. Countries that have socialized medicine (Canada, for example) have people with poor health - the "First Nations", for one.


i think you just demonstrated a link. the link is between socioeconomic status and health, the natives are poor and in poor health.

A link between poor socioeconomic status and health, but not socialized medicine and health.